THE PLANTAR REFLEX - RePub

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I. rn. extensor hallucis longus 2. rn. tibialis anterior 3. m. extensor digitorum longus 72 FIGURE 4 The muJCulus extensor hallucis longus and its relationship to neighbouring muscles (drawn after photographs from a post-mortem study).
Concentric needle electrodes were used in all muscles. The flexor hallucis longus was studied in a few patients, but this muscle did not show reflex activity. As these findings were in accordance with other work cited above, recording from this muscle was abandoned. The EHB, a small muscle, was first located by surface stimulation. The FHB electrode was introduced on the plantar side of the first metatarsal bone. The TA electrode was placed proximally. Needle position in these three muscles was checked by asking the subject to make the appropriate movement, and the electrodes were adjusted until an interference pattern of potentials was seen on the oscilloscope. Correct positioning of the EHL electrode is of critical importance but proved to be most difficult. The needle was introduced laterally above the ankle, at a point dividing the middle and distal third of a line between lateral malleolus and caput fibulae (this point proved to be most convenient to reach the bulk of the EHL muscle in a post-mortem specimen; see figure 4). Placement of the tip of the EHL electrode was checked by passive movement of the hallux, by the pattern of action potentials on voluntary dorsiflexion, and by electrical stimulation through the recording electrode. These control measures were repeated during and after each experiment. Outward or inward movement of the electrode was limited by an adhesive strap around the needle itself and by another one securing its head to the skin. Before each stimulus, care was taken that the muscles concerned were completely relaxed. Potentials were amplified and displayed on a two channel oscilloscope. Measurements were made from film. Effector of Babinski sign RESULTS The reflex activity in EHL and EHB after mechanical stimulation was studied in seven patients and nine control subjects. A reflex was considered to be present when recruitment of motoneurones was seen on more than one occasion: large motor units are activated late in the reflex and disappear early (Henneman et a!., 1974), so that all potentials together form a spindle shape on the oscilloscope screen. The results are shown in table VIII. EHL reflexes were present in all patients and in none of the control subjects. In contrast, EHB activity appeared in one third of the controls (not including the normal legs of the two patients) and was absent in more than half the patients. Figure 5 shows two illustrative examples. It can be safely concluded that the Babinski response is mediated by the EHL, and not by the EHB. 73
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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
Page 16 and 17:
Electromyographic recording from mu
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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 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
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
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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
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~ '->' 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
Page 138 and 139:
patients in the first group in whom
Page 140 and 141:
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. (
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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