From the foot-mouth reflex to the hand-mouth reflex a continuum of responses to Appendicular Compression

Pedroso, Fleming S.; Rotta, Newra T.

doi:10.1590/S0004-282X1997000200004

Abstracts

We studied the mouth opening response to appendicular compression in two groups of children. This study was performed with the intention of testing the semiologic role of the act of mouth opening following stimulation of various regions, based on the hand mouth reflex of Babkin. Group I was formed by 33 normal children who underwent monthly follow up assessments since birth; and group II consisted of 50 children older than 6 months of age, known to have a neurologic deficit and a neuro-psychomotor development equivalent to that of a child in the first trimester of life. We observed that the normal mouth opening response in group I was more pronounced following compression of the hand and forearm when compared to compression of the arm (p<0.001). This response could persist for as long as the first 6 months of life. We were not able to elicit a mouth opening response following compression of the lower limb in this group. Among children from group II, we observed mouth opening responses to stimulation of all limb segments. Within the upper limb, the response was more pronounced following compression of the hand in comparison to the forearm (p<0.01), and forearm in comparison to the proximal arm (p<0.01). Stimulation of the foot was more effective in eliciting a mouth opening response when compared to equivalent stimulation of the lower leg (p<0.05). However, there was no statistical difference when responses to stimulation of the lower leg and thigh were compared. The presence of the previously unreported foot-mouth response may serve as an indicator of central nervous system compromise and could be associated with a poorer prognosis. We believe that our observations of the specific foot-mouth response patterns may serve as a marker of early neuro-psychomotor development dysfunction during childhood.

neurologic examination; archaic reflexes; neuro-psychomotor development

Com a intenção de testar a importância semiológica da abertura da boca a estímulos em diferentes regiões, partindo do reflexo mão-boca de Babkin, foram estudadas as respostas de abertura da boca por compressão apendicular em dois grupos de crianças, sendo o grupo I constituído de 33 crianças normais acompanhadas desde o nascimento e revisadas ao final de cada mês e o grupo II constituído de 50 crianças com patologia neurológica com idade superior a 6 meses e cujo desenvolvimento neuropsicomotor (DNPM) fosse do 1° trimestre de vida. Observou-se que a evolução normal da resposta motora de abertura da boca no grupo I por compressão é mais eficiente na mão e antebraço do que no braço (p<0,001), podendo persistir durante o 1º semestre de vida. Não foi possível demonstrar esta resposta à compressão do membro inferior (MI). Nas crianças do grupo II, foi possível observar as respostas de abertura da boca aos estímulos em todos os segmentos apendiculares, sendo no membro superior (MS) o estímulo na mão mais efetivo do que no antebraço (p<0,01), no antebraço mais efetivo que no braço (p<0,01). Os estímulos no MI mostraram o pé mais efetivo do que a perna (p<0,05). Entretanto a eficácia do estímulo da perna em relação à coxa não foi estatisticamente significativo. A presença dessas respostas até agora não relatadas como pé-boca pode indicar maior severidade do comprometimento do sistema nervoso central, com pior prognóstico. Pensamos que estas observações possam ter especial interesse para os profissionais da reabilitação, constituindo mais um marcador de alterações neurológicas precoces no DNPM da criança.

exame neurológico; reflexos arcaicos; desenvolvimento neuropsicomotor

From the foot-mouth reflex to the hand-mouth reflex a continuum of responses to Appendicular Compression

Do reflexo pé-boca ao reflexo mão-boca: um continuum de respostas à Compressão Apendicular

Fleming S. Pedroso^I;Newra T. Rotta^II

^IM.D., Child Neurologist,

^IIM.D.,Ph.D., Child Neurologist, Associate Professor of Neurology at UFRGS.

