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LETTER TO THE EDITOR
Year : 2019  |  Volume : 22  |  Issue : 4  |  Page : 513
 

Extensor plantar response: The examination technique makes a crucial difference


Department of Neurology, St. John's Medical College Hospital, Bengaluru, Karnataka, India

Date of Submission01-Oct-2018
Date of Acceptance29-Oct-2018
Date of Web Publication25-Oct-2019

Correspondence Address:
Prof. Sarma R. K. Gosala
Department of Neurology, St. John's Medical College Hospital, Bengaluru, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aian.AIAN_425_18

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How to cite this article:
Gosala SR. Extensor plantar response: The examination technique makes a crucial difference. Ann Indian Acad Neurol 2019;22:513

How to cite this URL:
Gosala SR. Extensor plantar response: The examination technique makes a crucial difference. Ann Indian Acad Neurol [serial online] 2019 [cited 2019 Nov 14];22:513. Available from: http://www.annalsofian.org/text.asp?2019/22/4/513/256375




Sir,

I read with interest the article titled “Differentiating extensor plantar response in pathological and normal population” by Loo et al. in the AIAN journal.[1] The authors systematically studied this important question in 156 individuals and found that extensor responses were seen in 18.6% of feet of normal individuals. This included withdrawal response and Babinski response in nearly equal proportion. They must be commended for this meticulous work leading to a new observation, but some technical issues in the elicitation of the reflex are of concern:

  1. The authors have not specified the stimulus object that was used to elicit the reflex
  2. They have not mentioned how rapidly or slowly the stimulus was delivered. The textbook description of the test specifies that the stimulus must be delivered over 3–5 s [2]
  3. How superficial or deep was the stimulus applied? Plantar reflex is a superficial reflex and applying deeper pressure results in elicitation of a muscular reflex
  4. What is meant by great toe extension? Is it at interphalangeal joint or metatarsophalangeal joint of the great toe? Again, the textbook description is to observe the movement at metatarsophalangeal joint
  5. Was tensor fasciae latae contraction looked for? Even in the absence of great toe movement, tensor fasciae latae contraction may be observed in Babinski response.


In the absence of these important details of methodology of elicitation of the reflex, it may be premature and potentially erroneous to state that Babinski sign could be elicited in such a significant proportion of healthy individuals. It would be helpful if the authors could make videos of Babinski sign in some of their normal subjects available for review in the online version of the journal.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Loo SF, Justin NK, Lee RA, Hew YC, Lim KS, Tan CT, et al. Differentiating extensor plantar response in pathological and normal population. Ann Indian Acad Neurol 2018;21:144-9.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Campbell WW. De Jong's The Neurologic Examination. 6th ed. United States of America: Lippincott Williams & Wilkins; 2005.  Back to cited text no. 2
    




 

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