THE PLANTAR REFLEX - RePub

standard to measure the provisional opinion of the referring neurologist
as well as the value of a detailed clinical examination of the flexion
reflex.
Patients
METHODS
My colleagues from the department of neurology were asked to refer inpatients
or out-patients with equivocal plantar responses; resident and
specialist had to agree about the difficulty of interpretation. Thirty patients
were proposed and examined in the course of six months.
Stimulation and recording
Stimulation consisted of slowly stroking the lateral plantar border and
plantar arch with the smooth, blunt handle of a patella hammer. Recordings
were made from the following muscles:
- extensor hallucis longus (EHL)
- flexor hallucis brevis (FHB)
- tibialis anterior (TA).
The technique of electrode placement was similar to that described in
Chapter IlL
Clinical examination and exclusion of bias
To ensure maximal objectivity of the EMG results, they were kept
separate from the deliberations of the physicians in charge and from my
own examination. How this was done is shown schematically in figure 9.
First of all, I was not involved in the management of any of these patients.
The resident and specialist who referred the patient did this on a form;
they jointly rated the plantar reflex, choosing from five possibilities:
upward, possibly upward, absent, possibly downward and downward (the
two extremes were never chosen, which was in keeping with the purpose
of the study). The form was sent to the secretary of the study. I was
notified only of the patient's name and of the side where the clinicians
considered the plantar reflex most equivocaL The inconvenience of the
procedure to the patient did not permit investigation of both feet at the
same time.
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