Should the Babinski sign be part of the routine neurologic examination?

What is normal for foot tapping?

 

seems to a relative ability between limbs (eg. between able limb and paretic limb) in unilateral UMND (CVA) or generalised inability/slowness in bilateral UMND's (spinal lesion)...............see video (need RealPlayer) of foot tapping test http://www.neuroexam.com/content.php?p=28.........

in the Neurology article quoted, the authors report, "We found the Babinski sign was unreliable and a poor predictor of the presence of upper motor neuron weakness. Physicians often found it in unaffected limbs and failed to find it in affected limbs, and their confidence in the assessment did not predict accuracy." The Babinski sign correlated with known weakness in 56% of evaluations, with a sensitivity of 35% and specificity of 77%. Physician-rated level of confidence in the results of Babinski testing was not associated with whether results agreed with presence of upper motor neurone weakness.
In contrast to the findings with the Babinski sign, slowness of foot tapping correctly predicted upper motor neuron weakness in 85% of evaluations; the test's sensitivity was found to be 86% and specificity was 84%.
There were no significant differences in the sensitivity and specificity of testing between neurologists and non-neurologists for either test. The authors note, "The fact that these two groups performed nearly identically suggests that the poor performance of the Babinski sign is not related to physician skill or training, but rather to the sign itself." They add that the level of inaccuracy was similar for all physicians, so none used a specific technique that worked well.
The authors say that, although the Babinski sign is likely to continue to be useful in some cases, such as in uncooperative or comatose patients, physicians and neurologists should focus on other tests, including speed of foot tapping, for routine neurologic."

 

Dear All

What is "upper motor neurone weakness"?

Either the nerves are working or not. I have never heard of them having a form of 'strength'. Has anyone else?

Paul Conneely
www.musmed.com.au

 

"upper motor neuron weakness"

paul, had trouble finding that reference (in relevant article) myself, so googled it (if i had more time i'd database search it, but the union is about to start!)...found a few sites ...........................................................if that surname of yours bothers you mate, drop a few of those n's and e's...............c-o-n-l-e-y.........much simpler.......................(note admin 965..........getting worried?)

 

Dear One letters

Babinski sign is only present when there is a cerebral lack of supression to the spinal reflex.

When born the toes go up due to the lack of an appropriate supression signal from the brain.

About 1 years of age the appropriate signal is issued and this lasts for life except when it is lost classically in a stroke.

The point is that it is always there.

On the other hand foot tapping is not.

One thing that worries me is how can the null hypothesis be true if the Null- hypothesis-examiners set the question (hypothesis) when most likely they have the same training and thus ability to set the hypothesis in the first place.

10 examiners is a very small group and I doubt that you can do a valid Kappa score. A kappa of less than .6 is regarded as lousy in some books while others take 0.4 or better as good.

I would like to see how they derived these figures in such a small sample. Methinks they needed Fishers test along with a 2level T test.

The dodgy brothers are at it again

As the chant goes, '' give us 2n's, give us 2e's ..... what have we got...

Paul Conneely
www.musmed.com.au

 

i performed the babinski test on my daughter a couple of times not long after she was born and she not once showed a positive result

 

Dear Andy

Your result could be put in a 2X2 table under heading of specificity and sensitivity or was the test performed correctly or not.

The refex Babinski was describing is present in all of us. I cannot possibly see how there is an exception.

AS old Prof used say (time and time again) a swallow does not make it summer.

Paul Conneely.

 

For those who have access to Neurology, there is some correspondance on the initial article in this thread:
http://www.neurology.org/cgi/content/full/66/10/1607-a

 

The only probloem with this reference is that you have to be a fully paid up member to view it

Musmed.com.au

 

musmed i can send you an email with it attached in a doc file, mark C-O-N-L-E-Y

 

Dear Mark

I would like that

send via musmed@ihug.com.au
Regards
musmed

 

Dear Members,

Please find below a recently published article on the Babinski reflex I stumbled across this morning while wading through Medline on an un-related task. I have also attached a copy in PDF.

The study below compared the great toe reflex as elicited by the Babinski technique, in comparison to the same reflex as elicited by 3 alternative techniques: the Gordon, Chaddock and Oppenheim techniques. I have included below an excerpt from the full-text that describes these techniques, for those such as myself that may not be familiar with them.

Interestingly, the article posted at the top of this thread found a kappa coefficient value of 0.30 for the babinski reflex, indicating fair agreement between 5 neurologists and 5 non-specialist physicians (GP’s ?). The raters for the study below were all neurologists, and perhaps not surprisingly, they found a slightly higher kappa value of 0.54, indicating moderate inter-rater agreement. Of all 4 techniques, the Babinski was found to have the greatest inter-observer consistency:

Regards to all,

Andrew

 

Babinski reflex is only one of the tests and gives the professional an indication of how the secondary responses over ride the primary responses, those that we are born with. It can diferentiate between upper and lower motor neuron issues and I have used this to identify underlying CP issues that may have slipped through the Pediatric hospital system.
Alex Adam

 

A Systematic and Quantitative Evaluation of Plantar Stimulation: The effect of type, pattern, force of stimulation in eliciting an accurate plantar response
Satish V. Khadilkar et al
Clinical Neurology and Neurosurgery; Available online 5 March 2018

 

The Babinski sign in Renaissance paintings-a reappraisal of the toe phenomenon in representations of the Christ Child: observational analysis
François Sellal, Laurent Tatu
BMJ. 2020 Dec 10

 

The Babinski sign in the first Italian reports
Francesco Brigo et al
Neurol Sci. 2021 Jan 26