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"Extensor toe sign" by various methods in spastic children with cerebral palsy
1Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
Journal of Child Neurology
|June 10, 1998
Summary
The Gonda-Allen method is more sensitive for detecting the "extensor toe sign" in children with spastic cerebral palsy than the classic Babinski reflex. A positive "extensor toe sign" was negatively correlated with spasticity severity.
Area of Science:
- Neurology
- Pediatrics
- Clinical Assessment
Background:
- Upper motor neuron lesions in adults typically cause spasticity and an "extensor toe sign" upon plantar stimulation, also known as an extensor plantar response.
- Various methods exist to elicit this sign, including the Babinski reflex, with others becoming more sensitive when the reflexogenic zone expands due to upper motor neuron lesions.
- Reports on Babinski positivity in spastic cerebral palsy vary, prompting further investigation into diagnostic methods.
Purpose of the Study:
- To assess the sensitivity of different methods for eliciting the "extensor toe sign" in children with spastic cerebral palsy.
- To correlate the severity of spasticity with the positivity of the "extensor toe sign" elicited by various methods.
- To determine if combining methods increases the sensitivity of detecting the "extensor toe sign".
Main Methods:
- Eighty-one children diagnosed with spastic cerebral palsy were evaluated, with 150 limbs tested in total.
- Twelve distinct methods were used to elicit the "extensor toe sign" in each patient.
- Spasticity was assessed using the Ashworth Tone Scale, and its severity was correlated with "extensor toe sign" positivity.
Main Results:
- The Gonda-Allen sign demonstrated the highest sensitivity (90%), followed by Allen-Cleckley (82%) and classic Babinski (75%).
- Other elicitation methods showed less than 30% sensitivity, and combining methods did not increase overall sensitivity.
- A significant negative correlation was found between spasticity severity and the combined positivity of the "extensor toe sign" across all methods.
Conclusions:
- The majority of patients with spastic cerebral palsy exhibit a positive "extensor toe sign."
- The Gonda-Allen method is a more sensitive diagnostic tool for the "extensor toe sign" compared to the classic Babinski reflex in this population.
- A positive "extensor toe sign" is inversely related to the degree of spasticity in children with cerebral palsy.