THE PLANTAR REFLEX - RePub

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indicate consistent ratings. It is apparent that many observers fell short of this ideal line. Cohen (1960, 1968) developed a statistical method to measure observer agreement - a method which takes into account the agreement to be expected by chance, and which also weighs the extent of possible disagreements. If we apply this measurement to the intraobserver variation between the first and the second presentation, displayed in table V, we find that Cohen's factor 'weighted kappa' (ranging from 0 for chance agreement and l for full agreement) is 0.09 for film A and 0.28 for film B. These very low kappa values indicate that the usual clinical interpretation of plantar reflexes can be meaningless in some cases. The variation between different observers for the two films is indicated in table V by the totals in the margin. Because individual inconsistencies compensate each other to a large extent, the difference between ratings on the first and the second presentation is much less marked for the group as a whole. But the range of opinions is considerable, and the frequency distributions for both films have some characteristics in common: 1. All ratings were distributed among four of the five choices offered: one extreme of the scale was not opted for (unmistakably upward for film A, unmistakably downward for film B). 2. About one half of the observers agreed about one particular choice (possibly downward for film A, possibly upward for film B), while the other half were divided among the three other categories. 3. The category 'neither upward nor downward' is underrepresented in comparison with a symmetrical distribution. This variation between observers is superimposed upon the intraobserver disagreement which has already been proved to be extreme for these films. The combined effect can only make the reproducibility of interpretation even lower. Effects of preceding information The results for the 'information' group are shown in table VI. Like the 'no information' group, only a minority of the observers rated consistently (within the diagonals). An important difference is, however, that here the inconsistent ratings are not scattered symmetrically on both sides of the diagonal, but are skewed towards one side, according to the combined direction of bias. To investigate this further, all relevant differences between the various mean ratings - shown in figure 3 - were subjected to the t-test. For both films, I up resulted in significantly more pathological markings than luown (tA = 3.10, degrees of freedom (d.f.) = 19, p
unm i stakab I y upward possibly upward --L / / I down ..... - / -- / / / / I up I 0 neither upward nor downward possibly downward I 0 I down unmistakably downward first presentation second presentation FIGURE 3 MEAN RATINGS FOR <strong>THE</strong> TEST FILMS --~film A -- - - - - ~ film B 1 0 = no information fup = information suggesting Babinski sign !down = information suggesting normal plantar response 61
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THE PLANTAR REFLEX a historical, cl
Page 3 and 4:
THE PLANTAR REFLEX A HISTORICAL, CL
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Aan mijn ouders Aan Carien, Maarten
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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: TABLE VI RATINGS OF 'INFORMATION' G
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 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
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change of the plantar reflex was of
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An upgoing toe response in lower pr
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noticed no special features, and of
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'pyramidal syndrome' were not. Thei
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movements, but also the capacity to
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- rapid foot tapping on the couch,
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TABLE XVI FREQUENCY OF V ARlO US SI
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~ 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
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A second condition to be fulfilled
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eide met dubieuze voetzoolreflexen,
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waarin de Babinski-reflex verdween,
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BABINSKI,]. (1885). Recherches sur
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approche d'une interpretation du si
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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. (
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lombo-sacrCe avec amyotrophie globa
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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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