{"id":530,"date":"2017-03-01T10:11:59","date_gmt":"2017-03-01T10:11:59","guid":{"rendered":"http:\/\/neurous.dk\/?page_id=530"},"modified":"2018-07-03T07:42:23","modified_gmt":"2018-07-03T07:42:23","slug":"plantarrespons","status":"publish","type":"page","link":"https:\/\/neurous.dk\/?page_id=530","title":{"rendered":"PLANTARRESPONS"},"content":{"rendered":"<p>Den engelske, pensionerede p\u00e6diater PHW Rayner, der i mere end 20 \u00e5r havde haft Parkinson og sidst cervikal spinal-stenose , skrev i 1997 i et \u201dletter to the Editor of BMJ\u201d:<\/p>\n<blockquote><p><strong>Letter to the Editor of BMJ concerning the Babinski response<\/strong><br \/>\n\u00bbThe demonstration of the Babinski response is the most excruciatingly uncomfortable physical examination I know. Students, house physicians, registrars, research fellows, neurologists, and neurosurgeons alike cannot resist the masochistic urge to elicit a response, even when they know that it has been strongly positive for years.\u00ab [Rayner 1997].<\/p><\/blockquote>\n<p>Unders\u00f8gelse for Babinski refleksen er uden tvivl den hyppigst udf\u00f8rte unders\u00f8gelse i neurologien, og ogs\u00e5 den mest ber\u00f8mte; men hvordan oplever patienterne denne strygning under fods\u00e5lerne med en oftest lidt skarp genstand? Mange patienter accepterer et vist, men begr\u00e6nset ubehag ved plantarstimulationen, medens nogle finder at unders\u00f8gelsen er ekstremt ubehagelig. Man b\u00f8r derfor unders\u00f8ge plantarresponset med korrekt teknik og s\u00e5 sk\u00e5nsomt som muligt.<\/p>\n<p><strong>Unders\u00f8gelse<\/strong><br \/>\nPlantarresponset udl\u00f8ses ved at man langsomt helt bagfra stimulerer f\u00f8rst laterale del af fods\u00e5len og evt. ind medialt over forreste fodballe med en stump genstand fx en vatpind.<\/p>\n<p><iframe loading=\"lazy\" src=\"https:\/\/player.vimeo.com\/video\/211166166?app_id=122963\" width=\"1440\" height=\"810\" frameborder=\"0\" title=\"Unders&oslash;gelse for plantarrespons\" webkitallowfullscreen mozallowfullscreen allowfullscreen><\/iframe><\/p>\n<p>Det, som man observerer, er den f\u00f8rste bev\u00e6gelse i storet\u00e5ens grundled. Plantarresponset kan have 3 udfald:<\/p>\n<ol>\n<li style=\"list-style-type: none;\">\n<ol>\n<li>Flexor (det normale).<\/li>\n<li>Intet respons (kan v\u00e6re patologisk hvis responset p\u00e5 den anden side er flexor).<\/li>\n<li>Extensivt (Babinski-response). Det drejer sig om en relativ langsom (ligesom sej) dorsalfleksion af storet\u00e5en.<\/li>\n<\/ol>\n<\/li>\n<\/ol>\n<p><iframe loading=\"lazy\" src=\"https:\/\/player.vimeo.com\/video\/223769906?app_id=122963\" width=\"1440\" height=\"810\" frameborder=\"0\" title=\"Babinski-respons\" webkitallowfullscreen mozallowfullscreen allowfullscreen><\/iframe><\/p>\n<p>Campbell anf\u00f8rer i standardv\u00e6rket \u201cDeJong\u2019s the Neurological Examination\u201d de mest almindelig fejl ved unders\u00f8gelsen af plantarresponset som:<\/p>\n<blockquote><p>\u00bbThe most common mistakes are insufficient firm stimulation, placement of the stimulus too medially, and moving the stimulus too quickly so that the response does not have time to develop.\u00ab [Campbell 2013]<\/blockquote>\n<p>Efter vor erfaring er det ofte en for let og for hurtig stimulation, der resulterer i manglende response.<\/p>\n<p>Der er ingen grund til at se efter spredning af de andre t\u00e6er (\u201dl\u2019abduction des orteils [Babinski 1903], \u201dthe fan sign\u201d [Boers 2014]), der nogle gange sammen med ekstension af storet\u00e5en angives at udg\u00f8re \u201dden klassiske Babinskirefleks\u201d [Paulson et 2011], da observationen af dette ikke bidrager med yderligere udover bev\u00e6gelsen af storet\u00e5en og flytter focus bort fra denne [Patten 2004]. Campbell er af den same mening og udtrykker det s\u00e5ledes:<\/p>\n<blockquote><p>\u00bbThe only movements of significance are those of the great toe. Fanning of the lateral toes without an abnormal movement of the great toe is seldom of any clinical significance, and an absence of fanning does not negate the significance of great toe extension.\u00ab [Campbell 2013].<\/p><\/blockquote>\n<p>Endvidere angives det af Boers i en historisk oversigt over refleksunders\u00f8gelser fra 2014:<\/p>\n<blockquote><p>\u00bbBabinski never stated that great toe extension AND the fan sign were required for a valid Babinski sign.\u00ab [Boers 2014].<\/p><\/blockquote>\n<p>Stimulationen af fods\u00e5len kan som n\u00e6vnt ovenfor v\u00e6re ubehagelig og af hensyn til patienten er det derfor vigtigt at stoppe med stimulationen lige s\u00e5 snart responset er observeret. Nogle gange skal man bare lige markere et moderat tryk bagtil lateralt i fods\u00e5len for at f\u00e5 et plantar-respons eller Babinski-refleks. Enkelte gange udl\u00f8ses et ekstensivt plantar-respons allerede n\u00e5r dynen tages af; s\u00e5kaldt:\u201dbed sheet Babinski\u201d [Berger 2002, Campbell 2013].