THE PLANTAR REFLEX - RePub

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--------------~~- ~ '-" TARLE XXI "" PATIENTS SHOWING A PARADOXICAL DOWNWARD RESPONSE OF <strong>THE</strong> CREAT TOES AfTFR SPINAL TRANSECTION Ct!YC rtge rex dinicallevel .rperitd flexion ankle knee abdomiJhtl CI"Cilh/Sl. commentJ nr. of Jpinal featllres of reflex jerk jerk reflexes reflexes trcmsection downward toe re_rponses Sl 32 M D3 long latency, knee -3/-1 -!- + -Islow and flexion prolonged R (±) S2 16 M DS fast -I- + + + + +j+ S3 33 F Di! weak, bilateral -!- -!- -Irather slow knee and hip flexion ±) Si! 33 M C7 long latency, -!- +lj+l +2j+2 -I- -Iincomplete lesion: able to moderately moveR knee flexors, tib. anL, slow; sec ext. hall. longus (MRC 4); figure 13 some sensation left in L leg ss 41 M Cl weak, -!- + -I- + +j+ also present in earlier (brain death) prolonged (tonic) phase with extensor spasms so 22 F c 1 normal' + + -I- ! bilateral Babinski signs (brain death) S7 25 M Cl fast (brain de
FHB _j 0,2 mV 500 ms FIGURE 13 Efectromym;ram from the flexor hal/ucis b1·e1Jis in a patient with a paradoxical downward reJprm_fe o}- the great toe after spinal tranJection (patient 54. table XXI). with a clinical diagnosis of brain death within hours ol cessation of spontaneous respiration. Follow-up of the four paraplegic patients was limited by transfer to other centres, but case Sl and S3 showed bilateral Babinski signs after one month. The early findings in this group are listed in table XXI. The reflex plantar flexion was bilateral in all cases. It did not always show the distinguishing features of long latency, slow movement and prolonged duration; in two cases it was even unusually fast. In one case (S4) electromyography was possible, and the response was accompanied by electrical activity in the flexor hallucis brevis (figure 13 ). Although activation of the extensor hallucis longus muscle by plantar stimulation was conspicuously absent, weak contraction of knee or hip flexors occurred in two cases (Sl and S3 ). Finally, it must be stressed that the paradoxical downward response can appear without complete isolation of the lumbosacral cord: in case SS (brain death) it was for some time observed together with extensor spasms (respiration had already ceased), and patient S4 (lesion at C 7 ) was able to perform some distal movements on one side, including dorsiflexion of the toes' 135
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THE PLANTAR REFLEX a historical, cl
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THE PLANTAR REFLEX A HISTORICAL, CL
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Aan mijn ouders Aan Carien, Maarten
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TELEOLOGICAL SPECULATIONS - science
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- EMG result and 'final' neurologic
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LIST OF ILLUSTRATIONS figure page 1
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Electromyographic recording from mu
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The plantar reflex before Babinski
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viz. those of Striimpell (1899), Op
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These early reports did not reach m
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Charcot's concepts about hysteria w
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TABLE I STUDIES CONFIRMING BABINSKI
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False positive findings? Babinski's
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FLEXION AND EXTENSION SYNERGIES The
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confirmed by Walshe (1914). His is
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esult in disappearance of the Babin
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without an ipsilateral upgoing toe
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RIVAL SIGNS Confusion When Babinski
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8. Stroking the anterior surface of
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Contradictory findings THE PLANTAR
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Bersot 1920,'2! ? X ]l 2 Burr 1921
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curious case of one healthy infant
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9. Infants under one year of age ge
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INTRODUCTION Observer error: examin
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following a suggestion that most re
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TABLE IV INFORMATION PRECEDING THE
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TABLE VI RATINGS OF 'INFORMATION' G
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unm i stakab I y upward possibly up
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Clinical experience appeared to be
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CHAPTER III BABINSKI SIGN: STIMULUS
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TABLE VII CLINICAL COMMENTS ON THE
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Normal plantar response: flexor hal
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I. rn. extensor hallucis longus 2.
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TABLE VIII OCCURRENCE OF REFLEX ACT
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ecruited and even interrupted by EH
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value (the minimal stimulus intensi
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FIGURE 8 Relative dimen.riom and we
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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 and 102: 1. Contraction of the tibialis ante
Page 103 and 104: FHB I ! ¥ _j 02 FHB ...,. r~~a..,.
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 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
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