THE PLANTAR REFLEX - RePub

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Electromyographic recording from muscles that are active in the plantar reflex could be of help in equivocal cases. Unfortunately, there is no consensus on which muscle mediates the Babinski sign: the extensor hallucis longus (Landau and Clare, 1959, in keeping with older notions), or the extensor hallucis brevis (Kugelberg et a!., 1960; Grimby, 1963 a). In the latter studies electrical stimuli were used, and the boundary between the presence and absence of the Babinski sign was electromyographically indistinct. Reviewers avow that the plantar response is 'not a simple reflex' (Basmajian, 1974) and ·a manifold phenomenon' (Broda!, 1969). Could not this complexity be caused by the use of electrical stimuli? This question has been re-examined by recording from the roe muscles during stroking of the sole, i.e. while the great roe is actually going up or down. This done, we can go on to see whether electrical stimuli give the same result. If not, studies in which electrical stimuli are used should be interpreted with caution (Chapter Ill). Once the electromyographic patterns accompanying normal and pathological plantar responses are known, this technique can be applied to equivocal plantar reflexes. Are the electromyographic results consistent? This has been investigated by repetition and 'blind' interpretation, and the outcome in each patient has also been checked with the eventual neurological diagnosis. Then, clinical and electromyographic observations have been compared, and I have tried tO deduce from the differences and similarities a set of rules (and pitfalls) for the bedside interpretation of plantar reflexes (Chapter IV). The last main question in this study concerns the pathophysiology of the Babinski sign. On which descending fibres does it depend, which segmental pathways mediate it, and at what level in the lumbosacral cord do the descending and segmental fibre systems interact? After an appraisal of pathological studies, the termination of the descending fibres that are involved in the appearance of the Babinski sign has been investigated from a clinical angle: which other physical signs are most often associated with the Babinski response? More precisely, is the appearance of the Babinski sign linked tO motOr deficits, or rather tO segmental release phenomena? If such correlations give insight into physiological and anatomical relationships, can we conversely explain an unexpectedly absent Babinski sign by the concurrent absence of some other pathological features? Or can a dysfunction of intraspinal pathways also play a part? Finally I have tried to consider whether the association patterns of various pyramidal signs justify the concept of the 'upper motor neurone' (Chapter V). 16
CHAPTER I HISTORY OF THE PLANTAR REFLEX AS A CLINICAL SIGN 'Ich halte einen jeden Unterricht ohne historische Grundlage fur eine Barbarei.J (Virchow, 1865)
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 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
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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
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5. In general, reflex effects produ
Page 87 and 88:
INTRODUCTION When is an upgoing toe
Page 89 and 90:
stimulated side diminishes extensor
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30 patients with equivocal plantar
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A FHB EHL E TA EHL c FHB TA _j1mV 5
Page 95 and 96:
Inexperienced observer An additiona
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patient 2 3 4 5 6 7 8 sex F M M F F
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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
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3. BABINSKI SIGNS APPEARING IN OR D
Page 134 and 135:
--------------~~- ~ '-" TARLE XXI "
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DISCUSSION Two principal features e
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patients in the first group in whom
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The most striking examples of Babin
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eflex arc must have its impact at o
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hallucis longus motoneurones to seg
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9. The paradoxical downward toe res
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showed very little agreement with t
Page 150 and 151:
A second condition to be fulfilled
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eide met dubieuze voetzoolreflexen,
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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
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ACKNOWLEDGEMENTS I am grateful for
Page 185:
CURRICULUM VITAE De schrijver van d
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