Should the Babinski sign be part of the routine neurologic examination?

Timothy M. Miller; S. Claiborne Johnston

doi:10.1212/01.wnl.0000180608.76190.10

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Abstract

Background: The Babinski sign is a well-known sign of upper motor neuron dysfunction that is widely considered an essential element of a complete neurologic examination. Little is known about reliability and validity of this sign. A less well-known sign of upper motor neuron dysfunction, decreased speed of foot tapping, also has not been carefully evaluated. Scientific evaluation of findings of the physical examination is crucial in directing busy clinicians.

Methods: Ten physicians (five neurologists and five non-specialists) examined each foot of 10 subjects, 8 of whom had known unilateral upper motor neuron weakness, 1 had bilateral leg weakness secondary to ALS, and 1 had no known neurologic deficits. Our main outcome measures were inter-rater reliability (kappa values) and accuracy (agreement with known upper motor neuron weakness).

Results: The reliability of the Babinski sign was fair (kappa 0.30) and was substantial for foot tapping (kappa 0.73). Agreement with known weakness was 56% for Babinski sign and 85% for foot tapping. Reliability and accuracy for both tests were similar for neurologists and non-specialists.

Conclusions: The interobserver reliability and validity of the Babinski sign for identifying upper motor neuron weakness are limited. Slowness of foot tapping may be a more useful sign.

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Letters: Rapid online correspondence

Should the Babinski sign be part of the routine neurologic examination?
Steven R Brenner, Department of Neurology, St. Louis VA Medical Center, 915 North Grand, St. Louis, MO 63106SBren20979@aol.com
Submitted January 09, 2006
Reply from the Authors
Timothy M. Miller, MD, PhD, University of California, San Diego, 9500 Gilman Drive, MC 0670; La Jolla, CA 92093-0670timiller@ucsd.edu

S. Claiborne Johnston, MD, PhD
Submitted January 06, 2006
Should the Babinski sign be part of the routine neurologic examination?
Julien Bogousslavsky, University Hospital, Lausanne 1011, Switzerlandjulien.bogousslavsky@chuv.ch
Submitted January 06, 2006
Should the Babinski sign be part of the routine neurologic examination?
Bhupendra O. Khatri, MD, Center for Neurological Disorders, 2801 W. KK River Parkway, Suite 630, Milwakee WI 53215bokhatri@aol.com
Submitted January 06, 2006
Should the Babinski sign be part of the routine neurologic examination?
Michael Ronthal, MBBCh, FRCP, Harvard Medical School, Beth Israel Deaconess Medical Center, 330 Brookline, Boston, MA 02215mronthal@bidmc.harvard.edu
Submitted January 06, 2006
Should the Babinski sign be part of the routine neurologic examination?
J. van Gijn, MD, FRCP, FRCP(Edin), Department of Neurology, University Medical Centre Utrecht, Room G03.228, UMCU, Heidelberglaan 100, 3584 CX Utrecht, The Netherlandsjan@vangijn.com
Submitted January 06, 2006

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