THE PLANTAR REFLEX - RePub

More documents

Recommendations

Info

to happen because impulses are unable to reach the short toe flexors. On the other hand, active muscular tension in the patient is of course restricted to intact muscles: even a few discharging extensor hallucis longus motor units might then cause upward quivering of the great toe. This could have been the case in patients 6 and 7, who suffered from polyneuropathy. The flexor hallucis brevis, being more distal, was probably most involved, and in fact both patients showed scattered extensor hallucis longus activity, versus even fewer and later potentials of flexor hallucis brevis in one patient and none at all in the other. This possible mechanism does not detract from the principle that one need not be aware of the peripheral lesion to disqualify these upward toe movements if they are unrelated to the flexion reflex. 8. Pes cavus. This deformity has also acquired some notoriety for producing false-positive Babinski signs (Mumenthaler, 1976). It is true that the primary upward position ol the great toe mechanically favours further dorsiflexion by even the slightest activity of the extensor hallucis longus. This is the more so because pes cavus is often accompanied or even caused by atrophy of intrinsic foot muscles (Thomas, 1975; the hypothesis of Collier (1899) that increased tone of the extensor hallucis longus contributed to the deformity is untenable). But again, when the upward movement of the great toe is a genuine reflex (patient 10), it signifies abnormal processing of impulses in the spinal cord, irrespective of peripheral anatomy. Lacking Babinski response Finding an equivocal plantar response in the presence of other pyramidal signs is almost the reverse situation of finding it as an isolated phenomenon, and usually it presents fewer problems of clinical management. Close attention to toe movements in their relation to action of other leg muscles may also be helpful in this group, as shown above by the comparison of electromyographic results with clinical data. If a Babinski response is truly absent there are three possible reasons: 1. ]oint deformity. This is not unusual, especially in the form of hallux valgus. Figure 11 illustrates occult Babinski signs in a patient who could not even move his great toes voluntarily because of hallux valgus. 2. Peripheral nerve lesions. Pressure palsy of the lateral popliteal nerve is (or at least was) a common complication of chronic paraplegia, and precludes a Babinski sign (Collier, 1899; Marie, 1912; Marie and Thiers, 1913; Guttmann, 1952; Grossiord and Kahn, 1957; Landau and Clare, 1959). The same problem can occur at another level in motor neurone 102
FHB I ! ¥ _j 02 FHB ...,. r~~a..,... 500 ms - p.h.rh wnir 1: .! l h ~v ~--..... TA _j o.s mY 500 ms EHL FIGURE ll Occult Babinski signs in a 70-year-old male with cervical spondylotic m;,elopathy and hallux valguJ. 103
Page 1 and 2:
THE PLANTAR REFLEX a historical, cl
Page 3 and 4:
THE PLANTAR REFLEX A HISTORICAL, CL
Page 5:
Aan mijn ouders Aan Carien, Maarten
Page 8 and 9:
TELEOLOGICAL SPECULATIONS - science
Page 10 and 11:
- EMG result and 'final' neurologic
Page 13:
LIST OF ILLUSTRATIONS figure page 1
Page 16 and 17:
Electromyographic recording from mu
Page 19 and 20:
The plantar reflex before Babinski
Page 21 and 22:
viz. those of Striimpell (1899), Op
Page 23 and 24:
These early reports did not reach m
Page 25 and 26:
Charcot's concepts about hysteria w
Page 27 and 28:
TABLE I STUDIES CONFIRMING BABINSKI
Page 29 and 30:
False positive findings? Babinski's
Page 31 and 32:
FLEXION AND EXTENSION SYNERGIES The
Page 33 and 34:
confirmed by Walshe (1914). His is
Page 35 and 36:
esult in disappearance of the Babin
Page 37 and 38:
without an ipsilateral upgoing toe
