Motor System PLANNING Basal Ganglia

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EXECUTION

Idea

Cortical Association Area

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Premotor, Supplementary Motor and Motor Cortex

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Spinal Cord Brainstem

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Muscles

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Lateral Cerebellum
Figure 1: Motor System Impulse Map
NOTES: (2) Lateral Cerebellum initially received impulses from the cortical association area ( ) !otor Commands are "enerated

Intermediate Cerebellum

The motor system is part of the nervous system responsible for controllin" and re"ulatin" the activity of motor muscles# $efore s%eletal muscle activity is observed& Central Nervous System (CNS) should be activated& primarily neurons of the Cortical 'ssociation 'reas of the cerebral corte(# )o*ever& the "enerated impulse do not directly proceed to the cortical motor neurons& *ithout bein" se+uenced and coordinated by the accessory motor system comprisin" of the basal "an"lia and lateral cerebellum& and the cerebral corte(# o Lateral Cerebellum Alias: Neocerebellum& cerebro,cerebellum Movements Involved: -ast movements Functions: .nvolved in plannin" the movement that *ill happen in the ne(t se+uential movement (!ovements to Come) o /0resent: Seriously disturb rapid movement 0rovide appropriate timin" for each succeedin" movement o /0resent: -ailure of smooth pro"ression of movements Cannot predict ho* far different parts of the body *ill move in a "iven time 1nable to determine *hen the ne(t se+uential movement needs to be"in Succeedin" movement may be"in too early or& more li%ely& too late )elps time events other than movement of the body o 0redict ho* rapid a person is approachin" an ob2ect o Basal Ganglia Movements Involved: -ast and Slo* !ovements 'lso intimately related *ith the corticospinal tract 'lmost all motor and sensory nerve fibers connectin" the cerebral corte( and spinal cord pass throu"h the internal capsule# Function: 3ith Corticospinal Tract: o Control comple( patterns of motor activity /0resent: 4iffulty performin" any s%illed subconcious movement (e#"# 3ritin"& )ammerin")

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Caudate Nucleus: 0lays a ma2or role in the co"nitive control of motor activity5 3ith Cerebral Corte(: o 4etermine ho* rapid the movement is to be performed 6T.!E7 o To control ho* lar"e the movement *ill be 6S0'CE7 !otor impulses are "enerated and transmitted to the brainstem and spinal cord# o 3ith re"ards to the $rainstem: '(ial muscles and 0ro(imal muscles 8esponsible for posture Communication is mediated by the intermediate cerebellum90aleocerebellum 0aleocerebellum corte( brainstem o 3ith re"ards to the spinal cord 4istal muscles of the body 8esponsible for accurate and precise motor activites -or effective activity of s%eletal muscle& the muscle send impulses bac% to the CNS to the spinal cord# Thalamus relay motor impulses and do not modify motor impulses# They serve as neurons that allo* intercommunication bet*een diff parts of the CNS involved in the motor control#

What parts of the CNS have minimal effect on skeletal muscle? The limbic system (Amygdala hippocampus and parahippocampal region) and most especially, the hypothalamus: more concerned with visceral tissue activity. Motor Areas of the Brain: Cerebral Cortex, Basal Brainstem, !pinal Cord anglia, Cerebellum,

!ovement can be classified as: 8efle(es o 8apid& stereotyped involuntary responses o Least affected by a stimulus o (:) Cortical Neuron .nvolvement& (;) Spinal cord < $rainstem Neurons .nvolvement "#T$: %e&lexes CA""#T be considered involuntary movement since s'eletal muscles are ($)$"($"T on neuronal stimulation. *nvoluntary movement observed in smooth and cardiac muscles, impulses are generated by the muscle themselves. =oluntary !ovements o !ovement characteri>ed by t*o features? o 0urposeful ("oal directed) o Lar"ely learned (improves *ith practice) o (;) Cortical Neuron .nvolvement 60recentral "yrus& Cerebro,cerebellum7& (;) Spinal cord < $rainstem Neuron .nvolvement 8hythmic !otor 0atterns o Stereotype& repetitive movements that occur in refle(,li%e fashion after voluntary initiation !uscles *hich are fre+uently utili>ed& muscle activity *ill become almost li%e a refle(
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Guyton, pg) &*(

