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The classic and most sensitive indication of an upper motor neuron lesion is the sign described by Babinski in 1896 Numerous monographs and articles have been written about the sign: a quite comprehensive one, by van Gijn, and a classic but more arcane one by Fulton and Keller A movement resembling the Babinski sign is present in normal infants, but its de nite persistence or emergence in late infancy and childhood or later in life is an invariable indicator of a lesion at some level of the corticospinal tract In its essential form, the sign consists of extension of the large toe and extension and fanning of the other toes during and immediately after stroking the lateral plantar surface of the foot The stimulus is applied along the dorsum of the foot from the lateral heel and sweeping upward and across the ball of the foot The stimulus must be rm but not necessarily painful Several dozen surrogate responses (with numerous eponyms) have been described over the years, most utilizing alternative sites and types of stimulation, but all have the same signi cance as the classic response Clinical and electrophysiologic observations indicate that the extension movement of the toe is a component of a larger synergistic exion or shortening re ex of the leg ie, toe extension when viewed from a physiologic perspective is a exor protective (nocifensive) response The nociceptive spinal exion re exes, of which the Babinski sign is a part, are common accompaniments but not essential components of spasticity They, too, are exaggerated because of disinhibition or release of motor programs of spinal origin Important characteristics of these responses are their capacity to be induced by weak super cial stimuli (such as a series of pinpricks) and their tendency to persist after the stimulation ceases In their most complete form, a nocifensive exor synergy occurs, involving exion of the knee and hip and dorsi exion of the foot and big toe (triple exion response) With incomplete suprasegmental lesions, the response may be fractionated; for example, the hip and knee may ex but the foot may not dorsi ex, or vice versa In the more chronic stages of hemiplegia, the upper limb is characteristically held stif y in partial exion The hyperre exic state that characterizes spasticity may take the form of clonus, a series of rhythmic involuntary muscular contractions occurring at a frequency of 5 to 7 Hz in response to an abruptly applied and sustained stretch stimulus It is usually designated in terms of the part of the limb to which the stimulus is applied (eg, patella, ankle) The frequency is constant within 1 Hz and is not appreciably modi ed by altering peripheral or central nervous system activities Clonus depends for its elicitation on an appropriate degree of muscle relaxation, integrity of the spinal stretch re ex mechanisms, sustained hyperexcitability of alpha and gamma motor neurons (suprasegmental effects), and synchronization of the contraction-relaxation cycle of muscle spindles The cutaneomuscular abdominal and cremasteric re exes are usually abolished in these circumstances, and a Babinski sign is usually but not invariably present Spread, or irradiation of re exes, is regularly associated with spasticity, although the latter phenomenon may be observed to a slight degree in normal persons with brisk tendon re exes Tapping of the radial periosteum, for example, may elicit a re ex contraction not only of the brachioradialis but also of the biceps, triceps, or nger exors This spread of re ex activity is probably due not to an irradiation of impulses in the spinal cord, as is often taught, but to the propagation of a vibration wave from bone to muscle, stimulating the excitable muscle spindles in its path (Lance) The same mechanism is probably operative in other manifestations of the. asp.net upc-a UPC-A . NET Control - UPC-A barcode generator with free . NET ...
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c# barcode generator source code NET UPC-A Generator Controls to generate GS1 UPC-A barcodes in VB. NET , C# applications. Download Free Trial Package | Developer Guide included ... javascript barcode scanner input hyperre exic state, such as the Hoffmann sign and the crossed adductor re ex of the thigh muscles Also, re exes may be inverted, as in the case of a lesion of the fth or sixth cervical segment; here the biceps and brachioradialis re exes are abolished and only the triceps and nger exors, whose re ex arcs are intact, respond to a tap over the distal radius In addition to hyperactive phasic myotatic re exes ( tendon jerks ), certain lesions, particularly of the cervical segments of the spinal cord, may result in great enhancement of tonic myotatic re exes These are stretch re exes in which a stimulus produces a prolonged asynchronous discharge of motor neurons, causing sustained muscle contraction As the patient stands or attempts voluntary movement, the entire limb may become involved in intense muscular spasm, sometimes lasting for several minutes During this period the limb is quite useless Presumably there is both an interruption of lateral reticulospinal inhibitory in uences on the anterior horn cells and a release of the medial reticulospinal facilitatory effects needed in antigravity support (Henneman) With bilateral cerebral lesions, exaggerated stretch re exes can be elicited in cranial as well as limb and trunk muscles because of interruption of the corticobulbar pathways These are seen as easily triggered masseter contractions in response to a brisk downward tap on the chin (jaw jerk) and brisk contractions of the orbicularis oris muscles in response to tapping the philtrum or corners of the mouth In advanced cases, weakness or paralysis of voluntary movements of the face, tongue, larynx, and pharynx are added (bulbar spasticity or pseudobulbar palsy; see pages 426 and 445) There have been many investigations of the biochemical changes that underlie spasticity and the mechanisms of action of antispasticity drugs These have been reviewed by Davidoff Since glutamic acid is the neurotransmitter of the corticospinal tracts, one would expect its action on inhibitory interneurons to be lost As mentioned earlier, gamma-aminobutyric acid (GABA) and glycine are the major inhibitory transmitters in the spinal cord; GABA functions as a presynaptic inhibitor, suppressing sensory signals from muscle and cutaneous receptors Baclofen, a derivative of GABA, as well as diazepam and progabide, are thought to act by reducing the release of excitatory transmitter from the presynaptic terminals of primary afferent terminals Actually, none of these agents is entirely satisfactory in the treatment of spasticity when administered orally; the administration of baclofen intrathecally may have a more bene cial effect Glycine is the transmitter released by inhibitory interneurons and is measurably reduced in quantity, uptake, and turnover in the spastic animal There is some evidence that the oral administration of glycine reduces experimentally induced spasticity, but its value in patients is uncertain Interruption of descending noradrenergic, dopaminergic, and serotonergic bers is undoubtedly involved in the genesis of spasticity, although the exact mode of action of these neurotransmitters on the various components of spinal re ex arcs remains to be de ned Table 3-1 summarizes the main attributes of upper motor neuron lesions and contrasts them with those of the lower motor neuron. asp.net upc-a UPC-A Barcode Generator for ASP . NET Web Application
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