MOTOR SYSTEM II DR.

VILA
Motor System II
Leandro Vila, MD.

UPPER MOTOR NEURON LESION

Descending Fiber Tract is destroyed
Manifestations of Upper Motor Neuron Lesions:
Spastic Paralysis
How does Spastic Paralysis occur in Upper Motor Neuron
Lesions?
In Upper Motor Neuron Lesions, some of descending fiber
tracts (Lateral Corticospinal Tract) directly decussates on
your Anterior Horn Cells (Alpha Motor Neuron) but the
others
will
form
synapse
with
your
interneurons/association neurons. Take note that not all
interneurons are stimulatory some are inhibitory. They
release GABA and Glycine to inhibit the motor neuron
(alpha and gamma motor neurons).
NORMALLY:
Muscles Does not always contract: If you inhibit it,
there will be no Acetylcholine Muscles RELAX
If we want to contract our muscles voluntarily, it would
release Acetylcholine through your descending fiber
tract
If we want it to relax, interneuron will release GABA
Descending fiber tract is destroyed Nothing will
innervate the interneurons Inhibitory interneuron that
releases GABA or Glycine or other inhibitory
neurotransmitter will not be stimulated Alpha motor
neuron will be the one to stimulate itself it would
generate its own action potential, and would release
Acetylcholine Muscle will be contracted, hence, SPASTIC
PARALYSIS
Hyperreflexia

(Picture Above) LATERAL CORTICOSPINAL TRACT

From the Cerebrum, primarily from the Frontal Lobe Cross at the
Lower Medulla Oblongata Lateral side of the Spinal Cord to
terminate on each anterior horn cell When it terminates on the
anterior horn cell, it will innervate your alpha and gamma motor
neurons
Alpha Motor Neuron Release Acetylcholine Skeletal Muscle
Contraction
UPPER AND LOWER MOTOR NEURON LESION
LOWER MOTOR NEURON LESION
Motor Nucleus is affected
Cranial Nerve and Anterior Horn Cells are affected
Manifestations of Lower Motor Neuron Lesion:
Denervation atrophy
(+) Fasciculation and Fibrillations

Reflex travels from your receptor to your sensory neuron

to your motor neuron.
Descending fiber tract is destroyed If you tap a muscle
Stimulate the receptor which is innervated by sensory neuron
Innervate motor neuron Release Acetylcholine Reflex
in uninhibited because nothing stimulated the inhibitory
neuron It is uninhibited HYPERREFLEXIA (Reflexes are
reported as +++ or ++++)
Normal Reflex: ++
Hyporeflexia: +
Areflexia = 0
Do not report a reflex as 0 if you were not able to elicit
it because maybe you just dont know how to elicit it.

(+) Babinski reflex

(+) Oppenheim reflex
(+) Chaddock reflex
No fasciculation and fibrillation
Atrophy is secondary to disuse

CORTICOSPINAL TRACT

Fibrillation = muscle contraction that CANNOT be seen

Fasciculation = muscle contraction that CAN be seen
Flaccid Paralysis
You destroy the nerve itself (you destroy the axon) If it is
destroyed, no one will release Acetylcholine Muscle is
relaxed FLACCID PARALYSIS (It would not contract no
matter what you do)
Hyporeflexia

(Picture Above) CENTRAL CORD SYNDROME

Anterior White Commissure is affected It is where descending and
ascending tracts decussates
Lateral Spinothalamic Tract Decussates at the level of the spinal
cord Decussate at the Anterior White Commissure

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MOTOR SYSTEM II DR. VILA

The side that experienced weakness does not have full supply that is
why it only experienced weakness.
For example we are at the level of T1 At this level, you have
hemisection Anterior, Lateral and Posterior Funniculus is destroyed
Anterior Horn Cell is destroyed
What kind of motor neuron loss? UPPER MOTOR NEURON LOSS
because you destroyed the Anterior Horn Cell itself Below the
level of T1, anterior horn cells are not destroyed There would
still be supply to their descending tract (10%)

KNEE JERK REFLEX (PATELLAR-TENDON REFLEX)

(Picture Above) CORTICOSPINAL TRACT

Lateral Spinothalamic Tract Decussates at the level of the spinal
cord Decussate at the Anterior White Commissure
Other descending tracts like Medial Corticospinal Tract (same as
Anterior Corticospinal Tract)
80-90% of Corticospinal Go down to the lateral side
10% Go down to the medial side Terminate in the anterior
Decussate in the Anterior White Commissure Stimulate Anterior
Horn Cells on the CONTRALATERAL SIDE
As you can see, whether it is lateral or medial/anterior corticospinal,
they will stimulate the anterior horn cells on the contralateral side.
The only difference is where they decussate.