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Motor System
E(ample: 4rivin" a Car Learned motor movements involve E(ample: 0ostural support movement (e#"# upri"ht head position) (;) Cortical Neuron .nvolvement& (;) Spinal cord and $rainstem Neuron .nvolvement

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'n intact refle( arc is re+uired for motor activity to occur# ' refle( arc is the basic unit of inte"rated refle( activity involvin" the follo*in" components: Sensory organs (-i"ure 2): involve stretch receptors? for intrinsic muscle control? operate on a subconscious level o Muscle Spindles Intra!usal Muscle Fibers Small s%eletal muscle fiber *hose central re"ion has fe* or no actin and myosin filaments Figure 2 Muscle spindle showing its rel tion to the l rge Thus the central e!tr "us l s#elet l $uscle "i%ers& 'Gu(ton) pg *+,potion does not contract @roups .a and .. 'fferents& arran"ed in parallel *ith e(trafusal muscle fibers 4etect both static and dynamic chan"es in muscle len"th (Stretch Sensitive 8eceptors) 're encapsulated in muscle mantle? .n the belly of the muscle The muscle spindle receptor can be e(cited in 2 *ays: Annulospiral Sensory "nding: Len"thenin" the *hole muscle& strechin" the midportion Flo#er Spray "nding: Contractin" the end portion 6.nnervated by A motoneruons7& strechin" the midportion $ypes o! Sensory "nding %rimary "nding Annulospiral ending o @roup .a o innervate both the nuclear ba" and nuclear chain o detect amount of muscle stretch but more sensitive to te rate of chan"e of muscle len"th o velocity Figure . E""erent Neurons nd corresponding sensitive fibers sensor( endings o .mportance: tells the CNS& most especially the spinal cord& that the muscle is contractin"9in motion due to the increase fre+uency of muscle len"th chan"e o .nvolve in dynamic movement9%inesthesia Secondary "ndings Flo#er Spray o @roup .. o innervate only the nuclear chain fibers o not sensitive to rate of chan"e of muscle len"th o provides information about the static len"th of the muscle

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Motor System
o .mportance: Tell center of the startin" len"th of the muscle? tell the center that the muscle is not contractin"9not movin" .nvolve in static movement

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Golgi $endons @roup .b afferents& arran"ed in series *ith e(trafusal muscles fivers# 4etect muscle tension (Tension Sensitive 8eceptors) A!!erent neurons o Classification based on conduction velocity Type '+ B Type 'C B Type 'D Classification based on fiber diameter 6commonly used classfication7 @roup .a& @roup .b and @roup .. Center o 'rea *here sensation is perceived o Spinal cord9$rainstem& Cerebral corte( and others "!!erent neurons Figure . 0ensor( Endings o / motor neuron Effectors: E(trafusal muscle fiber !a%e up the bul% of the muscle 0rovide the force muscle contraction or "enerate tension o & motor neuron Effectors: !uscle Spindles9.ntrafusal muscle fiber 6Ees& the sensory or"an7 -unction: !aintain sensitivity of the muscle even if it is stimulated& by increasin" the ade+uate stimulus 2 types of A motoneurons 4ynamic A fibers o , spindle sensitivity to the rate of chan"e of stretch (nuclear ba") o , phasic activity of .a fibers Static A fibers o , spindle sensitivity to steady& maintained stretch (nuclear chain) o , tonic activity of .a fibers NOT.CE: !uscle spindle are sensory receptor *ith an afferent nerve and an efferent nerve# Types of intrafusal fibers based on the arran"ement of the nuclei o Nuclear bag !ibers Nuclei 'rran"ement: Clusters Thic%er than nuclear chain 4etect the rate of chan"e in muscle len"th (fast& dynamic chan"es) 're innervated by a "roup .a afferent )ave nuclei collected in a central ba" re"ion o
NOTE: conditional operands used above illustrates the proportion of fiber type used by the motor system

