THE PLANTAR REFLEX - RePub

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TABLE VIII OCCURRENCE OF REFLEX ACTIVITY IN EHL AND EHB AFTER MECHANICAL STIMULATION EHL EHB Controls (n=9) Patients (n=7) 0/9 7 !7 3/9 l/7 FHB A FHB B EHB EHB EHL l Jl's;eu~ '41';~' _jo.4mV EHL 500msec FIGURE 5 Reflex activity in FHB, EHB, and EHL after mechanical stimulation (arrows) o/ the plantar surface in a normcd subject (A) and in a p~ttient with a Babinski sign (B). Mechanical stimulation: effects in EHL and FHB The second half of this study concerns 15 patients and 40 control subjects. Recording from the EHB was abandoned, as activity in this muscle proved irrelevant to the occurrence of the Babinski sign. Attention was focused on activity in the two 'reins' of the plantar reflex, EHL and FHB. The effects of mechanical stimulation were studied first. In general, reflex activity appeared within 0.5 to 1 second after the beginning of stimulation. No efforts were made to determine exact reflex latencies after mechanical stimulation (Magladery et a!., 1958; Drobny et a!., 1974); such measurements are impeded by a variable delay between the 74
moment the skin is touched and the moment the stimulus becomes maximal. When stimulation had ended, the activity dwindled within a few hundreds of milliseconds. If potentials continued to appear, this could be attributed to voluntary contraction: repetition of the procedure when the subject was sufficiently relaxed then no longer showed the prolonged activity. This rule evidently does not apply if flexor spasms are present, but these can be recognized clinically. There was a strong tendency towards reciprocal reflex activity: when the FHB was active (as in most controls) the EHL was not, and vice versa. Recruitment of FHB motor units was observed in only one of the 15 patients, a 46-year-old male with traumatic brain injury. In view of the findings in the initial experiments, it was not surprising that recruitment of the EHL was found in all patients with a Babinski sign (table IX). EHL reflexes were also synchronous with activity in theTA in all patients (table X). TABLE IX OCCURRENCE OF REFLEX ACTIVITY IN EHL AFTER MECHANICAL AND ELECTRICAL STIMULATION Controls (n=40) Patients (n=15) Mechanical (1)*/40 15/15 Electrical 14/40 10/15 * this result was equivocal (see text) TABLE X OCCURRENCE OF REFLEX ACTIVITY IN EHL AND TA AFTER MECHANICAL STIMULATION --------------------- TA and EHL EHL alone TA alone Controls (n=40) Patients (n= 15) 0/40 15/15 (1)/40 0/15 l/40 0/15 In three control subjects, reflex activity of the TA was found to occur unaccompanied by contraction of the EHL. In one control subject recruitment of EHL motor units was repeatedly recorded. This 49-year-old man, complaining of non-specific headaches, had bilateral pes cavus and was apt to show voluntary upward movement of the big toe. The potentials in the EHL continued for seconds after stroking, FHB potentials were also 75
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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
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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
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 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
Page 122 and 123: - 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
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~ 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
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--------------~~- ~ '-" 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)
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DEJERINE, ]., and LEVY V j\LENSI, J
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FRIEDMAN, E. D. (1920). On a possib
Page 166 and 167:
GROSS, F. (1971). The Emperor"s clo
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IIDA, M., and BASMAJIAN,]. V. (1974
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LANDAU, W. M., and CLARE, M. H. (19
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MANFREDI, M., SACCO, G., and SIDER!
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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
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WALSHE, F. M. R. (1956). The Babins
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ACKNOWLEDGEMENTS I am grateful for
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CURRICULUM VITAE De schrijver van d
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