ABSTRACT

We studied the mouth opening response to appendicular compression in two groups of children. This study was performed with the intention of testing the semiologic role of the act of mouth opening following stimulation of various regions, based on the hand mouth reflex of Babkin. Group I was formed by 33 normal children who underwent monthly follow up assessments since birth; and group II consisted of 50 children older than 6 months of age, known to have a neurologic deficit and a neuro-psychomotor development equivalent to that of a child in the first trimester of life. We observed that the normal mouth opening response in group I was more pronounced following compression of the hand and forearm when compared to compression of the arm (p<0.001). This response could persist for as long as the first 6 months of life. We were not able to elicit a mouth opening response following compression of the lower limb in this group. Among children from group II, we observed mouth opening responses to stimulation of all limb segments. Within the upper limb, the response was more pronounced following compression of the hand in comparison to the forearm (p<0.01), and forearm in comparison to the proximal arm (p<0.01). Stimulation of the foot was more effective in eliciting a mouth opening response when compared to equivalent stimulation of the lower leg (p<0.05). However, there was no statistical difference when responses to stimulation of the lower leg and thigh were compared. The presence of the previously unreported foot-mouth response may serve as an indicator of central nervous system compromise and could be associated with a poorer prognosis. We believe that our observations of the specific foot-mouth response patterns may serve as a marker of early neuro-psychomotor development dysfunction during childhood.

Key words: neurologic examination, archaic reflexes, neuro-psychomotor development.

RESUMO

Com a intenção de testar a importância semiológica da abertura da boca a estímulos em diferentes regiões, partindo do reflexo mão-boca de Babkin, foram estudadas as respostas de abertura da boca por compressão apendicular em dois grupos de crianças, sendo o grupo I constituído de 33 crianças normais acompanhadas desde o nascimento e revisadas ao final de cada mês e o grupo II constituído de 50 crianças com patologia neurológica com idade superior a 6 meses e cujo desenvolvimento neuropsicomotor (DNPM) fosse do 1° trimestre de vida. Observou-se que a evolução normal da resposta motora de abertura da boca no grupo I por compressão é mais eficiente na mão e antebraço do que no braço (p<0,001), podendo persistir durante o 1º semestre de vida. Não foi possível demonstrar esta resposta à compressão do membro inferior (MI). Nas crianças do grupo II, foi possível observar as respostas de abertura da boca aos estímulos em todos os segmentos apendiculares, sendo no membro superior (MS) o estímulo na mão mais efetivo do que no antebraço (p<0,01), no antebraço mais efetivo que no braço (p<0,01). Os estímulos no MI mostraram o pé mais efetivo do que a perna (p<0,05). Entretanto a eficácia do estímulo da perna em relação à coxa não foi estatisticamente significativo. A presença dessas respostas até agora não relatadas como pé-boca pode indicar maior severidade do comprometimento do sistema nervoso central, com pior prognóstico. Pensamos que estas observações possam ter especial interesse para os profissionais da reabilitação, constituindo mais um marcador de alterações neurológicas precoces no DNPM da criança.

Palavras-chave: exame neurológico, reflexos arcaicos, desenvolvimento neuropsicomotor.

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Acknowledgements

We are indebted to Alexandre T. Rotta, M.D. (Division of Critical Care Medicine Children's Hospital of Buffalo, State University of New York at Buffalo) for his helpful suggestions, editorial assistance and critical review of the manuscript.

Aceite: 12-dezembro-1996.

Division of Neurology, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil:

Dr. Fleming Salvador Pedroso - Rua Garibaldi 1096/207 - 90035-052 Porto Alegre RS - Brasil.

