Hoover Test

What is a Hoover Sign?

Hoover’s sign is a test or a maneuver used by practitioners to identify functional weakness in the lower extremities, detect possible malingering, and diagnose mild cases of hemiparesis in patients. The response to instructions of the test, which is the basis of interpretation, relies on a person’s crossed extensor reflex. To explain, a patient will be asked to lift either their paretic or non-paretic leg. Naturally, because of the crossed extensor reflex, the leg they have not raised should respond by pushing down that leg’s heel into the examiner’s hand.

A patient will test positive for the test if:

• They don’t attempt to lift the affected limb, and the examiner doesn’t feel pressure pushing down into your hand from the unaffected limb.
• They lift the unaffected limb against the resistance, and the examiner senses pressure pushing down into your hand from the affected limb.

Generally, this test doesn’t come with a template. However, for ease and reference, we’ve created a Hoover Sign or just for you. In our template, you will see the following:

• Basic information such as patient name, examiner’s name, and date
• Instructions on how to conduct the test
• A guide on how to know if your patient got a negative or positive test
• A dedicated space for the patient’s results as well as additional notes you may have

Going to conduct the test soon and want a copy of our template? Check the section below for a guide on how to download and use our template.

How does this Hoover Test work?

Download the Template

Access and download our template by doing either of the following:

• Click the “Download Template” or “Use this Template” button above
• Go to Carepatron’s template library on our website or app and search for “Hoover Test”

Conduct the Test

Once you’ve filled out the basic information, such as the patient’s name, examiner’s name, and date, you may conduct the test.

Though there are instructions on how to do the Hoover Test on our template, for good measure, we’ll also add the step-by-step instructions here.

1. Have your patient lie down or be in a supine position on an examination table.
2. Stand at the feet of the patient and cup the calcaneus (heel) of the patient. Your left hand must be grasping their right heel and your right hand must be grasping their left heel.
3. Lift both heels upward. Their feet should be lower or around your chest height.
4. Ask the patient to make an active straight leg raise on the involved side.
5. While they do step 4, feel if there’s pressure from the unaffected limb.
6. Afterward, repeat step 4 on the unaffected limb but this time add resistance.
7. While they do step 4, feel if there’s pressure from the affected limb.

Interpret and Proceed with the Next Steps

As soon as you’ve done the test, interpret and record your patient’s results. Here’s the guide we’ve also provided on the template on how to interpret the test results:

(-) Negative test if:

• The patient attempts to lift the affected limb, and you sense pressure pushing down into your hand from the unaffected limb.
• The patient lifts the unaffected limb against the resistance, and you don’t sense pressure pushing down into your hand from the affected limb.

(+) Positive test if:

• The patient doesn’t attempt to lift the affected limb, and you don’t feel pressure pushing down into your hand from the unaffected limb.
• The patient lifts the unaffected limb against the resistance, and you sense pressure pushing down into your hand from the affected limb.

Recording your patient’s results is as simple as ticking the negative or positive checkbox on the template and writing down additional notes if you have any. Afterward, you may proceed to let the patient know of the results of the test.

Do note that if you have noticed that they are malingering, you must be considerate and gentle when letting them know of the results. If this happens, it’s best to ask if they are dealing with problems that led them to impose a fictitious disease on themselves.

Scoring

Since the Hoover test isn’t quantitative, scoring the test will only be ticking the negative or positive checkbox based on the corresponding interpretation. 

When to use these Hoover assessments?

A practitioner can use the Hoover assessment when the patient expresses concerns about weakness in their lower extremities, specifically their leg or hip.

When using these tests, however, don’t forget the following:

• Have your patient calm down and explain the instructions well to them. Patients who don’t understand what to do and may want to prove that they cannot lift their leg won’t give all of their effort during the test.
• Conduct further tests if possible. You may get false positives if the patient refuses to raise their leg because of their pain. To add, it can be a challenge for the practitioner to differentiate between a person that actually has functional weakness versus one who is pretending that their leg is weak.

Who is this Hoover Test PDF for?

Practitioners who can benefit the most from having a PDF copy of our Hoover test template are:

• Neurologists or Psychiatrists - Patients exhibiting neurological disorder symptoms will most likely head to a neurologist or psychiatrist. These practitioners may use this test to check if the patient may have neurological damage causing their weakness or mild hemiparesis.
• Physiotherapists - Patients greatly affected by the weakness in their lower extremities may head to a physiotherapist. They may use this test to check the severity of the weakness and possibly help manage the weakness or possible mild paresis.

Other doctors, such as general or orthopedic physicians, may also utilize this test if their patient shares their concerns. And upon obtaining results, they may refer their patients to the corresponding specialists.

Benefits of these free Hoover’s Test Templates

Easy to Learn and Use

Given that this test only has seven steps and that the movements are simply repeated on opposite sides it’s easy to learn and furthermore, easy to use.

Consistent and Straightforward Observation

This test may ask for a patient’s observation; however, compared to others, no degree of responses may need further explanation. Rather, only a positive and negative result will be especially helpful because practitioners who wish to use the results as a reference will easily understand them without asking the examiner for further explanations.

Encourage Patient-Doctor Communication

Whether the patient is malingering or has a functional weakness, the test encourages the doctor and patient to elaborate upon what they’re feeling or going through so that they may be given a diagnosis/treatment by the main practitioner or be referred to a specialist that can help them with their concerns.

Empowers the Patient

In certain cases, upon undergoing the test, the patient may see that they aren’t as incapable as they may feel. As a result, this may empower them to ask for help to improve quickly or continue with their current plan because of its effectiveness.

Accessible

With our digitally editable and downloadable Hoover test template, medical practitioners can easily access not only the template for guidance and recording but fellow practitioners can also access the information they may need anytime, anywhere, on any gadget.

Reference

(2023). Retrieved 27 April 2023, from ://litfl.com/wp-content/uploads/2019/07/Pract-Neurol-2001-Stone-50-3.pdf

ARIEFF, A. (1961). The Hoover Sign. Archives Of Neurology, 5(6), 673. doi: 10.1001/archneur.1961.00450180095012