The “arm-drop” In this test, a supposedly paralysed arm is dropped over the patient's face to see if they will protect themselves from its fall. This has also been described as a test on the unconscious patient. However, the arm must be so weak for this test to be interpretable that we suggest it rarely adds information. A less aggressive variation is to watch the speed and smoothness with which arms fall down from an outstretched position on to the lap. In functional weakness, this may be slower and jerkier. This has not been validated. Pseudo waxy flexibility Occasionally a patient complaining of weakness may find that if their limbs are put in a certain position—for example, with the arms outstretched—they will inexplicably maintain their position even to the point that they are unable to get them down again. This phenomenon is similar to that seen in people undergoing stage hypnosis. Sternocleidomastoid test Recently Diukova et al reported that 24 of 30 patients (80%) with functional hemiparesis had sternocleidomastoid weakness, usually ipsilateral, whereas only three of 27 patients (11%) with a vascular hemiparesis had weakness of the sternocleidomastoid muscle (which is bilaterally innervated and so is rarely weak in upper motor neurone lesions).14