THE PLANTAR REFLEX - RePub

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occasions and without knowledge of previous ratings. Subsequently, discharge letters and follow-up notes were consulted, covering a period of up to two years after the investigation. Electromyographic criteria Guidelines as to what electromyographic patterns make up a pathological EHL reflex - representing a Babinski sign - were derived from Chapter III, which includes findings in 15 patients with a clear Babinski response and in 40 control subjects: 1. The EHL reflex should coincide with a reflex in the T A. Isolated potentials in the EHL could result from irritation by the tip of the recording electrode, especially when the needle is levered by voluntary or reflex activity of other muscles through which it was inserted. 2. Potentials should be dense enough not to be separately identifiable ('interference pattern'- that is, at 500 msjcm time base). The potentials can be either continuous or in regular clusters (clonic reflex- of course not to be confused with clonic tendon jerks (Barre, 1926)). 3. Larger potentials should appear in the middle of the reflex, indicating recruitment of motoneurones of increasing size, so that, ideally, a spindle shape is formed. On the other hand it should be kept in mind that, besides motor unit size, electrode position is another factor determining spike amplitude. 4. The end of the reflex should be visible: voluntary withdrawal rends to linger on for a few seconds, and flexor spasms are hardly to be expected in this group of patients. 5. There should be no concomitant reflex in the FHB. Starting from these criteria, the EMG patterns of each investigation were allocated to one of five possible categories. Relevant examples are shown in figure 10. If the qualifications for a pathological EHL reflex were partly met, a probable EHL reflex could be rated; this was minimally defined by the presence of the first two criteria in two out of the six photographs. When neither of these two pathological ratings was applicable, the result was considered normal, and was further specified as definite or probable FHB reflex (cf. criteria 2, 3 and 4 for the EHL) or no reflex activity at all. Strictly speaking, an absent reflex can be abnormal when a FHB response is found on the other side (Harris, 1903; Kino, 1927), bur only one side was investigated. 92
A FHB EHL E TA EHL c FHB TA _j1mV 500ms EHL EHL FIGURE 10 Patterns of activity in EHL. Beginning of stimtdation marked by arrou·s. A. Pathological EHL reflex: synchronous with TA, merged potential.r, spindle-like, no FHB reflex. B. Probably pathological EHL reflex: synchronous tV'ith TA, merged potentials in cluJten, some recruitment, FHB reflex present. C. No pathological EHL reflex: TA silent, no clear merging of potentials, no recmitment or decreasing of activity, FHB reflex pnsent. 93
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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
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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
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Charcot's concepts about hysteria w
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TABLE I STUDIES CONFIRMING BABINSKI
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False positive findings? Babinski's
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FLEXION AND EXTENSION SYNERGIES The
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confirmed by Walshe (1914). His is
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esult in disappearance of the Babin
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without an ipsilateral upgoing toe
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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 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: 30 patients with equivocal plantar
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
Page 130 and 131: ~ '->' 0 TABLE XX PATIENTS SHOWING
Page 132 and 133: 3. BABINSKI SIGNS APPEARING IN OR D
Page 134 and 135: --------------~~- ~ '-" TARLE XXI "
Page 136 and 137: 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)
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DEJERINE, ]., and LEVY V j\LENSI, J
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FRIEDMAN, E. D. (1920). On a possib
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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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