(Picture Above) COMPONENTS OF A REFLEX ARC

REFLEX We have a receptor, sensory neuron, center, motor neuron,
and effector
In motor system, our effector is always the skeletal muscle.
At the level of the Spinal Cord:
Sensory Neuron Spinal Nerve, Dorsal Root Ganglion
Motor Neuron Anterior Horn Cells (Particularly Alpha and
Gamma Motor Neurons)

Lateral Corticospinal Tract

PYRAMIDAL TRACT The reason why it is called your Pyramidal Tract
is because it decussates at the Pyramidal Decussation in your Lower
Medulla.
Medial/Anterior Corticospinal Tract
Included in the EXTRAPYRAMIDAL TRACT It does not decussate on
the pyramids. It goes straight down and decussates at the level of the
spinal cord.

(Picture Above) HEMISECTION OF THE SPINAL CORD BROWNSEQUARD SYNDROME

This is why when you have a hemisection What is affected is the
medial corticospinal tract On one side you have paralysis, and on
the other side you will have weakness

(Picture Above) KNEE JERK REFLEX (PATELLAR TENDON REFLEX)

When you elicit a knee jerk reflex, what stretch receptors are you
stimulating? MUSCLE SPINDLE
How do you elicit patellar tendon reflex?
1. Ask the patient to sit on a high chair Make sure that the legs are
hanging
If there is no high chair, ask the patient to cross his/her legs
2. Using the reflex hammer, tap the patella
Not totally at the patella Tendon will only pass through it
(Tendon is near the patella)
When you strike the reflex hammer You stimulate the
MUSCLE SPINDLE first

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MOTOR SYSTEM II DR. VILA

MUSCLE SPINDLE AND GOLGI TENDON
Skeletal muscle Inside it you will find MUSCLE SPINDLE
Tendon You will find GOLGI TENDON
When you strike the tendon, you stretched the muscle Muscle
Spindle is stretched
When muscles contract, you stretch Golgi Tendon
Both are stretch receptors, but it depends how you stretch it.

Sensory Neuron/
Sensory Innervation
Motor Innervation
Stimulus

Monitors

MUSCLE SPINDLE

GOLGI TENDON

IA and II

IB

Gamma Motor
Neurons
Stretch
(Stimulated when the
muscle is stretched)
Stretching of the
muscle

Contraction
(Stimulated when the
muscle contracted)
Contraction/Tension
built by the muscle
during muscle
contraction

If it is a sensory receptor, it is innervated by sensory neurons. Muscle

Spindles are an exemption. They are also innervated by motor
neurons. It is also innervated by Gamma Motor Neurons.
What is the reaction of your muscle when you stimulated it? CONTRACT
What happened when it contracted? STRETCH/RELAX
MUSCLE SPINDLE
Stretch sensitive receptor
Consists of thin intrafusal muscle
fibers attached to the associated
muscle fibers which surrounds the
muscle spindle.
Inside the muscle spindle
Intrafusal Fiber
Whole muscle Extrafusal
Fiber
Intrafusal Muscle Fibers are devoid of
actin-myosin contractile elements.
They form a capsule containing
several nuclei.
When nuclei are arranged in a
linear fashion NUCLEAR CHAIN
When nuclei are clustered or
clumped in the central region
NUCLEAR BAG
As mentioned earlier, muscle spindle is quite unique It has both
sensory and motor innervation Motor Innervation: Gamma
Motor Neuron Gamma Motor Neuron Supply Intrafusal
Fibers Both Nuclear Chain and Bag Why? In its end, it has
actin and myosin filaments That is why it is stretched and return
to its normal
Golgi Tendon When it is stretched, it does not return No actin
and myosin filaments, what they have is connective tissue
That is why muscle spindle has an efferent innervation and golgi
tendon doesnt.
Two types of sensory fibers are associated with muscle spindle intrafusal
muscle fibers:
PRIMARY ENDINGS
SECONDARY ENDINGS
Annulo Spiral
Flower Spray
Type Ia myelinated sensory fiber
Type II myelinated sensory fiber
Innervates both the nuclear bag
Innervates only the nuclear
and nuclear chain
chain fibers