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Motor System
o Nuclear c'ains Nuclei 'rran"ement: Chains98o*s Thinner than nuclear ba" 4etect static chan"es in muscle len"th are more numerous than nuclear ba" fibers

"#T$: The &iner the movement o& the muscle, the greater the number o& intra&usal muscle spindles (e.g. distal body parts: hands, &eet and head). #nce spindle is activated, the muscle contracts (+yotatic %e&lex,!trech %e&lex). !trech muscle &iber roup *a and roup ** (orsal root (orsal horn + and - "eurons Contract muscle "!!ectors o 0roduce a refle( action (e!le) Action !ay involved simultaneous contraction of some muscles and rela(ation of other muscle 6'"onist and 'nta"onist7 !ay involve either somatic or visceral responses *hich could occur simultaneously .nvolves activation of one or several synapses 6s%eletalFmotor neuronG and visceralFautonomic neuronG synapses7 )appens even *ithout conscious perception .mpulses are modified in various parts of the CNS o $ypes o! (eponses Static (esponse 3ea%& continuous: for posture9balance .nvolves activity of the nuclear ba" and nuclear chain6more activity7 .nvolves activation of "roup .a and "roup .. neurons 6more activity7 'ctivates + motorneurons and static A fiber *ynamic response Stron"& sudden: for carryin" load& *hen doin" *or% .nvolves activity mostly of the nuclear ba"? same activity of the nuclear chain @reater activity of the "roup .a neurons Oppose sudden chan"es in muscle len"th 'ctivates + motor neurons and dynamic A fibers
Myotatic (e!le) !uscle Spindle @roup .a + and A motor neurons Contract !uscle 6+ motor neurons!aintain Sensitivity of muscle 6A motor neurons7 Stimulatory 5& immediately synapse *ith the anterior motor neurons Inverse Myotatic (e!le) @ol"i Tendon @roup .b + and A motor neurons 8ela( !uscle 6+ motor neurons!aintain Sensitivity of muscle 6A motor neurons7 .nhibitory 2& synapse *ith an inhibitory interneuron and an anterior motor neuron#

(eceptor A!!erent Nerve "!!erent Nerve "!!ect Impulses Number o! Synapse +t'er Names

Myotonic (e!le)

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Motor System

Alias: !yotatic refle(9!uscle spindle , stretch sensitive receptor @roup .a and .. sensory neurons Stimulates the alpha motorneurons as *ell as the "amma motorneurons 8esultin" to muscular contraction Inverse Myotatic (e!le) Alias: .nverse Stretch Len"thenin" 8esponse 8efle(: $ear in mind& a muscle rela(in"& is simply revertin" to its restin" len"th& not increasin" the len"th of its fiber# 'uto"enic .nhibitory 8efle(: *hen a muscle develop tension9muscle contract& that tension is inhibited by the .nverse !yo"enic 8efle(# Thus !uscle 8ela(es 4isynaptic and 0olysynaptic 8efle(: Synapses *ith the inhibitory interneuron and anterior motor neuron o Since& . o& synapsescontraction / . o& synapsesrelaxation (urationcontraction / (urationrelaxation @TO,tension sensitive receptor @roup .b sensory neurons Stimulates an inhibitory interneuron (spinal cord) .nhibitin" the alpha motor neurons 8esultin" to muscular rela(ation

Motor Areas o! t'e Nervous System Spinal Cord o (e)ed Laminae ,Gray Matter Lamina .: contains cells of the dorsal nucleas (Clar%eHs column) and ventral column 0osterior spinocerebellar tract# .t also contains the intermedio, lateral nucleus in thoracic and upper lumbar re"ions Lamina / 0 1: motor neurons in the medial and lateral re"ions Medial: controls a(ial muscles Lateral: controls distal muscles Lamina 12: neurons around the central canal o Complete transaction o! t'e spinal cord 0ermanent 0araple"ia .nitially -laccid& then becomes Spastic 0araple"ia Loss of Sensations Spinal Shoc% Loss of spinal refle( Loss of 'utonomic functions: Symphathetic and 0arasymphathetic o Some 0arasymphathetic nerve arise from cranial nerves Last for a minimum of 2 *ee%s 5st to recover: Sensory -unction 8ecovery is possible for some somatic and autonomic refle(es (e#"# %nee 2er%& *ithdra*al9fle(or9pain refle(& micturition and erection) '"e (59+) 8ecovery 0eriod

