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The Babinski Reflex has a direct influence on the development of gravity, grounding, stability, and balancing reactions. Its developmental task is to integrate grounding and stability. This reflex also affects the hips and the jaw position.
Diabetes mellitus is a chronic systemic disease, which is characterized by hyperglycaemia. Long-term morbidity of DM results in peripheral neuropathy, diabetic neuropathy, which causes sensory disturbance in the limbs and a failure or absence of deep tendon reflexes. The autonomic nerve system is also affected by DM and the disorder leads to bladder-bowel dysfunction.
Meanwhile, cervical myelopathy also shows sensory disturbance in the limbs, and bladder dysfunction. Most of severe-diabetic patients already have sensory disturbance in the limbs, and bladder dysfunction, therefore these findings cannot be used to clarify the presence of cervical myelopathy in patients suffering from DM. Furthermore, deep tendon hyperreflexias that are the typical signs for cervical myelopathy will not be apparent in patients with DM (as per above). Thus, the diagnosis of cervical myelopathy in patients suffering from DM is difficult.
The Babinski reflex or plantar reflex is incorporated into routine neurological examination in order to test the integrity of the corticospinal tract 1. The test does not require sophisticated equipment or active patient participation and can therefore be performed in patients who are otherwise unable to cooperate with a full neurological examination.
The corticospinal tract originates from the cerebral cortex and descends through the brainstem and spinal cord to synapse with alpha neurons of the peripheral nervous system 1. Damage anywhere along the corticospinal tract can result in the presence of the Babinski reflex.
Use a dull or blunt instrument to run up the lateral plantar aspect of the foot from the heel to the little toe and across the metatarsal pad to the base of the great toe. If there is extension (upward movement or dorsiflexion) of the great toe with or without fanning of the other toes, Babinski reflex is said to be present. If the toes deviate downward the reflex is absent. If there is no movement this is considered a neutral response and has no clinical significance 1,2.
In infants with an incompletely myelinated corticospinal tract the Babinski reflex may be present up to 24 months of age which is considered normal in the absence of other neurological signs or symptoms 1.
The Babinski reflex is part of the routine neurological examination to evaluate the integrity of the corticospinal tract. However, in settings where patients withdraw with plantar stimulation, or if there is a lesion on the lateral plantar aspect of the foot, evaluation of the Chaddock reflex offers a reasonable alternative to the Babinski reflex. Both the Babinski and Chaddock reflex test the integrity of the corticospinal tract. When a lesion occurs anywhere along this corticospinal tract, the examiner may obtain a positive reflex. The examiner watches for dorsiflexion (upward movement) of the big toe and fanning of the other toes. This is referred to as a \"positive reflex,\" or one may state that the \"reflex is present.\" When there is a downward deviation of the toes, this means the reflex is absent. This activity reviews the indications, contraindications, performance, and interpretation of the Chaddock reflex and highlights the role of the interprofessional team in assessing patients with neurological deficits.
Objectives: Outline the indications for the evaluation of the Chaddock reflex. Describe the technique involved in evaluating the Chaddock reflex. Describe the clinical relevance of a positive Chaddock reflex. Explain the importance of a well-coordinated interprofessional team in the care of patients undergoing Chaddock reflex evaluation to assess the integrity of the corticospinal tract.
Charles Gilbert Chaddock introduced the External Malleolar sign as an alternative to Babinski reflex in 1911. This was later referred to as Chaddock reflex. Kisaku Yoshimura described a very similar sign in 1906 in the Japanese medical literature as a variation on the Babinski sign. Both the Chaddock reflex and the Babinski reflex test the integrity of the corticospinal tract (CST). Both reflexes are easy to elicit and do not require significant cooperation from the patient, and therefore can be performed in patients who cannot fully cooperate with the neurological exam. The Babinski reflex is more commonly utilized as a part of the routine neurological exam. However, alternatives such as Chaddock sign can be employed when the patient exhibits a significant withdrawal response to plantar stimulation when performing the Babinski reflex.