Detects amount of muscle

stretch but more sensitive to
the rate of change of muscle
length
Velocity sensitive fibers

Not sensitive to rate of change

of muscle length but provides
information about the static
length of the muscle
--

STRETCH REFLEX
Type Ia sensory fibers conduct impulses to the spinal cord entering
the dorsal root and synapse directly (monosynaptic) with alpha motor
neurons in the ventral horn that conduct impulses to the extrafusal
muscle fibers in the same muscle where the type Ia fibers originated.
Also known as MYOTATIC REFLEX which results to contraction of the
stretched muscle
Stretch Reflex has two components: DYNAMIC PHASE AND STATIC
PHASE
STATIC PHASE (RESPONSE)
DYNAMIC PHASE (RESPONSE)
Weak, slow, continuous
Strong, sudden stretch of the
stretch of the muscle spindle
muscle spindle For carrying
For posture and balance
load, when doing work
Involves almost equal activity
Involves activity mostly of the
of the nuclear bag and nuclear
nuclear bag; same activity of
chain
the nuclear chain
Involves activation of group Ia
Greater activity of the group Ia
and group II neurons
neurons
Activates alpha motor neurons
Activates alpha motor neurons
and static gamma fibers
and dynamic gamma fibers
Oppose sudden changes in
--muscle length
(Picture on the Left)
INTRAFUSAL FIBERS OF
MUSCLE SPINDLE
IA Primary Afferent
(Annulospiral) Supply
both nuclear bag and
chain
II Secondary Afferent
(Flower Spray) Supply
only nuclear chain
That is why 2 will supply
your nuclear chain IA
and II
Only 1 will supply your
nuclear bag IA
On the picture: II supplies
both Static Nuclear Bag
Fiber and Nuclear Chain
Fiber
DYNAMIC RESPONSE
Responsible for DYNAMIC RESPONSE Primary Endings
Rate of the change or velocity of the change in the length
Dynamic Reflexes = Rate in the change of muscle length
STATIC RESPONSE
Responsible for STATIC RESPONSE Secondary Endings
Maintain length of muscle fiber
When you maintain the length of your muscle fiber, the sensory
neuron that will send information about the maintenance of the
length of the muscle which is contracting will be your secondary
endings
Which is the one that gives the signal that the muscle is shortening
and lengthening Primary Endings
When you maintain a certain length Secondary Endings

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MOTOR SYSTEM II DR. VILA

RECALL: TYPE OF SKELETAL MUSCLE
Names
SLOW TWITCH
FAST TWITCH
Type I
Type IIa
Type IIb
Other Names
Red Muscle
White Muscle
White Muscle
Size
Small
Intermediate
Bigger
Strength
Weak
Intermediate
Stronger
Release of
Slow
Fast
Rapid
ATP
Aerobic
Aerobic
Anaerobic
Metabolism
Slow Oxidative
Fast Oxidative
Glycolysis
Number of
Many
Many
Few
Mitochondria
Myoglobin
Greater
Greater
Lesser
Vascularity
Greater
Greater
Lesser
Glycogen
Greater
Intermediate
Greater
Content
Fatigability
Resistant
Intermediate
Prone
Size of Motor
Smaller
Intermediate
Bigger
Units
Endurance
Greater
Intermediate
Lesser
Size of Motor
Smaller
Intermediate
Bigger
Neuron
Twitch
Longer
Shorter
Shorter
Duration
Hypertrophy
+
+
Activation
Usually first
Intermediate
Usually last
Threshold
Lower
Intermediate
Higher
Size Principle: First to be recruited are the small muscle fibers
GOLGI TENDON
Tension sensitive encapsulated receptors which consist of a net like
collection of knobby nerve endings among the fascicles of a tendon
arranged in series with the extrafusal muscle fibers
Intermingle with the tendon fibers
Stimulated when the tension imposed by muscle contraction is increased
Like the muscle spindle, the golgi tendon organ reacts vigorously when
the tendon is undergoing stretch (dynamic response) and then settles
down to a steady state level that is proportional to the degree of tension
(static response)

