Functional movement symptom | Positive sign | Description |
Can be present in all functional movement symptoms | Variability | Generally refers to changing patterns over time, including susceptibility to distraction and enhancement with attention |
Distractibility | Movement normalizes during a cognitive or motor task | |
Enhancement with attention | Movement worsens/emerges when attention is drawn to it | |
Motor inconsistency | Movements are preserved in some circumstances and impaired in others (eg, dorsiflexion weakness during power testing, and able to stand or put on shoes when not examined) | |
Incongruency | A clinical picture incompatible with known organically determined patterns | |
Suggestibility | Movement is elicited with verbal instruction or by a maneuver from the examiner (eg, tuning fork test) | |
Weakness | Hoover sign | Weakness of hip extension in a paretic leg that resolves with contralateral hip flexion against resistance in the normal leg |
Hip abductor sign | Weakness of hip abduction in a paretic leg that resolves with contralateral hip abduction against resistance in the normal leg | |
Finger abduction sign | Weakness of finger abduction that resolves with contralateral finger abduction against resistance | |
Give-way/collapsing weakness | Limb collapses from a normal position with a light touch, or normal strength is developed and then suddenly collapses | |
Absent pronator drift | Extended supinated arm drifts down without pronation | |
Co-contraction | Simultaneous contraction of agonist and antagonist resulting in no/little movement | |
Tremor | Variability | Changes in tremor characteristics (usually frequency and/or direction) over time and with position |
Entrainment | Tremor takes up the same frequency of an externally cued rhythmic movement (either patient or examiner) | |
Co-contraction | Simultaneous contraction of agonist and antagonist resulting in tremor | |
Whack-a-mole sign | Emergence or worsening of an involuntary movement in a separate body part when the initially affected body part is suppressed by examiner restraint | |
Myoclonus/jerks | Variability | Duration, distribution, and/or latency (if stimulus sensitive) of jerks variable |
Entrainment | Jerks take up the same frequency of an externally cued rhythmic movement (either patient or examiner) | |
Axial/facial jerks | Axial or facial jerks predominate | |
Gait/balance disorder | Gait variability | Inconsistent deficits in gait and stance with normal periods of walking observed |
Monoplegic leg-dragging gait | The leg is dragged at the hip behind the body instead of performing a circumduction | |
Excessive slowness | Excessive slowness or hesitation incompatible with a neurologic disease | |
"Walking on ice" gait | A walking pattern mimicking ice skating or as if on slippery ground | |
Functional Romberg | Constant falls towards or away from the observer, large-amplitude body sway building up after a latency of a few seconds, and improvement of balance with distraction | |
Uneconomical postures | A walking pattern that requires considerable effort as well as balance to maintain the posture (eg, crouching, dragging) | |
Knee-buckling | The knees give way but without full collapse | |
Swivel chair sign | Preserved ability to propel a swivel chair while seated | |
Facial symptoms | Functional facial spasms | Tonic pulling of the lips (or jaw) to one side with or without contralateral frontalis activation; usually ipsilateral platysma overactivation |
Functional blepharospasm | Closed eyelids resist retraction | |
Fixed dystonia | Hand posture | Flexed digits 3 to 5 with preserved pincer function |
Foot posture | Inversion and plantar flexion in the foot and ankle | |
Cervical posture | Laterocollis, ipsilateral shoulder elevation, and contralateral shoulder depression | |
Slowness/parkinsonism | Excessive slowness | Excessive slowness or hesitation incompatible with a neurologic disease |
Hypokinesia without decrement | Continuously slow movements on repetitive testing without true decrement of speed or amplitude seen in bradykinesia | |
Paratonia/Gegenhalten | Variable resistance during passive manipulation of a joint | |
"Huffing and puffing" sign | Simple movements appear effortful | |
Tics | Functional tics | Not fully stereotyped, interfere with speech or voluntary actions, lack of clear premonitory urge, and inability to voluntarily suppress |
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