1. Babkin PS. The establishment of reflex activity in early postnatal life. In The central nervous system and behaviour. Translated from the Russian by the U.S. Department of Health, Education and Welfare. Washington, DC: Public Health Service 1960;24-32.
2. Bieber I. Grasping and sucking. J Nerv Ment Dis 1940; 91:31 -36.
3. Diament AJ. Exame neurológico do lactente. In Diament A, Cypel S (eds). Neurologia infantil. Ed 3. São Paulo: Atheneu 1996:33-62.
4. Futagi Y, Abe J, Tanaka J, Okamoto N. The diagnostic valve of the Babkin reflex. No Hattatsu 1987:19:392-396.
5. Futagi Y.TagawaT, Otani K. Primitive reflex profiles in infants: differences based on categories of neurological abnormality. Brain Dev 1992;141:294-298.
6. Humphrey T. Pattern formed at upper cervical spinal cord level by sensory fiber of spinal and cranial nerves. Arch Neurol 1955;73:36-46.
7. Julião OF. O exame neurológico do adulto. In Tolosa APM, Canelas HM (eds). Propedêutica neurológica: temas essenciais. Ed 2. São Paulo: Sarvier 1971:333-375.
8. Lefèvre AFB. Contribuição para a padronização do exame neurológico do recém-nascido normal. Tese de Livre Docência, Faculdade dc Medicina da Universidade de São Paulo. São Paulo, 1950
9. Lippman K. Überden Bakinschen reflex. Arch Kinderheilk 1958;157: 234-238.
10. Marinesco G, Radovici A. Sur un reflexe cutané nouveau: le reflexe palmo-mentonnier. Revue Neurol 1920;27:237-240.
11. Martin JH, .Jessell TM. Modality coding in the somatic sensory system. In Kandel ER. Schwartz .JH, Jessell TM (eds). Principles of neural science. Ed3. East Norwalk: Prentice-Hall, 1991:341-352.
12. Paine RS. Brazelton TB. Donovan DE. Drorbaugh JE, Hubbell JP, Sears M. Evolution of postural reflexes in normal infants and in the presence of chronic brain syndromes. Neurology 1964;4:1036-1048.
13. Parmelee AM. The hand-mouth reflex of Babkin in premature infants. Pediatrics 1969;31:734-740.
14. Pedroso FS. Rotta NT. Evolução do reflexo mão boca: valor semiológico. XIII Congresso Brasileiro de Neurologia e Psiquiatria Infantil: Temas Livres. Brasília, Outubro 1995:41.
15. Pedroso FS, Rotta NT. Exame neurológico do recém-nascido: reflexo mão boca de Babkin. XIII Congresso Brasileiro de Neurologia e Psiquiatria Infantil: Temas Livres. Brasília, Outubro 1995,44.
16. Penfield W. Rassmussen T. The cerebral cortex of man: a clinical study of localization of function. New York: Macmillan. 1950.
17. Prechtl HFR. The neurological examination of the full-term new born infant. In Clinics in developmental medicine 63. Ed 2. Spastics International Medical Publication. London: William Heinemann. 1977.
18. Reis DJ. The palmomental reflex, a fragment of a general nociceptiveskin reflex: a physiological study in normal man. Arch Neurol 1961;4:486-498.
19. Rotta NT. Desenvolvimento psicomotor. Pesquisa Médica (Porto Alegre) 1973;9:617-628.
20. Santos GLM, Da Silva AS, Novais SL. Reflexo de Babkin no recém-nascido: nova área reflexógena. .1 Pediatria 1996;72: 172-180.
21. Swaiman KE. Neurologic examination after the new born period until 2 year of age. In Swaiman KF. Pediatric neurology: principles and practice. Ed 2. St. Louis: C.V. Mosby, 1994:43-52.
22. Thomas A, Dargassics SA. Études ncurologiques sur le nouveau-né et le jeune nourrisson. Paris: Masson, 1952.
23. Volpe ,JJ. The neurological examination: normal and abnormal features. In Volpe JJ. Neurology of the newborn. Ed 3. Philadelphia: W.B. Saunders, 1995:95-124.

Publication Dates

Publication in this collection
10 Nov 2010
Date of issue
June 1997

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Babkin PS. The establishment of reflex activity in early postnatal life. In The central nervous system and behaviour. Translated from the Russian by the U.S. Department of Health, Education and Welfare. Washington, DC: Public Health Service 1960;24-32.

[2] 2. Bieber I. Grasping and sucking. J Nerv Ment Dis 1940; 91:31 -36.