\u00a0eller n\u00e5r man puster p\u00e5 fods\u00e5len [Tfelt-Hansen, personlig observation].<\/p>\n<p><strong>OBS:<\/strong> Medial stimulation af fods\u00e5len kan udl\u00f8se plantar-refleksen med fleksion af t\u00e6erne, og b\u00f8r helt undg\u00e5s. Som alternativ til plantarresponse-unders\u00f8gelsen hos meget kildne patienter eller patienter med kraftig afv\u00e6rgen ved plantar-stimulation kan Chaddocks refleks bruges, se Babinski-\u00e6kvivalenter nedenfor.<\/p>\n<p><strong>Babinski-\u00e6kvivalent<\/strong><br \/>\n<em>Chaddocks refleks<\/em><br \/>\nMan stimulerer lige under laterale malleol og k\u00f8rer langsomt fremad evt. til lillet\u00e5en helt lateralt p\u00e5 fodryggen. Responset er som ved unders\u00f8gelse af plantar-responset. Ekstensivt t\u00e5-f\u00e6nomen ses oftest b\u00e5de ved Babinski og Chaddock, men kan ses hver for sig. Bruges mest til meget kildne patienter og ved kraftig afv\u00e6rgen ved plantar-stimulation [DeJong\u2019s 2013]. Selv kaldte Chaddock responset \u201dthe external malleolar sign\u201d [Chaddock 1911, Okun &amp; Koehler 2004].<\/p>\n<p><iframe loading=\"lazy\" src=\"https:\/\/player.vimeo.com\/video\/206207006?app_id=122963\" width=\"1440\" height=\"810\" frameborder=\"0\" title=\"Chaddocks refleks\" webkitallowfullscreen mozallowfullscreen allowfullscreen><\/iframe><\/p>\n<p>&nbsp;<\/p>\n<span class=\"collapseomatic \" id=\"id6a3e23f06bd99\"  tabindex=\"0\" title=\"<strong>Referencer<\/strong>\"    ><strong>Referencer<\/strong><\/span><div id=\"target-id6a3e23f06bd99\" class=\"collapseomatic_content \">\n<strong>Berger JR, Fannin M.<\/strong> <em>The \u201cbedsheet\u201d Babinski.<\/em> South Med J 2002; 95 (10): 1178-1179.<\/p>\n<p><strong>Campbell WW.<\/strong><em> DeJong\u2019s The neurologic Examination.<\/em> Seventh Edition. Wolters Kluwer; Lippincott, Williams and Wilkins, Philadelphia 2013: 1-818.<\/p>\n<p><strong>Patten J.<\/strong><em> Neurological differential diagnosis.<\/em> Second Edition. Springer, London 2004: 1-449.<\/p>\n<p><strong>Paulson OB, Gjerris F, Soelberg S\u00f8rensen P.<\/strong><em> Klinisk neurologi og neurokirurgi.<\/em> 5.udgave, FADL\u2019s Forlag 2010: 1-675.<\/p>\n<p><strong>Petersen JA, Schubert M, Dietz V.<\/strong><em> The occurrence of the Babinski sign in complete spinal cord injury.<\/em> J Neurol 2010; 257(1): 38-43.<\/p>\n<p><strong>Rasimakers PG, Cabezas MC, Smal JA, van Gijn J.<\/strong><em> Teaching the plantar reflex.<\/em> Clin Neurol Neurosurg 1991; 93 (3): 201-204.<\/p>\n<p><strong>Rayner PHW.<\/strong> <em>The Babinski sign: Eliciting the sign brings out doctors&#8217; masochistic tendencies.<\/em> BMJ 1997; 314(7077):371.<\/p>\n<p><strong>van Gijn J.<\/strong><em> The Babinski sign and the pyradimal syndrome.<\/em> J Neurol Neurosurg Psychiatry 1978; 41(10): 865-873.<\/p>\n<p><strong>van Munster CE, Weinstein HC, Vitdekaaq BM, van Gijn J.<\/strong><em> The plantar reflex: additional value of stroking the lateral border of the foot to provoke an upgoing toe sign and the influence of experience.<\/em> J Neurol 2012; 259(11): 2424-2428.<br \/>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Den engelske, pensionerede p\u00e6diater PHW Rayner, der i mere end 20 \u00e5r havde haft Parkinson og sidst cervikal spinal-stenose , skrev i 1997 i et \u201dletter to the Editor of BMJ\u201d: Letter to the Editor of BMJ concerning the Babinski response \u00bbThe demonstration of the Babinski response is the most excruciatingly uncomfortable physical examination IContinue reading &rarr;<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-530","page","type-page","status-publish","hentry","no-thumb"],"_links":{"self":[{"href":"https:\/\/neurous.dk\/index.php?rest_route=\/wp\/v2\/pages\/530","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/neurous.dk\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/neurous.dk\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/neurous.dk\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/neurous.dk\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=530"}],"version-history":[{"count":40,"href":"https:\/\/neurous.dk\/index.php?rest_route=\/wp\/v2\/pages\/530\/revisions"}],"predecessor-version":[{"id":949,"href":"https:\/\/neurous.dk\/index.php?rest_route=\/wp\/v2\/pages\/530\/revisions\/949"}],"wp:attachment":[{"href":"https:\/\/neurous.dk\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=530"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}