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Observed belo* the level of in2ury Brainstem o -unction: 0rovides bac%"round contraction: trun%& nec% and pro(imal portions of the limbs o Supports the body a"ainst "ravity Antigravity Muscles: E(tensors Only the arm anti"ravity muscles are fle(ors o 8eticular 'ctivatin" System: 8esponsible for *a%efulness

Figure , Inputs to the $otor s(ste$ o" the %r inste$

$rainstem60ons7 I =estibular Nuclei6via !edial and Lateral =estibulospinal tract7 I Cerebellum Continuous involuntary maintenance of posture 'ffects a(ial anti"ravity muscles =estibular nuclei specifically selectively control the e(citatory si"nals to the different anti"ravity muscles to maintain e+uilibrium in response to si"nals from the vestibular apparatus2

Motor Center

Brainstem Medullary .eticular /ormation Lateral .eticular /ormation Anterior Motor 0euron

.ubrospinal tract

Anti gra1ity muscles

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Guyton, %(!

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Motor System
Figure 4 E!tensor Inhi%ition

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Corte( I !edullary Neurons Transmit inhibitory to the anti"ravity muscles Counteract stimulatory activity of the pons

1r inste$ Control o" Posture 2eticulospin l tr ct o A22ects acti1ity o2 proximal muscles and muscles o2 t3e trun4 o A22ects mostly extensors o 53e excitatory and in3ibitory reticular nuclei constitute a controllable system t3at is manipulated by motor signals 2rom t3e cerebral cortex o Pontine reticulospin l tr ct Generally stimulatory on bot3 extensors and 2lexors, but greater e22ect on extensors 6riginates in t3e nuclei in t3e pons and pro7ects to t3e 1entromedial spinal cord o Medull r( reticulospin l tr ct Generally in3ibitory on bot3 extensors and 2lexors, but greater e22ect on extensors 53us, you can 2lex t3e body part and c3ange position (e)g) C3anging 3ead position 6riginates in t3e medullary reticular 2ormation and pro7ects to spinal cord interneurons in t3e intermediate gray area Figure * 3ecere%r te nd decortic te postures o Tr nsections Abo1e Pontine .eticular /ormation8Bet9een pons and midbrain 3ecere%r te 2igidit( o :xplanation; Bloc4age o2 strong cortical, red nucleus, and basal ganglia input to t3e medullary reticular nuclei< Lac4ing t3is input renders t3e medullary reticular in3ibitor system non=2unctional Cortex and midbrain are not capable o2 exerting t3eir e22ects on t3e muscles o2 t3e body 53e 3ig3est center controlling t3e muscles is t3e pons, 93ic3 is excitatory o C3aracteri>ed by; , excitability o2 extensors ? tonic labyrint3ine re2lexes ? tonic nec4 re2lex ? spinal re2lex = rig3ting re2lex (midbrain 2unction
"#T$: %ighting re&lex is a midbrain &unction.

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P3ysical C3aracteristics

Motor System :xtension and 3yperpronation o2 arms :xtension and internal rotation o2 legs 6pist3otonos (Arc3ing o2 nec4 and bac4

Abo1e Midbrain 3ecortic te 2igidit( o :xplanation; Cause o2 3yperextension o2 lo9er extremities, same as decerebrate< Cause o2 3yper2lexion o2 upper extremities is due to rubrospinal excitation# o C3aracteri>ed by; ? rig3ting re2lex ? tonic labyrint3ine re2lex ? tonic nec4 re2lex = spontaneous mo1ement (automation o P3ysical C3aracteristics /lexion o2 arms 9it3 extension and internal rotation o2 legs Body is extended except upper extremities o Common Cause; Stro4e, @unger8@yperglycemiaAdue to its dependency on glucose-