Page 39 and 40:
RIVAL SIGNS Confusion When Babinski
Page 41 and 42:
8. Stroking the anterior surface of
Page 43 and 44:
Contradictory findings THE PLANTAR
Page 45 and 46:
Bersot 1920,'2! ? X ]l 2 Burr 1921
Page 47:
curious case of one healthy infant
Page 50 and 51:
9. Infants under one year of age ge
Page 53 and 54: INTRODUCTION Observer error: examin
Page 55 and 56: following a suggestion that most re
Page 57 and 58: TABLE IV INFORMATION PRECEDING THE
Page 59 and 60: TABLE VI RATINGS OF 'INFORMATION' G
Page 61 and 62: unm i stakab I y upward possibly up
Page 63 and 64: Clinical experience appeared to be
Page 65: CHAPTER III BABINSKI SIGN: STIMULUS
Page 68 and 69: TABLE VII CLINICAL COMMENTS ON THE
Page 70 and 71: Normal plantar response: flexor hal
Page 72 and 73: I. rn. extensor hallucis longus 2.
Page 74 and 75: TABLE VIII OCCURRENCE OF REFLEX ACT
Page 76 and 77: ecruited and even interrupted by EH
Page 78 and 79: value (the minimal stimulus intensi
Page 80 and 81: FIGURE 8 Relative dimen.riom and we
Page 82 and 83: the two separate bursts of electrom
Page 84 and 85: 5. In general, reflex effects produ
Page 87 and 88: INTRODUCTION When is an upgoing toe
Page 89 and 90: stimulated side diminishes extensor
Page 91 and 92: 30 patients with equivocal plantar
Page 93 and 94: A FHB EHL E TA EHL c FHB TA _j1mV 5
Page 95 and 96: Inexperienced observer An additiona
Page 97 and 98: patient 2 3 4 5 6 7 8 sex F M M F F
Page 99 and 100: Practical use of the flexion reflex
Page 101: 1. Contraction of the tibialis ante
Page 105 and 106: Finally the method of stimulation.
Page 107: CHAPTER V THE BABINSKI SIGN AND THE
Page 110 and 111: TABLE XIV THEORIES INVOKING A SUPRA
Page 112 and 113: change of the plantar reflex was of
Page 114 and 115: An upgoing toe response in lower pr
Page 116 and 117: noticed no special features, and of
Page 118 and 119: 'pyramidal syndrome' were not. Thei
Page 120 and 121: movements, but also the capacity to
Page 122 and 123: - rapid foot tapping on the couch,
Page 124 and 125: TABLE XVI FREQUENCY OF V ARlO US SI
Page 126 and 127: ~ N 0\ TABLE XVIII PATIENTS WITH A
Page 128 and 129: ~ N 00 TABLE XIX LACK OF CORRELATIO
Page 130 and 131: ~ '->' 0 TABLE XX PATIENTS SHOWING
Page 132 and 133: 3. BABINSKI SIGNS APPEARING IN OR D
Page 134 and 135: --------------~~- ~ '-" TARLE XXI "
Page 136 and 137: DISCUSSION Two principal features e
Page 138 and 139: patients in the first group in whom
Page 140 and 141: The most striking examples of Babin
Page 142 and 143: eflex arc must have its impact at o
Page 144 and 145: hallucis longus motoneurones to seg
Page 146 and 147: 9. The paradoxical downward toe res
Page 148 and 149: showed very little agreement with t
Page 150 and 151: A second condition to be fulfilled
Page 152 and 153:
eide met dubieuze voetzoolreflexen,
Page 154 and 155:
waarin de Babinski-reflex verdween,
Page 156 and 157:
BABINSKI,]. (1885). Recherches sur
Page 158 and 159:
approche d'une interpretation du si
Page 160 and 161:
BUCK, D. de, and MOOR, L. de (1900)
Page 162 and 163:
DEJERINE, ]., and LEVY V j\LENSI, J
Page 164 and 165:
FRIEDMAN, E. D. (1920). On a possib
Page 166 and 167:
GROSS, F. (1971). The Emperor"s clo
Page 168 and 169:
IIDA, M., and BASMAJIAN,]. V. (1974
Page 170 and 171:
LANDAU, W. M., and CLARE, M. H. (19
Page 172 and 173:
MANFREDI, M., SACCO, G., and SIDER!
Page 174 and 175:
NYBERG-HANSEN, R., and RINVIK, E. (
Page 176 and 177:
lombo-sacrCe avec amyotrophie globa
Page 178 and 179:
STRDMPELL, A. VON (1887). Ueber ein
Page 180 and 181:
WALSHE, F. M. R. (1956). The Babins
Page 183 and 184:
ACKNOWLEDGEMENTS I am grateful for
Page 185:
CURRICULUM VITAE De schrijver van d
show all

THE PLANTAR REFLEX - RePub

Create successful ePaper yourself

Delete template?

Save as template?