Ziv I, Djaldetti R, Zoldan Y, Avraham M, Melamed E
Department of Neurology, Rabin Medical Centre, Petah-Tiqva, Israel.
J Neurol. 1998 Dec;245(12):797-802. doi: 10.1007/s004150050289.
The differentiation of "non-organic" limb weakness from genuine paralysis is sometimes difficult in neurological practice. To address this problem, we developed a computerized quantitative method, based on the Hoover's test principle, that determines the extent of involuntary limb activation when contralateral movement is performed. Measurements of hip or arm extension isometric force are performed during direct maximal voluntary effort and during contralateral hip flexion. Maximal involuntary/voluntary force ratio (IVVR) is calculated. IVVR of the lower limbs in ten healthy subjects was 0.614, 0.044 (mean, SEM). Similar results were obtained from seven patients with genuine weakness and in the non-affected limbs of nine patients with "non-organic" mono- or hemiparesis. In contrast, IVVR in the affected limbs in the "non-organic" group was markedly increased (2.48, 0.61; P < 0.001). The same pattern was elicited in the upper limbs (2.27, 0.46 vs 0.406, 0.06; P < 0,001). We conclude that Hoover's sign in "nonorganic" paralysis is a preservation or increase of a normal synkinetic phenomenon. Quantitative measurement of the IVVR can serve as a useful ancillary test in diagnosing non-organic weakness in either lower or upper limbs.
在神经科临床实践中，区分“非器质性”肢体无力与真正的瘫痪有时很困难。为了解决这个问题，我们基于胡佛试验原理开发了一种计算机化定量方法，该方法可确定对侧运动时肢体非自主激活的程度。在直接最大自主努力期间和对侧髋关节屈曲期间测量髋关节或手臂伸展等长力。计算最大非自主/自主力比（IVVR）。十名健康受试者下肢的IVVR为0.614±0.044（均值，标准误）。七名真正肌无力患者以及九名“非器质性”单瘫或偏瘫患者未受影响肢体也得到了类似结果。相比之下，“非器质性”组受影响肢体的IVVR显著增加（2.48±0.61；P<0.001）。上肢也出现了相同模式（2.27±0.46对0.406±0.06；P<0.001）。我们得出结论，“非器质性”瘫痪中的胡佛征是正常联带运动现象的保留或增加。IVVR的定量测量可作为诊断下肢或上肢非器质性无力的有用辅助检查。