Cere%r l corte! Motor corte! o Anterior to t3e central sulcus occupies t3e posterior 18# o2 t3e 2rontal lobe o . su% re s Pri$ r( Motor Are (BA " 6rigin o2 motor commands, a2ter modi2ication o2 t3e basal ganglia and lateral cerebellum Cortical e22erent >one, start o2 motor impulses t3at are directed to9ards muscle Site o2 t3e motor 3omunculus B muscle spindles + 3omunculus representation Pre$otor Are .esponsible 2or setting posture at t3e start o2 planned complex motor acti1ity .ecei1ed ma7or input 2rom t3e posterior parietal cortex and its output in2luences c3ie2ly t3e medial descending pat39ay Anterior premotor cortex Ade1elops a Cmotor imageD- Posterior Premotor cortex A:xcites successi1e pattern o2 motor acti1ity E(Primary motor cortex FF (Basal Ganglia ? 53alamus Primary motor Cortex G 0upple$ent r( Motor Are Concerned 9it3 mental re3earsal o2 planned motor acti1ity Causes complex contraction t3at is usually bilateral a22ecting mostly t3e upper extremities 0eeds stronger stimulation to cause contraction Contractions are o2ten bilateral
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Ganong, C3apter 1%

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Actors have a developed !upplementary +otor Area, whereas Athletes have a developed Cerebrocerebellum.

Posterior P riet l Corte!'PPC) 0o$ tic 0ensor( Associ tion Are ) 1A +- nd the 0o$ tic 0ensor( Are s'00A) 1A .)5)2o Generate motor responses Sensation must occur be2ore Motor impulses are generated o PPC pro7ect to t3e premotor area and t3e supplementary motor area o SSA pro7ect to t3e primary motor cortex Other speci li6ed cortic l re s th t control $otor "unction o 1roc 7s Are Hocal cord muscles o 8olunt r( e(e $o9e$ent "ield:Front l E(e $o9e$ent "ield Holuntary mo1ement o2 t3e eyes to9ards di22erent ob7ects Controlling eyelid (e)g) Blin4ing o ;e d rot tion re :licits 3ead rotation< closely associated 9it3 t3e eye mo1ement 2ield o Are o" ; nd 0#ill (I ; Motor Apraxia, uncoordinated and nonpurpose2ul mo1ements 3escending P thw (s LEFT o Passes t3roug3 t3e internal capsule o (I ; Motor Problems o Cortico%ul% r tr ct <F ce nd Nec#= o Concerned 9it3 t3e acti1ity o2 t3e motor nuclei o2 LEFT 2IG;T se1eral cranial ner1es ( o Can in2luence motorneurons controlling nec4 muscles, 2acial muscles, 7a9 muscles and extraocular muscles and tongue< in ot3er 9ords, nec4 up :xcept posterior portion o2 t3e Figure + Cortico%ul% r Tr ct 3eadAcer1ical muscleo @a1e ipsi and contra control, ipsi; upper portion< contra; upper and lo9er portion Gi1en, t3e re2erence point J Motor nucleus Lesion Be2ore; (x Contra, Lo9er Lesion A2ter; (x Ipsi, Kpper and Lo9er o Corticospin l tr ct:P(r $id l Tr ct:Upper $otor neurons <Trun# nd Li$%s= o Most important output pat39ay 2rom t3e cerebral cortex o Passes t3roug3 t3e posterior limb o2 t3e internal capsule o 6rigin (L ; #*; primary motor area #*; premotor area "*; parietal area o Comprises o2 '*L Lateral Corticospinal tract and !*L medial Corticospinal tract o L ter l Corticospin l tr ct <3ist l Muscles= Constitutes '*L o2 t3e 2ibers Pro7ection 2ibers are mostly coming 2rom t3e primary motor cortex /ibers cross at t3e midline o2 t3e medullary pyramid Castillo, Aileen Page 1*

