1.Withdrawal response in healthy adults
KS Chew ; LK Oon ; RA Lee ; KS Lim ; CT Tan
Neurology Asia 2010;15(2):159-165
Background: Withdrawal response was used to explain extensor plantar response in population without
pyramidal dysfunction but there is lack of data characterizing this response in normal population.
Objective: To characterize withdrawal response from pain and tickle sensation in population without
any neurological defi cit. Methods: The study was carried out using four different stimuli, namely
heat-induced pain, cold-induced pain, electric-induced pain using electromyography stimulator and
ticklish sensation using superworm (Zophobas morio), applied to normal subjects in University
Malaya Medical Centre, Kuala Lumpur. Results: Heat-induced pain resulted in fl exion of the big toe
(61.1%), other toes (62.3%), ankle dorsifl exion (82.6%), knee fl exion (83.9%) and hip fl exion (83.9%).
Electric-induced pain showed fl exion of the big toe (27.7%), other toes (28.3%), ankle dorsifl exion
(51.0%), knee fl exion (76.0%) and hip fl exion (76.0%). Ticklish sensation showed fl exion of the big
toe (14.8%), other toes (14.8%), ankle dorsifl exion (22.7%), knee fl exion (21.9%), and hip fl exion
(21.9%). There was signifi cant correlation between fear and ticklish sensation induced withdrawal
responses and extension of big toe. Cold induced pain resulting in big toe fl exion (6.4%), other toes
(6.9%), dorsifl exion of ankle (7.1%), fl exion of knee (6.9%), and hip fl exion (6.9%). Females were
more responsive to heat, males to electrical stimulation. The prevalence of big toe extension ranged
from 11.0% (electrical), 6.3% (ticklish), 4.8 (heat), to 0% (cold), a mean of 5.2% overall.
Conclusion: Withdrawal response caused by nociceptive and ticklish sensation consists mostly of big
toe fl exion and of other toes, ankle dorsifl exion and fl exion of the knee and hip. Extension of the big
toe is seen in about 5% of all the stimulation.