Normally: It would return

In comatose patient, when you release it It would return,
but it would have repetitive movements until it stops
Reflex-like
REFLEX
Receptor Sensory Neuron Motor Neuron Effector (Skeletal Muscle)
RECEPTOR: Muscle Spindle, Golgi Tendon, and Free Nerve Endings (PAIN)
or sometimes touch
Touch Sometimes you perceive it as pain, so sometimes, when
someone holds/taps you, you feel surprised/shocked Withdraw
self from the stimuli
You perceive it as a noxious stimulus: Noxious stimuli Tendency
is to move away from it, especially if it is a withdrawal reflex

SENSORY ORGAN: Muscle Spindle, Golgi Tendon, Free Nerve Endings

AFFERENT NEURON: I, II III, IV
CENTER: Spinal Cord (if it is a spinal cord reflex)
EFFERENT NEURON: Alpha or Gamma Motor Neuron
EFFECTOR: Skeletal Muscle

TYPES OF REFLEX
MYOTATIC REFLEX Monosynaptic
INVERSE MYOTATIC Disynaptic
WITHDRAWAL REFLEX Polysynaptic
MYOTATIC REFLEX
Monosynaptic Example: KNEE JERK REFLEX
Receptor: Muscle Spindle
Sensory Neuron: Dorsal Root Ganglion Ia and II
Center: Spinal Cord
Motor Neuron: Alpha Motor Neuron
Effector: Skeletal Muscle
RECIPROCAL INHIBITION
When you stimulate the flexor, you inhibit the extensor
You cannot stimulate both flexor and extensor at the same time
In the Knee-Jerk Reflex, the stimulatory portion is monosynaptic.
If you insert reciprocal inhibition to the picture, it will become
polysynaptic.
RENSHAW CELL
Interneuron Release inhibitory neurotransmitter Inhibit both
stimulatory and inhibitory
It doesnt mean that when it is inhibitory, it is really inhibited When
you inhibit the inhibitor = stimulation

TYPES OF MOVEMENT GENERATED BY MOTOR SYSTEM

VOLUNTARY MOVEMENT
Voluntary
Movement is purposeful
Learned
REFLEXES
Rapid
Stereotype
Involuntary
RYTHMIC MOTOR PATTERNS
Stereotype
Repetitive
Confer initially as fast repetitive Eventually stops
Can be seen in pathologic conditions, especially in an upper motor
neuron lesion
Upper Motor Neuron Lesion Comatose patient (CVA,
hemorrhage) Try to dorsiflex the foot for some time
Release
Normally: It would return
In comatose patient, when you release it It would return,
but it would have repetitive movements until it stops

DYNAMIC REFLEX
Sensory Neuron: Ia Primary Afferent Supplying Nuclear Bag and
Nuclear Chain (Intrafusal Fiber)
Static Reflex Secondary Afferent Supply on the Nuclear
Chain
INVERSE MYOTATIC
Disynaptic
Receptor: Golgi Tendon
Knee-Jerk Reflex Stretch muscle (MYOTATIC) Reaction:
Contraction Stimulate INVERSE MYOTATIC

Sensory Neuron: Ib
Center: Spinal Cord
Motor Neuron: Alpha Motor Neuron

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MOTOR SYSTEM II DR. VILA

We know that there is no motor neuron that innervates golgi
tendon, however, there is a motor neuron in inverse myotatic
reflex. It is a reflex, so it just doesnt end at the center (it should
have a receptor, sensory neuron, center, motor neuron and an
effector).
Effector: Skeletal Muscle
WITHDRAWAL REFLEX
Reflex when you are trying to avoid noxious stimulus
Withdraw Usually a flexor reflex
Polysynaptic Involves the contralateral and ipsilateral leg
Receptor: Pain Receptor (Free Nerve Endings)
Sensory Neuron: Spinal Nerve
Center: Spinal Cord
Motor Neuron: Alpha Motor Neuron
Effector: Skeletal Muscle

(Picture Above) WITHDRAWAL REFLEX

Example: Stepping on a nail
Withdrawal Reflex
Commonly if it is upper extremities, it is bilateral
Lower extremities Cross extensor Flex the ipsilateral
involved extremity, extend the uninvolved extremity so that it
would be able to support the body

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