Motor System

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Medi

Concerned 9it3 control o2 distal musculature (3ands, 2ingers, lo9er legs and 2eet 6nly 3a1e contralateral control Generally 2acilitates acti1ity o2 2lexor muscles and in3ibits extensors Mediates 2ine and s4illed mo1ements Includes t3e rubrospinal tract Corticoru%r l nd 2u%rospin l tr ct o (? /lexor and (= :xtensors; Mistal Muscles o2 t3e arms l Corticospin l tr ct <Pro!i$ l:Trunc l Muscles= Constitutes !*L o2 t3e 2ibers Pro7ection 2ibers are mostly coming 2rom t3e premotor cortex /ibers donNt cross at t3e midline o2 t3e medullary pyramid /ibers cross at t3e le1el o2 t3e spinal cord Concerned 9it3 t3e control o2 axial muscles (trun4 and proximal limbs @a1e contralateral and ipsilateral control Mediates postural ad7ustments and gross mo1ements Assist t3e brainstem in ad7usting posture Includes reticulospinal, 1estibulospinal and tectospinal tracts L ter l 8esti%ulospin l tr ct o Po9er2ul (? o2 extensors and (= o2 2lexors o Concerned 9it3 maintenance o2 posture 9it3 accompanying mo1ement o2 t3e 3ead and maintenance o2 postural tone Tectospin l tr ct o Controls acti1ity o2 nec4 muscles in response to 1isual and auditory stimuli Corticotect l tr ct o Concerned 9it3 t3e turning mo1ement o2 t3e 3ead and eyes associated 9it3 reac3ing mo1ements o2 t3e arm o A22ects mostly re2lex t3an 1oluntary eye mo1ements
0estibulo1ocular re&lex: %e&lex movement o& the eyeball Corticotectal tract: 0oluntary eye movements

Medi n Longitudin l F sciculus o Concerned 9it3 re2lex mo1ements o2 t3e 3ead and nec4 in response to 1isual and 1estibular stimuli

"#T$: 2lexor: intrinsic movement3 $xtensors: postural ad4ustment

Upper $otor neurons o 0eurons in all motor pat39ays under direct8indirect control by t3e cerebral cortex, cerebellum and basal ganglia o Corticobulbar; 0eurons be2ore t3e motor neurons o2 t3e C0 o Corticospinal; 0eurons be2ore t3e 1entral 3orn o P(r $id l 0(ste$ Lesion (Kpper Motorneuron Lesions o @ypotonic muscles o Oea4ness and clumsiness o Initially no muscle atropy disuse atrop3y o Mi22iculty o2 per2orming 1oluntary mo1ements Castillo, Aileen Page 11

Motor System o o @yperacti1e re2lexes 0o 2asciculation8/ibrillation

2asciculation: involuntary minute muscle twitches3 muscle &ascicles3 visible 2ibrilations: involuntary minute muscle twitches3 muscle &iber3 not visible but &elt

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Spasticity (Clasp 4ni2e reaction8clonus Clonus8Clasp Pni2e reaction; .esistance to contraction Positi1e Babins4i sign 6bser1ed; Contralaterally

Lower $otorneurons o + and Q motorneurons o2 t3e spinal cord and t3e motor components o2 t3e cranial ner1e nuclei o 0eurons 3a1ing 2inal direct lin4 9it3 t3e muscles o Lower Motorneuron Lesions o Muscle 9ea4ness and immediate atrop3y o @ypoacti1e8absent re2lexes o /laccidity o /asciculation8/ibrilations o 0egati1e Babins4i sign o 6bser1ed; Ipsilaterally E!tr p(r $id l s(ste$ o .est o2 t3e descending motor pat39ay o Some areas o2 t3e brainstem o Some areas o2 t3e basal ganglia o Subt3alamic nucleus o Substantia nigra o Cerebellum o Some spinal pat39ays o Hestibular nuclei o E!tr p(r $id l 0(ste$ Lesions o Muscular .igidity o In1oluntary mo1ements (@ypo4inetic or @yper4inetic o 0o muscle 9ea4ness o 0o re2lex c3anges 1 s l G ngli o /or 2eedbac4 regulation o2 mo1ements (corrects and e1aluates mo1ement as t3ey 3appen o In1ol1ed B:/6.: and AS 9e per2orm t3e mo1ements o Plays an essential role in initiating most motor acti1ities (A)P) are noted 2irst in t3e basal ganglia be2ore t3e cortical motor areas o /or cogniti1e control o2 motor acti1ities o A22ects all s4eletal muscle o Functions o" the 1 s l G ngli o In3ibition o2 motor tone8Mamping /unction Castillo, Aileen Page 1!