[3] 3. Diament AJ. Exame neurológico do lactente. In Diament A, Cypel S (eds). Neurologia infantil. Ed 3. São Paulo: Atheneu 1996:33-62.

[4] 4. Futagi Y, Abe J, Tanaka J, Okamoto N. The diagnostic valve of the Babkin reflex. No Hattatsu 1987:19:392-396.

[5] 5. Futagi Y.TagawaT, Otani K. Primitive reflex profiles in infants: differences based on categories of neurological abnormality. Brain Dev 1992;141:294-298.

[6] 6. Humphrey T. Pattern formed at upper cervical spinal cord level by sensory fiber of spinal and cranial nerves. Arch Neurol 1955;73:36-46.

[7] 7. Julião OF. O exame neurológico do adulto. In Tolosa APM, Canelas HM (eds). Propedêutica neurológica: temas essenciais. Ed 2. São Paulo: Sarvier 1971:333-375.

[8] 8. Lefèvre AFB. Contribuição para a padronização do exame neurológico do recém-nascido normal. Tese de Livre Docência, Faculdade dc Medicina da Universidade de São Paulo. São Paulo, 1950

[9] 9. Lippman K. Überden Bakinschen reflex. Arch Kinderheilk 1958;157: 234-238.

[10] 10. Marinesco G, Radovici A. Sur un reflexe cutané nouveau: le reflexe palmo-mentonnier. Revue Neurol 1920;27:237-240.

[11] 11. Martin JH, .Jessell TM. Modality coding in the somatic sensory system. In Kandel ER. Schwartz .JH, Jessell TM (eds). Principles of neural science. Ed3. East Norwalk: Prentice-Hall, 1991:341-352.

[12] 12. Paine RS. Brazelton TB. Donovan DE. Drorbaugh JE, Hubbell JP, Sears M. Evolution of postural reflexes in normal infants and in the presence of chronic brain syndromes. Neurology 1964;4:1036-1048.

[13] 13. Parmelee AM. The hand-mouth reflex of Babkin in premature infants. Pediatrics 1969;31:734-740.

[14] 14. Pedroso FS. Rotta NT. Evolução do reflexo mão boca: valor semiológico. XIII Congresso Brasileiro de Neurologia e Psiquiatria Infantil: Temas Livres. Brasília, Outubro 1995:41.

[15] 15. Pedroso FS, Rotta NT. Exame neurológico do recém-nascido: reflexo mão boca de Babkin. XIII Congresso Brasileiro de Neurologia e Psiquiatria Infantil: Temas Livres. Brasília, Outubro 1995,44.

[16] 16. Penfield W. Rassmussen T. The cerebral cortex of man: a clinical study of localization of function. New York: Macmillan. 1950.

[17] 17. Prechtl HFR. The neurological examination of the full-term new born infant. In Clinics in developmental medicine 63. Ed 2. Spastics International Medical Publication. London: William Heinemann. 1977.

[18] 18. Reis DJ. The palmomental reflex, a fragment of a general nociceptiveskin reflex: a physiological study in normal man. Arch Neurol 1961;4:486-498.

[19] 19. Rotta NT. Desenvolvimento psicomotor. Pesquisa Médica (Porto Alegre) 1973;9:617-628.

[20] 20. Santos GLM, Da Silva AS, Novais SL. Reflexo de Babkin no recém-nascido: nova área reflexógena. .1 Pediatria 1996;72: 172-180.

[21] 21. Swaiman KE. Neurologic examination after the new born period until 2 year of age. In Swaiman KF. Pediatric neurology: principles and practice. Ed 2. St. Louis: C.V. Mosby, 1994:43-52.

[22] 22. Thomas A, Dargassics SA. Études ncurologiques sur le nouveau-né et le jeune nourrisson. Paris: Masson, 1952.

[23] 23. Volpe ,JJ. The neurological examination: normal and abnormal features. In Volpe JJ. Neurology of the newborn. Ed 3. Philadelphia: W.B. Saunders, 1995:95-124.