THE PLANTAR REFLEX - RePub

These new facts firmly support the relationship between the Babinski
response and affections of the pyramidal tract. In theory, a role of other
descending fibre systems cannot be excluded with certainty for all cases.
Broda! ( 1969), for instance, takes such a broad view about the release of the
Babinski sign. However, there is no suitable candidate to fill the place of an
alternative pathway that is crossed and descends low enough in the spinal
cord. In infra-human primates the rubrospinal tract is closely connected
with the pyramidal system, at least in functional terms (Kuypers, 1973 ),
but its extent in man is controversial (Stern, 1938; Sie Pek Giok, 1956).
Having found that there are insufficient reasons to attribute the
presence of a Babinski sign to dysfunction of any system other than the
pyramidal tract, we are left with the reverse problem - why the relationship
is not, in the words of Babinski (1898), a necessary one. A condition
where the upgoing toe sign is often conspicuously absent is the acute
transverse lesion of the spinal cord.
A paradoxical downward toe response in spinal shock
Most patients discussed in this section are victims of war or, more
recently, of traffic, and I should like to start by ciring Babinski (1922), in
that he was one of the few writers on the subject to call attention to the
human misery lying behind what little scientific advancement was made.
The study of reflexes in patients with complete paraplegia had been
impeded for some time by the tenacity of 'Bastian's law' (1890), which
proclaimed that total transections of the spinal cord in man were followed
by permanent areflexia. Previous case reports to the contrary were held in
doubt as to the completeness of the lesion. On the Continent, Bruns ( 1893)
was a strong advocate of this law. Nevertheless, Bastian himself (1890)
mentioned 'very slight movements of the toes . . when the soles of the
feet are strongly tickled', and in 1899 Collier described the newly discovered
Babinski sign in three cases of a complete cord lesion; he was to be
joined by Go!dflam (1903 ). At the International Congress of Medicine in
1900, Bruns defended only the absence of tendon reflexes, and in this form
the law survived (Collier, 1904; Walshe, 1914; Dejerine and Mouzon,
1914; Holmes, 1915), until dispelled by improved nursing care (Riddoch,
1917). The reflex depression proved to be only temporary, although of
longer duration- days or even weeks- than in animals with 'spinal shock'
(Hall, 1841).
During this phase of reflex depression after spinal transection, some
noted an unexpected downward response of the great toe. Apart from
casual remarks of Harris (1903) and van Woerkom (1911) the first
descriptions were those of the Dejerines and Mouzon (1914, 1915), who
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