The plantar reflex is the reflex that arises when the sole of the foot is stimulated with a blunt instrument. Reflexes can take one of two forms. In normal adults, plantar reflexes cause a downward response from hallux (flexion). The upper (extension) response of hallux is known as Babinski's response or Babinski's mark , named after neurologist Joseph Babinski. The presence of Babinski marks can identify spinal cord and brain disease in adults, and also exists as a primitive reflex in infants.
While first described in the medical literature by Babinski in 1896, reflexes have been identified in art at least as early as Madonna Bottonselli and Children With Angels, painted in the mid-15th century.
Video Plantar reflex
Method
The lateral side of the sole of the foot is rubbed with a blunt instrument or device so as not to cause pain, discomfort, or injury to the skin; the instrument is run from the heel along the curve to the toes (metatarsal pads). Many reflex hammers are tapered at the end of the handle to the point used to test the plantar response in the past, however, because tightening of the infection control regulation is no longer recommended. Either using a single device or a thumb nail should be used.
There are three possible responses:
- Flexibility: toes curved downward and inward, and legs upside down; this is the response seen in healthy adults.
- indifferent: no answer.
- Extensors: dorsoflex hallux, and other toes spread; this is a Babinski sign, which indicates damage to the central nervous system.
Because the lesions responsible for the sign are widespread, then also areas where the afferent Babinski response can be obtained. Babinski's response is also normal during sleep and after long periods of walking.
Maps Plantar reflex
Interpretation
Babinski's marks may show upper motor neuron lesions that are damaged in the corticospinal tract. Occasionally, pathologic plantar reflexes are the first and only indication of a serious disease process and abnormally clear plantar reflexes often require a detailed neurological investigation, including brain CT or spine MRI scans, as well as lumbar puncture for the study of cerebrospinal fluid.
The phrase "Babinski negative sign" is sometimes used for normal plantar flexor responses.
In baby
Babies will usually show extensor responses. In one study of 256 healthy infants, the response to the test was extensor at 73.8%, flexor in 8.9%, and vague in 17.3% Extensor response was due to corticospinal pathways that traveled from the brain down the spinal cord not completely mielin at this age, so the reflexes are not hampered by the cerebral cortex. Extensor responses usually disappear - giving way to the flexor response - at 12 months of age. Her persistence above the age of 2-3 shows problems in the brain or spinal cord.
Path
Afferent: Nociception is detected in the dermatome S1 and radiates to the tibial nerve to the sciatic nerve to the root L5, S1 and the synapse in the anterior horn to obtain a motor response. Eferent: Motor response back through L5, root S1 to sciatic nerve to bifurcation. The flexor leg is innervated by the tibial nerve. Extensor toe (extensor hallicus longus, extensor digitorum longus) is innervated by deep peroneal nerve. Loss of normal adult descending pyramidal control of the reflex arc to suppress the extensor withdrawal of the toes in the plantar reflex known as the Babinski sign.
Relationship with Hoffmann Reflex
Hoffmann reflexes are sometimes described as the limb equivalent of Babinski's sign as both indicate upper motor neuron dysfunction. Mechanically, they differ significantly; Finger reflex reflex is a simple monosynaptic spinal reflex involving the flexor digitorum profundus that is normally completely inhibited by the upper motor neurons. The pathways producing the plantar response are more complicated, and not monosynaptic.
Responses like Babinski
Plantar reflexes can be obtained in several ways, described at the end of the nineteenth and early twentieth centuries. It has its own eponymus.
- Bing mark - many pins on the dorsum of the foot
- Cornell sign - scratching along the inner side of the longucis hallucis longus tendon
- Chaddock sign - wipes the lateral malleolus
- Gonda's Sign - stretch and suddenly release the 4th toe
- Gordon Sign - suppresses calf muscle
- Moniz sign - strong passive plantar flexion of the ankle
- Oppenheim's sign - apply pressure to the medial side of the tibia
- Schaeffer's sign - punched the Achilles tendon
- Silva sign - pinching the femoral rectus muscle
- Stransky sign - loudly kidnaps and suddenly releases the big toe
- StrÃÆ'¼mpell sign - patient tries to flex knee against resistance
- Throckmorton reflex - percussion over metatarsophalangeal joints of the big toe
Abnormal reflex seen as toe flexion
- Bekhterev-Mendel reflex - 2 to 5 foot flexion on foot dorsum percussion
- Rossolimo marks - excessive flexion of the toes caused by rapid percussion at the tips of the toes
References
Source of the article : Wikipedia
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