this course describes the Babinski sign and other common related tests used to assess the pyramidal or corticospinal tract tract in other to clinically diagnose an upper motor neuron lesion.
3. Introduction
■ The Babinski reflex (plantar reflex) was described by the neurologist Joseph
Babinski in 1896.
■ Since that time, it has been incorporated into the standard neurological
examination.
■ The Babinski reflex tests the integrity of the corticospinal tract (CST).
■ The CST is a descending fiber tract that originates from the cerebral cortex
through the brainstem and spinal cord.
■ The CST is considered the upper motor neuron (UMN).
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4. Introduction
■ Stimulation of the lateral plantar aspect of the foot (S1 dermatome) normally
leads to plantar flexion of the toes (due to stimulation of the S1 myotome).
■ Babinski sign occurs when stimulation of the lateral plantar aspect of the foot
leads to extension (dorsiflexion or upward movement) of the big toe (hallux).
■ Also, there may be fanning of the other toes.
■ This suggests that there is been spread of the sensory input beyond the S1
myotome to L4 and L5.
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5. Indications
■ The Babinski reflex is done as part of the routine neurological exam and is
utilized to determine the integrity of the CST.
■ The presence of a Babinski sign suggests damage to the CST.
■ Babinski reflex is especially important in the setting where there is suspicion
of spinal cord injury or stroke, as it may be an early indicator of the presence
of these emergency conditions.
■ The only contraindication to performing the Babinski reflex is a lesion (such as
an infection) in the affected area of the foot that precludes the effective
performance of the reflex.
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6. Description
■ The patient should be relaxed and comfortable.
■ It is best to advise the patient that the sensation may be slightly
uncomfortable.
■ To test for the Babinski sign, the instrument is run up the lateral plantar side
of the foot from the heel to the toes and across the metatarsal pads to the
base of the big toe.
■ A negative response leads to plantar flexion of the toes
■ A positive response leads to extension (dorsiflexion or upward movement) of
the big toe (hallux).
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7. Description
■ In infants with CST, which is not fully myelinated, the presence of a Babinski sign in
the absence of other neurological deficits is considered normal up to 24 months of
age.
■ Babinski’s may be present when a patient is asleep.
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8. Babinski Related signs
■ Hoffman sign
■ The Hoffman sign is an involuntary flexion movement
of the thumb and or index finger when the examiner
flicks the fingernail of the middle finger down.
■ The reflexive pathway causes the thumb to flex and
adduct quickly.
■ A positive Hoffman sign indicates an upper motor
neuron lesion and corticospinal pathway dysfunction
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9. Babinski Related signs
■ Bekhterev-Jacobsohn Reflex
■ The reflex is indicative of a lesion in the pyramidal tract of the upper limb.
■ The Bekhterev-Jacobsohn reflex is best performed with the patient sitting or lying
in the supine position with both arms extended and relaxed.
■ The examiner can tap the radius with his or her hand or finger or can use a reflex
hammer that is held in the opposite hand.
■ A positive (or abnormal) reflex is abduction of the wrist and definite flexion of the
fingers, specifically focused on the distal interphalangeal joints.
■ A negative (or normal) reflex is when the fingers remain extended without any
flexion or movement of the fingers or wrist.
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10. Babinski Related signs
■ Chaddock sign
■ Just like the Babinski sign, the Chaddock sign test
for the integrity of the cortico spinal track.
■ Chaddock reflex is elicited by stimulating the
dorsolateral aspect of the foot from the posterior
portion of the skin just beneath the external
malleolus anteriorly and along the external edge of
the foot.
■ Both the Chaddock and Babinski reflex lead to
dorsiflexion of the big toe and fanning of the other
toes when there is a dysfunction of the CST.
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11. Babinski Related signs
■ Gordon Reflex
■ Gordon reflex, also called the paradoxical flexor
reflex, is a clinical sign utilized to detect upper motor
neuron lesions.
■ Evaluation of this reflex is simple and rapid and does
not require the use of any equipment.
■ It is particularly beneficial in the diagnosis of
pyramidal tract lesions.
■ IT’s extremely useful in cases where the Babinski
reflex cannot be completed due to the poor
cooperation of the patient or in an equivocal
response.
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12. Babinski Related signs
■ The Gordon reflex is best completed with the patient lying in the supine position
with legs extended.
■ The patient needs to be relaxed without the contraction of the leg muscles.
■ The practitioner places his or her hand on the calf muscle underneath the
patient’s leg, then lifts and supports the leg with the other hand at the ankle
area.
■ The practitioner then tightly squeezes the calf muscle while monitoring the
ipsilateral toes.
■ The Gordon reflex is positive (or abnormal) if there is an extensor plantar reflex or
extension of the big toe with fanning of the other toes.
■ A negative (or normal) Gordon reflex is no response in the toes with squeezing of
the ipsilateral calf muscle.
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13. Babinski Related signs
■ Oppenheim reflex
■ Like the previous tests, it help to evaluate the
corticospinal tract (pyramidal tract)
■ It’s elicited by stroking along the medial side of the
tibia.
■ A positive response is the dorsiflexion of the big
toe, sometimes accompanied by fanning of the
other toes.
■ the normal response would be no movement of the
big toe.
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14. Babinski Related signs
■ Moniz sign
■ Moniz sign is a clinical sign in which forceful passive plantar flexion of the
ankle elicits an extensor plantar reflex.
■ It is found in patients with pyramidal tract lesions, and is one of a number of
Babinski-like responses.
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15. In Fine
■ Testing for the Babinski sign is a way of evaluation of the corticospinal or
pyramidal tract, therefore defining an uppermotor neuron lesion.
■ They’re are many other signs both on the upper and lower limb, which like the
Babinski sign can help in the evaluation of upper motor neuron lesion.
■ Understing these signs enable the clinician to have a clue of the location of a
lesion, especially in emergencies situations.
■ In case of contrindication of a sign, another one can be used interchangeably.
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