TABLE 2185 Common Motor Reflexes Tested in Neurologic Examination

PLANTAR REFLEX This reflex, described by Babinski originally as an up-going large toe and fanning of the other toes, was elicited using a goose quill. After a 10-year dispute with Sherrington and the English neurophysiologists, Babinski settled for motion of the large toe alone but supposedly still carried the goose quill. Observing the movement of the other toes can occasionally prove helpful, however, when the response of the large toe is in doubt. Asymmetry of the plantar reflexes should be observed and recorded.

A strong or painful stimulus is not needed to elicit the plantar reflex. A gentle sensory stimulus from the heel towards the toes in the distribution of S1 in the lateral foot will suffice. If the plantar response is contaminated by withdrawal, externally rotating the leg, so that the lateral knee lies on the stretcher, does much toward minimizing the effects of withdrawal.

ABDOMINAL REFLEX The abdominal reflex is obtained by gentle scratching as with a broken Q-tip stick in all four abdominal quadrants. The normal response is contraction of the abdominal musculature in that quadrant. The reflex is normally present in people with strong abdominal musculature, but may be absent in older persons or those with abdominal surgery or multiple pregnancies. The normal finding is similar in relevance to a normal plantar response. The chief value of the reflex is when there is asymmetry or loss below a certain level. Finding normal abdominal reflexes in the face of asymmetrical plantar reflexes decreases some concern over the asymmetrical plantar reflexes.

ANAL REFLEX The superficial anal reflex results from a contraction of the levator ani and associated peroneal muscles when perianal skin is scratched on either side. It is lost with damage to S3-S4, segments of the spinal cord or their nerve roots. This reflex, as well as rectal sphincter tone, is important to assess following spinal cord trauma.

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