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So no 7er4y mo1ement8tremors 9ill occur< So mo1ements are smoot3 and 9ell coordinated o Controls gross intentional (1oluntary mo1ement Astriatumo Pro1ides bac4ground muscle tone 2or intended mo1ement Assist t3e brainstem neurons in t3e maintenance o2 posture o In1ol1ed in t3e planning8programming o2 motor acti1ities o :ssential 2or t3e initiation and execution o2 slo9 mo1ements Aglobus pallidus external segmento :ssential 2or regulating 2ast mo1ements Aglobus pallidus internal segment2 I$port nt P thw (s o 3irect p thw ( :n3ances motor acti1ity Controls rapid motor acti1ity Mecrease acti1ity 9ill cause 3ypo4inetic be3a1ior o Indirect p thw ( .educes motor acti1ity Controls slo9 motor acti1ity Mecrease acti1ity 9ill cause 3yper4inetic be3a1iour 1 s l G ngli In>uries o ;(per#inetic de"ects ;untington7s Chore :xcessi1e rapid mo1ement a22ecting 2ace and upper extremities C3aracteri>ed by trinucleotide repeat expansion) o Commonly, cytosine=adenine=guanine (CAG repeats Caudate n); underacti1ity o2 GABA8Ac3 or 61eracti1ity o2 Mopamine Loss o2 intrastriatal GABAnergic and c3olinergic neurons .eleases t3e pallidum 2rom in3ibition 3yper4inesia An autosomal dominant disorder (abnormal gene is located near t3e end o2 t3e s3ort arm o2 c3romosome " Age onset; #* to $*
!ydenham5s chorea: Bacterial in origin 6untington7s chorea: "eurological disorder

Athetosis :xcessi1e slo9 mo1ement, 9orm li4e 0eurons o2 t3e Corpus Striatum or 53alamus are a22ected Associated 9it3 cerebral palsy Orit3ing mo1ements 3(stoni Simultaneous contraction o2 all s4eletal muscles o2 t3e body ;e$i% llis$us Subt3alamic n) :xcessi1e rapid mo1ement8Hiolent mo1ement o2 upper and lo9er extremities Aone side;(po#inetic 3e"ects P r l(sis Agit ns (Par4insonRs disease

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.esults 2rom 9idespread destruction o2 t3e substantia nigra and pars compacta t3at connects dopamine=secreting ner1e 2ibers to t3e caudate nucleus and putamen Sin dopaminergic acti1ities 9it3 relati1e ,in c3olinergic acti1ities 0igrostriatal tract Age group; usually %* and abo1e o Toungest; !(, Mic3eal U) /ox 0igns nd 0($pto$s o" P r#inson?s o @a1e 3ypo4inetic and 3yper4inetic de2ect, since t3e damage is extrapyramidal in nature o @ypo4inetic de2ects A4inesia; Absence o2 mo1ements Brady4inesia; Slo9 in initiating mo1ements Lac4 o2 2acial expressions (mas4ed 2ace Lac4 o2 associated mo1ements Mi22iculty in initiating and stopping mo1ements S3u22ling (2estinating gait 6ne small step at a time o @yper4inesia de2ects Cog=93eel rigidity; Vcatc3esV during passi1e motion Lead pipe rigidity Passi1e (resting tremors; Vpill rollingV

