Consistency of the Babinski reflex and its variants

Abstract

Background and purpose: The Babinski Reflex, first described in 1896, is still an integral part of the neurological examination. Many have studied the consistency of this reflex, but none have compared the inter- and intra-observer consistency of the Babinski reflex and its variants.

Methods: Thirty-four subjects were examined by six neurologists. The Babinski, Gordon, Chaddock, and Oppenheim reflexes were tested, and each neurologist concluded if the plantar response was flexor or extensor. Six subjects were re-tested 1 week later to determine intra-observer consistency.

Results: The Babinski reflex had the highest interobserver consistency with a kappa value of 0.5491. The Chaddock, Oppenheim, and Gordon reflexes had kappa values of 0.4065, 0.3739, and 0.3515, respectively. For intra-observer consistency, Gordon was the most consistent with a kappa value of 0.6731. When reflexes were combined in pairs, the Babinski and Chaddock reflexes together were the most reliable.

Conclusions: The Babinski reflex was shown to be the most consistent between examiners. The Gordon reflex had the highest intra-observer consistency; however, the small sample size should limit conclusions drawn from this calculation. Clinicians often utilize more than one reflex to examine the plantar response; the combination of the Babinski and Chaddock reflexes was the most reliable.