When the lateral aspect of the foot is stroked with a dull instrument, this triggers afferents which mediate nociception stimulation of the S1 dermatome. The sensory input travels up the tibial and sciatic nerve to the S1 nerve root and triggers an efferent response at that spinal level causing downward contraction of the toes. The CST normally prevents the spread of this reflex to other nerve roots. When there is a pathological process that leads to dysfunction of the CST, there is spread of this sensory stimulation to adjacent nerve roots L5, L4, L3, L2, which leads progressively to increase in flexion (shortening) of LE. One observes deviation (dorsiflexion) of the big toe upward and fanning of the other toes. This is a positive Chaddock reflex.
The Babinski reflex is part of the routine neurological examination to evaluate the integrality of the CST. However, in the setting where the patient has significant withdrawal to plantar stimulation, or if there is a lesion (such as an infection) on the lateral plantar aspect of the foot, then the Chaddock reflex offers a reasonable alternative. In the setting of stroke and spinal cord injury, the presence of this reflex may be an early indication of these emergent conditions.
Generally, a dull instrument is used to perform the Chaddock reflex. A sharp instrument should be avoided to prevent pain or injury to the skin. Traditionally, the end of a reflex hammer, a tongue depressor, or edge of a key are utilized to elicit this reflex.
The patient should be relaxed and comfortable when the examiner performs the Chaddock reflex. The patient should be advised that the sensation may be slightly uncomfortable. Patients may experience a tickling sensation, but this is less likely than with Babinski reflex which requires plantar stimulation. The examiner should ensure that the dorsolateral aspect of the foot is free of any lesions before proceeding.
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 flexion of the big toe and fanning of the other toes when there is a dysfunction of the CST.
Both the Babinski and Chaddock reflex test the integrity of the CST. When a lesion occurs anywhere along this CST, the examiner may obtain a positive reflex. The examiner watches for dorsiflexion (upward movement) of the big toe and fanning of the other toes. This is referred to as a \"positive reflex,\" or one may state that the \"reflex is present.\" When there is a downward deviation of the toes, this means the reflex is absent. The absence of the reflex suggests that the CST may be intact. If there is no response, this is considered a neutral response and has no clinical significance.
In comatose patients, one may see a triple flexion response. In this case, one observes dorsiflexion of the big toe, the fanning of the other toes, dorsiflexion of the foot, as well as knee and hip flexion. This represents profound dysfunction of the CST, with the spread of the reflex to the L3 and L2 myotomes. Care must be made to distinguish this from a withdrawal response. The triple flexion response is very stereotyped whereas the withdrawal response varies with each stimulation.
The advantage of Chaddock reflex over the Babinski reflex is that it may minimize withdrawal due to plantar stimulation. Because the CST has a long course, the presence or absence of these reflexes is useful in determining the health of the central nervous system.
The emergency department physician, neurology nurses, neurologist, internist, and therapists often perform a neurological exam. To test for the integrity of the CST, the Babinski reflex is often performed. However, when the Babinski is not possible, the Chaddock reflex is an alternative. It is important to remember that the validity of the Chaddock reflex has never been tested in large clinical studies. The reflex was introduced decades ago and it is sporadically used. A stroke or spinal cord injury should never be confirmed or refuted on the basis of the Chaddock reflex. An imaging test should always be done to confirm the CNS pathology.
If you think you or your child may have a retained reflex, you should get it evaluated by a professional. Simple exercises are often all that is needed to integrate the reflex and reduce the associated symptoms.
In medicine and neurology, the Babinski reflex or Babinski sign is a reflex that can identify disease of the spinal cord and brain and also exists as a primitive reflex in infants. When non-pathological it is called the plantar reflex while the term Babinski's sign refers to its pathological form.
Infants will also show an extensor response. A baby's smaller toes will fan out, and their big toe will dorsiflex slowly. This happens because the corticospinal pathways that run from the brain down the spinal cord are not fully myelinated at this age, so the reflex is not inhibited by the cerebral cortex. The extensor response disappears and gives way to the flexor response around 12-18 months of age. 59ce067264