title: Kinematic and kinetic analysis of the inter- and intra-applicator assessment of the Babinski reflex.
abstract: OBJECTIVE
  The first aim was to quantify variability in the mechanical technique used by neurologists to elicit the Babinski reflex. The second aim of the study was to assess if the mechanical technique is an important determinant of the subsequent reflex response.
  
  
  METHODS
  In this study, twelve neurologists elicited the Babinski reflex five times on the same foot of the same participant using a special reflex hammer which recorded the force and duration of the stroke. Hallux movement, tibialis anterior maximum EMG amplitude and pain felt by the participant for each stroke were recorded.
  
  
  RESULTS
  A large inter- and intra-applicator variability was shown amongst the neurologists. The change in hallux angle was significantly correlated with the duration of the stroke (R(2)=0.18, P<0.01), maximum (R(2)=0.14, P=0.01) and average (R(2)=0.17, P<0.01) force used to elicit the reflex. No correlations were shown between the hammer forces and duration and the maximum amplitude of the tibialis anterior. Significant correlations were shown between the pain score and the maximum (R(2)=0.15, P<0.01) and average (R(2)=0.17, P=0.001) force used to elicit the Babinski reflex.
  
  
  CONCLUSIONS
  These results indicate that there was substantial variation when performing the Babinski reflex test within and between neurologists which could lead to differences in the resultant reflex and therefore may affect subsequent diagnoses.
authors.affiliation: Biomechanics Laboratory, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand Medical School, 7, York Road, Parktown, 2193 South Africa. Electronic address: chloe.dafkin@gmail.com.
authors.forename: C
authors.initials: C
authors.lastname: Dafkin
authors.affiliation: Biomechanics Laboratory, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand Medical School, 7, York Road, Parktown, 2193 South Africa.
authors.forename: A
authors.initials: A
authors.lastname: Green
authors.affiliation: Biomechanics Laboratory, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand Medical School, 7, York Road, Parktown, 2193 South Africa.
authors.forename: S
authors.initials: S
authors.lastname: Kerr
authors.affiliation: Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand Medical School, 7, York Road, Parktown, 2193 South Africa.
authors.forename: A
authors.initials: A
authors.lastname: Raymond
authors.affiliation: Division of Neurosciences, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand Medical School, Parktown, South Africa.
authors.forename: D
authors.initials: D
authors.lastname: Veliotes
authors.affiliation: School of Civil and Environmental Engineering, Faculty of Engineering and the Built Environment, University of the Witwatersrand, 1, Jan Smuts Avenue, Braamfontein, 2000 Johannesburg, South Africa.
authors.forename: A
authors.initials: A
authors.lastname: Elvin
authors.affiliation: Physiotherapy Department, Faculty of Health Sciences, University of the Witwatersrand Medical School Faculty of Health Sciences, University of the Witwatersrand Medical School, Parktown, South Africa.
authors.forename: B
authors.initials: B
authors.lastname: Olivier
authors.affiliation: Biomechanics Laboratory, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand Medical School, 7, York Road, Parktown, 2193 South Africa.
authors.forename: W
authors.initials: W
authors.lastname: McKinon
mesh_terms: D001696:Biomechanical Phenomena; D004576:Electromyography; D006801:Humans; D007700:Kinetics; D009460:Neurologic Examination / Q000295:instrumentation / Q000379:methods*; D009462:Neurology; D015588:Observer Variation; D012021:Reflex, Abnormal; D001405:Reflex, Babinski / Q000502:physiology*; D015203:Reproducibility of Results; D018709:Statistics, Nonparametric; D013314:Stress, Mechanical
keywords: Applicateur; Applicator; Babinski reflex; Babinski réflexe; Hallux; Tibialis anterior