Plantar Response Profile of High-Risk Infants at One Year of Life

Abstract

To clarify the plantar reflex profile at 1 year of life in different categories of neurodevelopmental abnormalities, plantar responses were examined prospectively in 204 high-risk infants, of whom 58 developed cerebral palsy, 22 had developmental retardation without motor disturbance, and 124 were normal at a follow-up examination at 3 years of age. The plantar response was extensor in 82.3% of infants subsequently found to be neurologically normal at the first month of life, becoming flexor at the age of 9 and 11 months in 68.5% and 86.3%, respectively. Twenty-one (42.9%) of 49 patients with various types of spastic cerebral palsy demonstrated a combined extensor response (ie, dorsiflexion of the great toe with fanning of the remaining toes) as early as the first month of life. Children with spastic quadriplegia and hemiplegia more frequently demonstrated a combined extensor response compared to diplegic patients. The combined extensor plantar response remains a reliable prognostic clinical tool that contributes to an earlier diagnosis of spastic cerebral palsy as early as the first month of life. (J Child Neurol 1999;14:514-517).

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References

Landau W. , Clare M. : The plantar reflex in man, with special reference to some conditions where the extensor response is unexpectedly absent. Brain 1959;82:321-355.

Landau WM : Clinical definition of the extensor plantar reflex. N Engl J Med 1971;285:1149-1150.

Ross ED , Velez-Borras J. , Rossman NP : The significance of the Babinski sign in the newborn. A reappraisal. Pediatrics 1976;57:13.

Jaynes ME , Gingold MK , Hupp A. , et al: The normal plantar response in normal newborn infants. Clin Pediatr 1997;36:649-652.

Hogan GR , Milligan JE : The plantar reflex in the newborn. N Engl J Med 1971;285:502-503.

Rich EC , Marshall RE , Volpe JJ : Plantar reflex flexor in normal neonates. N Engl J Med 1973;289:1043.

Volpe JJ : The neurological examination: Normal and abnormal features, in Volpe JJ (ed): Neurology of the Newborn, 3rd ed. Philadelphia, WB Saunders, 1995, pp 105-106.

Haslam Rha : Neurologic evaluation, in Behrman RE , Klingman RM , Arvin AM (ed): Nelson's Textbook of Pediatrics, 15th ed. London, WB Saunders, 1996, p 1673.

Menkes JH : Textbook of Child Neurology, 4th ed. Philadelphia, Lea & Febiger, 1990.

10.

Purves-Stewart J. , Worster-Drought C. : The Diagnosis of the Nervous Diseases, 10th ed. London, Edward Arnold, 1952.

11.

Babinski MJ : De l'abduction des orteils. Rev Neurol 1903;11:728.

12.

Katijar GP , Sen S. , Agarwal KN : Plantar response during infancy. Acta Neurol Scand 1976;53:390-394.

13.

Gingold MK , Jaynes ME , Bodensteiner JB , et al: The rise and fall of the plantar response in infancy. J Pediatr 1998;133:568-570.

14.

Bax CO : Terminology and classification of cerebral palsy. Dev Med Child Neurol 1964;6:295-297.

15.

Hagberg B. , Hagberg G. , Olow I. , von Wendt L: The changing panorama of cerebral palsy in Sweden, V. The birth year period 1979-1982. Acta Paediatr Scand 1989;78:283-290.

16.

Vangijn J. : The Babinski reflex. Postgrad Med J 1995;71:645-648.

17.

Landau WM : Babinski's reflex, sign of, in Adelman G (ed): Encyclopedia of Neuroscience. Boston, Birkhauser, 1987, pp 109-110.

18.

Bodensteiner JB : Plantar responses in infants. J Child Neurol 1992;7:311-313.

19.

Marcus JC : Flexor plantar responses in children with upper motor neuron lesions. Arch Neurol 1992;49:1198-1199.

20.

Zafeiriou DI , Tsikoulas IG , Kremenopoulos GM , Kontopoulos EE : Using postural reactions as a screening test to identify high-risk infants for cerebral palsy: A prospective study. Brain Dev 1998;20: 307-311.

21.

Zafeiriou DI , Tsikoulas IG , Kremenopoulos GM : Prospective follow-up of primitive reflex profiles in high-risk infants: Clues to an early diagnosis of cerebral palsy . Pediatr Neurol 1995;13:148-152.