THE PLANTAR REFLEX - RePub

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ecruited and even interrupted by EHL activity, and there was no coactivation of the TA. These features suggest that persistently insufficient relaxation was the cause of the EHL activity, rather than a pathological reflex mechanism. Activity of the FHB was found in all control subjects with a downward toe response on inspection, although the density of the electromyographic pattern was not always proportional to the briskness of the clinical response. These relative differences may be due to shortcomings of the recording technique or to individual anatomical variations. Nine subjects in the control group were judged to have absent plantar reflexes on clinical grounds; three of these showed only minimal FHB activity, six none at alL This means, at least for the subjects in this study, that clinically absent plantar reflexes are genuinely absent and do not represent an undecided tug of war between EHL and FHB. Electrical stimulation: effects in EHL and FHB Brief electrical stimuli to the plantar surface were applied in the same 15 patients and 40 controls, and the reflex effects are shown in Table IX together with those after mechanical stimulation. A reflex was considered to be present when potentials appeared repeatedly within 150 ms of stimulation, showing an interference pattern that lasted for 50 ms at least. These criteria are more or less arbitrary; the consequences of defining them otherwise will be discussed below. In five of the 15 patients with a Babinski sign, electrical stimuli failed to activate the EHL. In one of them this failure was confirmed in three subsequent experiments. He was a 56-year-old man with spastic paresis of the right leg following haemorrhage from an arteriovenous malformation in the left parietal parasagittal region. In another patient, a 50-year-old man with a paraparesis probably due to multiple sclerosis, there were very brisk flexor reflexes of both legs, which could be elicited even by stroking the plantar surface with a finger pad. But electrical shocks were insufficient to evoke a response even at maximal intensity (Figure 6, B). Of the three remaining 'false-negative' patients, one had sustained a severe cerebral concussion, both the others were suffering from paraparesis of unknown ong1n. In the control group, electrical stimuli evoked EHL reflexes in about one out of every three subjects. One example (a healthy neurologist!) is shown in figure 6,A. It could be possible that in these control subjects the stimulus strength exceeded the intensities required for activating the EHL in patients, and this was investigated further. The stimulus strength (mean values when inconstant) was expressed in multiples of the tactile threshold 76
electrical stimulation mechanical stimulation A 1,, ' ' It __jo.lmV SOmsec _jo:4mV 500msec B FHB .. , . _jo.lmV 50msec SOOmsec 0.4rrW FIGURE 6 Reflex activity in FHB and EHL after electrical and mechanical stinm!ation (arrows) o/ the plantar surface in a normal subject (A) and in a patient with a Babinski sign (B). 77
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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
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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
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,
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
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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
Page 185:
CURRICULUM VITAE De schrijver van d
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