An electromyographic study of the pathological plantar response

doi:10.1016/0022-510X(74)90143-9

Journal of the Neurological Sciences

Volume 23, Issue 1, September 1974, Pages 71-79

https://doi.org/10.1016/0022-510X(74)90143-9 Get rights and content

Abstract

In 5 normal subjects and 26 patients with extensor plantar responses, an electromyographic (EMG) analysis of the hallux movements in the plantar reflex were carried out by using a new technique of mechanical stimulation. Mechanical stimuli consisting of a series of repetitive pin-pricks were applied to 3 sites of the plantar surface of the foot, and the discharges in the flexor hallucis brevis and in the extensor hallucis longus were recorded with needle electrodes. The EMG reflex responses to the mechanical stimulation applied to the lateral side of the sole were divided into 5 types which corresponded well with each of the various components of the plantar responses evoked during routine clinical examination. In normal subjects, mechanical stimuli applied to the lateral side of the sole frequently elicited no reflex response in the extensor hallucis longus, whereas in patients with a pronounced Babinski plantar response extensor hallucis longus activity only was occasionally evoked without any activity in flexor hallucis brevis. These findings suggest that in patients with the Babinski plantar response, the threshold of reflex excitation of the extensor hallucis longus may be lowered and this results in inhibition of the flexor hallucis brevis.

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Cited by (3)

Kinematic and kinetic analysis of the inter- and intra-applicator assessment of the Babinski reflex
2014, Neurophysiologie Clinique
Citation Excerpt :
For this reason, a stroking mechanical stimulus may be considered to be more accurate and more representative of the method used in clinical conditions than an electrical stimulus [2,15,20,24]. Nevertheless electrical stimulation has been used in many studies to elicit extensor toe movement [4,8,9,10,15,20]. This is most likely due to its controllable, measurable properties and the fact that electromyographic latency can be calculated with the use of an electrical stimulus [19].
The first aim was to quantify variability in the mechanical technique used by neurologists to elicit the Babinski reflex. The second aim of the study was to assess if the mechanical technique is an important determinant of the subsequent reflex response.
In this study, twelve neurologists elicited the Babinski reflex five times on the same foot of the same participant using a special reflex hammer which recorded the force and duration of the stroke. Hallux movement, tibialis anterior maximum EMG amplitude and pain felt by the participant for each stroke were recorded.
A large inter- and intra-applicator variability was shown amongst the neurologists. The change in hallux angle was significantly correlated with the duration of the stroke (R² = 0.18, P < 0.01), maximum (R² = 0.14, P = 0.01) and average (R² = 0.17, P < 0.01) force used to elicit the reflex. No correlations were shown between the hammer forces and duration and the maximum amplitude of the tibialis anterior. Significant correlations were shown between the pain score and the maximum (R² = 0.15, P < 0.01) and average (R² = 0.17, P = 0.001) force used to elicit the Babinski reflex.
These results indicate that there was substantial variation when performing the Babinski reflex test within and between neurologists which could lead to differences in the resultant reflex and therefore may affect subsequent diagnoses.
Le premier objectif était de quantifier la variabilité dans la technique mécanique exercée par les neurologues lorsqu’ils testent le réflexe de Babinski. Le second objectif était d’évaluer si cette technique mécanique déterminait le réflexe obtenu.
Nous avons demandé à douze neurologues de tester le réflexe de Babinski cinq fois sur le même pied de la même personne. Ils se servaient d’un marteau réflexe qui nous permettait d’enregistrer la force et la durée de leur geste. À chaque fois que le réflexe était testé, nous enregistrions le mouvement de l’hallux avec des caméras, l’amplitude maximale du muscle tibialis anterior par électromyographie et la douleur perçue par le participant avec une échelle d’évaluation visuelle.
Il y avait une large inter- et intra-variabilité entre neurologues dans l’exécution du geste provoquant le Babinski. Le changement d’angulation de l’hallux était corrélé significativement avec la durée du geste (R² = 0,18, p < 0,01), ainsi que les forces maximale (R² = 0,14, p = 0,01) et moyenne (R² = 0,17, p < 0,01) utilisées pour exécuter le réflexe. En revanche, il n’y avait pas de corrélation entre ces mesures et l’amplitude maximale enregistrée par l’EMG au niveau du muscle tibialis anterior. Il y avait une corrélation significative entre le score de douleur et les forces maximale (R² = 0,15, p < 0,01) et moyenne (R² = 0,17, p = 0,001) exercées pour obtenir le réflexe de Babinski.
Ces résultats indiquent qu’il y a une variation importante dans la technique mécanique exercée par différents neurologues, ainsi que par le même neurologue, pour exécuter le réflexe de Babinski. Ceci pourrait induire des différences dans la réponse réflexe obtenue dans un même patient, ce qui pourrait avoir un impact sur le diagnostic neurologique.
Reverse Chaddock sign
2011, Brain and Nerve
The Babinski sign: The first hundred years
1996, Journal of Neurology

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An electromyographic study of the pathological plantar response

Abstract

Lower limb cutaneous reflexes in hemiplegia

Brain

Studies of spasticity in man, Part 1 (some features of spasticity)

Brain

Studies of spasticity in man, Part 3 (Analysis of reflex activity evoked by noxious cutaneous stimulation)

Brain

Studies of spasticity in man, Part 4 (Changes in flexion reflex with repetitive cutaneous stimulation in man)

Brain

Normal plantar response: integration of flexor and extensor reflex component

J. Neurol. Neurosurg. Psychiat.

Pathological plantar response: disturbance of the normal integration of flexor and extensor reflex components

J. Neurol. Neurosurg. Psychiat.