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S O R W A Y . P R I N C I P A L : PROFESSOR G . H . M O N R A D - K R O H S . M . D .
REFLEXES O F S P I N A L AUTOMATISM
nY
AXEL 0WRE
METHODS O F INVESTIGATION
The neurological routine examination, including motility,
co-ordination, sensation, tendon and cutaneous reflexes, gives
no certain information with regard to reflexes of spinal
automatism. When the inverted plantar reflex is observed the
reflexes of spinal automatism are as a rule present.
Normal individuals who are subjected to painful irritation of
the sole of the foot withdraw the leg involuntarily; that is to
say, they perform a flexion which may possibly mislead an
26 1
untrained observer, the only distinctive physiological indication
- apart from speed, extent and character - being a plantar
motion of the big toe while this motion is dorsal in the
pathological condition. There is, however, a sure distinction,
as a dorsal mofion in the ankle joint brought about by stimuli
not applied to the sole of the foot warrants the assumption of
a diseased condition (Babinski).
a. Nature of Stimuli. The stimuli adequate to elicit reflexes
of spinal automatism are all kinds of irritation which cause a
sense of pain in the normal organism. Pricking, stroking or
scratching with a pin, pinching, cold and hot water and faradic
currents are the means of irritation employed.
The receptive field of reflexes of spinal automatism includes
all the layers of tissue, and these reflexes ma y be elicited not
only by application of stimuli to the skin but also to joints,
tendons, muscles, periosteum an d bones.
There are several methods of irritation which various
investigators have maintained to be the most expedient. Thus
Marie and Foix employ either a plantar motion of the toes
which are held in the hand and bent rather brusquely in the
plantar direction or they squeeze the blade of the foot over the
metatarsal bones i. e. exercise a transversal pressure on the
foot. Both these methods give good reflex responses, but the
first method conceals the movements of the toes a n d the field
of irritation is rather extended. Babinski recommends pinch-
ing of the skin as the best method of irritation. In this connec-
tion the reflex dorsal motion of the big toe observed by Schaf-
fer, Oppenheim an d Gordon by pinching of the Achilles tendon,
frontal pressure of the tibia and pinching of the muscles of
the leg below the knee may be called to mind. These methods
of irritation also give flexion reflex.
The Writer has found that pinching of the skin with the
fingers or with pincers and pricking or stroking with a pin are
the most expedient methods of irritation in the great majority
of cases. I n the course of the present examinations all the
above mentioned methods of irritation have been employd, but
careful observations have shown that even the faradic current,
262
TONUS
Under normal conditions it is supposed that the pyramidal
tracts from the cerebral cortex and the extra-pyramidal tracts
from corpus striatum convey to the muscular system a tonus-
subduing influence. A weakening or cessation of the functions
of these tracts will therefore result in an increase of tonus (cf.
hemiplegia, paralysis agitans). It is moreover supposed that,
under normal conditions, a tonus-increasing influence comes
from the cerebellum and the labyrinth as well as Prom the
periphery through the posterior roots. In cases of affections
influencing these tracts hypotonia or atony will result (cf. tabes
dorsalis).
Sherrington has proved that the reflex system which main-
tains the postural tonus, i. e., the tonus of the erect position, is
composed of a series of reflex arcs, spinal and prespinal. The
prespinal centres are generally situated in the mid-brain and
their activity is supported by influences from the labyrinth and
the cerebellum. Now the fact is that these prespinal centres
become more and more predominant in relation to the spinal
centres as the upright position and action of walking becomes
more and more customary. In man these centres seem to have
superior functional control and, when the spinal cord is severed,
the ,reflex tonuscc seems to disappear from the extensors of the
extremities. (Sherringfon).
In Sherrington’s opinion the conditions to be considered in
connection with the object we have in view should be as fol-
lows:
In conditions of human disease corresponding to ,decerebrate
rigidity(( (hemiplegia simplex and duplex and other simple
affections of the pyramidal tracts) the prespinal centres will be
intact and, freed from the subduing influence of the pyramidal
tracts, they will bring about a pronounced hypertonia of the
extensors - )>posturaltonuscc - with predominant activity in
these. This corresponds well with the clinical experience, as
increased tendon- jerks, crossed extensor reflex, ,Ph&nomkne
d’allongementcc and extensor thrust are reflex actions to be
observed in these conditions.
270
until he feels with his fingers that the bed is wet or hears the
sound of water in the urinal. Evacuation of the bowels take
place, to begin with only, at intervals of weeks unless a laxative
is employed.
T o recapitulate shortly the delineation of the disease: the
first phase, the shock stage, characterized not only by flaccidity
or >>flabbiness((of the muscles, but also by a suppression of the
organic functions; the second phase, the reflex stage, marked
by the return of muscular tonus accompanied by reflex activity,
lively reflexes of spinal automatism, appearance of spontaneous
reflex movements, automatic function of the bladder and
rectum, incomplete return of the genital function, increased
secretion of perspiration and hyper- irritability of the smooth
muscles of the skin. (Lhermiffe).
As may be seen from this exposition there is an essential
difference between the incomplete and the complete transverse
affection in several respects, of which the most marked are the
distribution of tonus and reflex irradiation. If a systematic
examination is carried out, it is in any case possible to
distinguish clinically between the physiologically incomplete
and the complete transverse affection. If not anatomically
complete this is of no significance in the clinique as restoration
can never be looked for.
SUMMARY
1 . A wnrm bath of 37' C . provides the best condition for tlic scientific
investigalion of the reflexes of spinal automatism in man.
2. In the routine examination it is reconiinended to pinch thc anterior
aspect of the leg just above the ankle. If this inanipulation elicits
dorsal movement a t the ancle, it signifies, as pointed out by Babinski
- a lesion of the pyramidal tract. The method of Babinski is
therefore of greater clinical value t h a n the passive flexion of the
toes employed hy Pierre Marie.
3. The reflexes of spinal automatism on the whole furnish a fairly
reliable indication of a pyramidal lesion.
285
4. The crossed extension reflex is ( i n addition to the plantar and
flexion reflexes) of great value for the distinction between a coni-
plcte an d an incomplete transversal lesion of the cord, inasmuch ns
its presence usually indicates an incompleie lesion.
5. Within the reflexogenous zone the reflexes - i n all cases examined
- ar e found to hc more easily elicited from the inside t h an from
the outside of ihe calf, which disagrees with ihc findings of Riddoch.
6. The rcflexogerious zone of the reflexes of spinal automatism (par-
ticularly of the flexor reflexes) often extends over part of or the
whole of the abdominal area.
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