Cere%ellu$ In1ol1ed in t3e 2eed 2or9ard regulation o2 motor acti1ities; planning o2 mo1ement be2ore t3ey are initiated Alateral regions Plays ma7or role in t3e timing o2 motor acti1ities and in rapid sm) progression 2rom one mo1ement to t3e next = motor coordination (1ermis8intermediate regions ) o Control o2 balance or eWuilibrium o Synergy = controls rate, 2orce, range and direction o2 mo1ement Aspinocerebellumo :ssential 2or motor learning (oli1ary nuclei Acerebrocerebellum An to$ic l nd Function l 3i9ision o Neocere%ellu$:Cere%rocere%ellu$:L ter l 2egions Control o2 1oluntary mo1ements as 9ell as learned mo1ements (3ig3ly s4illed, rapid, integrated mo1ements /eed2or9ard regulation; Lateral Cerebellum< /eedbac4 regulation; Basal Ganglia Prediction o2 mo1ements (planning, programming and timing o2 mo1ements Bra4ing action and damping action .ecei1ed input 2rom t3e cerebral cortex by 9ay o2 t3e pontine nuclei o 0pinocere%ellu$:p leocere%ellu$:Inter$edi te regions Control o2 muscle tone and posture (truncal muscles Maintenance o2 eWuilibrium during mo1ement Pro1ides smoot3 and coordinated mo1ement o2 t3e extremities (proximal areas Castillo, Aileen Page 1"

Motor System

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Control o2 rapid motor acti1ities bra4ing and damping actions Control o2 rate, 2orce, range and direction o2 ongoing mo1ements .ecei1es input 2rom t3e spinal cord o 8esti%ulocere%ellu$:Archicere%ellu$:Posterior regions Maintenance o2 eWuilibrium and posture Controls t3e balance bet9een agonist and antagonist muscles during rapid c3anges in body positions .egulates eye mo1ement, stance and gait (eWuilibrium and learning induced c3anges in Hestibulo=ocular .e2lex Mominated by 1estibular input Clinic ll() the cere%ellu$ is di9ided s git ll( o In>ur( to the $idline 6one Location; Anterior and posterior 1ermis, t3e 2locculonodular lobe and t3e 2astigial nuclei Misorder o2 stance and gait ataxia /eet uses side9ard mo1ement to mo1e 2or9ard MaleWuilibrium /alse Positi1e .ombergNs test o 6pen eyes, s9aying mo1ement 5itubation; tremor o2 t3e body and 3ead 5ilted posture o2 t3e 3ead 0ystagmus o In>ur( to the l ter l 6one Location; Cerebellar 3emisp3eres, t3e dentate and t3e nuclei o2 eac3 side Mecomposition o2 mo1ement; di22iculty per2orming mo1ements in1ol1ing se1eral 7oints V7er4y, irregularV :)g) Cannot 2lex 2ingers simultaneously Past=pointing Misorder o2 stance and gait Ataxia Ataxic stance; Bent 2or9ard, 2eet 9ide apart @ypotonia Mysart3ria; Slurring o2 speec3 Mysdiadoc3o4inesia8Mysr3yt3mo4inesia Intention tremor Impaired c3ec4 and rebound; di22iculty returning to original position 0ystagmus 5est .ange, Mirection o2 motion and .apidity o2 mo1ement o /inger to nose test Slo9 mo1ement, 9it3 di22iculty o /inger = nose = 2inger test o @eel to s3in test (x Cerebellum; /oot immediately mo1es a9ay 2rom t3e leg

3i""erenti ting Cere%ell r Pro%le$ "ro$ 1 s l G ngli Pro%le$ 3i""erenti ting Cere%ell r pro%le$ "ro$ n 'X'X- 1 s l G ngli into!ic tion Cere%ellu$ Bot3 3a1e t3e same gait, but an Intoxicated person mo1es bac49ard, 93ereas a person 9it3 a cerebellar problem mo1es 2or9ard)

Castillo, Aileen Page 1$

Motor System
@ l# 0t nd Ataxic Gait I 5remor 6ne small step at a time X 5remor

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Castillo, Aileen Page 1%