Lectures 3 , 4

Dr. Ayar Shakir

Anterior Motor Neurons
Located in each segment of anterior horns of cord gray
matter. They give rise to the n. f that leave the cord by way
of anterior roots & directly innervate skeletal m. fibers.
Two types, alpha & gamma motor neurons.
Alpha Motor Neurons.
Give rise to large type A alpha motor n. fibers, averaging
14 micrometers in diameter; these fibers branch many times
after they enter M & innervate large skeletal m. fibers.
Stimulation of a single alpha n. fiber excites from three to
several hundred skeletal m. f, collectively called the motor
unit.
Gamma Motor Neurons.
excite contraction of skeletal m. f,
much smaller ,
located in the spinal cord anterior horns.
Gamma motor neurons transmit impulses through smaller
type A gamma motor n. fibers, (5 micrometers in
diameter), which go to small, special skeletal m. f
(intrafusal fibers) , constitute the middle of the m. spindle,
which helps control basic m. “tone,” .
Interneurons
Present in all areas of cord gray matter—
dorsal horns, anterior horns, & intermediate areas .
About 30 times as numerous as the anterior motor neurons.
Small & highly excitable, & capable of firing as rapidly as
1500 times / second.
Many interconnections with one another.

Only a few incoming sensory signals from spinal nerves or

from brain terminate directly on the anterior motor neurons.
Almost all these signals are transmitted first through
interneurons, where they are appropriately processed.
Located in anterior horns , in close association with motor neurons,
are a large number of small neurons .
Almost immediately after the anterior motor neuron axon leaves the
body of the neuron, collateral branches from the axon pass to
adjacent Renshaw cells.
Inhibitory cells transmit inhibitory signals to the surrounding motor
neurons.
Thus, stimulation of each motor neuron tends to inhibit adjacent
motor neurons, an effect called lateral inhibition.

Motor system uses lateral inhibition to focus, or sharpen, its

signals to allow unabated transmission of the primary signal in the
desired direction while suppressing the tendency for signals to
spread laterally.
2 special types :
M spindles
distributed throughout the belly of M & send
information to the nervous system about M
length or rate of change of length
Golgi tendon organs ,
located in M tendons & transmit information
about tendon tension or rate of change of
tension.
The simplest manifestation of M spindle
function .

Whenever M is stretched suddenly,

excitation of the spindles causes reflex
contraction of the large skeletal M fibers of
the stretched M & also of closely allied
synergistic muscles.
Type Ia proprioceptor n. f originating in m. spindle &
entering a dorsal root of spinal cord.
A branch of this fiber then goes directly to anterior horn
of cord gray matter & synapses with anterior motor
neurons that send motor n. f back to the same m. from
which the m. spindle fiber originated.
Thus, this is a monosynaptic pathway that allows a
reflex signal to return with the shortest possible time
delay back to the m. after excitation of spindle.
Most type II fibers from the m. spindle terminate on
multiple interneurons in the cord gray matter.
Knee Jerk & Other M. Jerks.
Knee jerk can be elicited by striking patellar tendon with a reflex
hammer; this instantaneously stretches quadriceps m. & excites a
dynamic stretch reflex .
When large numbers of facilitatory impulses are being transmitted
from upper regions of CNS into the cord, m. jerks are greatly
exaggerated.
Conversely, if the facilitatory impulses are depressed or abrogated,
m. jerks are considerably weakened or absent.
Large lesions in the motor areas of the cerebral cortex but not in the
lower motor control areas (especially strokes or brain tumors) cause
exaggerated m. jerks in the opposite side .
M jerks can oscillate .
Can be explained in relation to ankle clonus, as
follows:
Clonus occurs only when the stretch reflex is
highly sensitized by facilitatory impulses from
brain.
To determine the degree of facilitation of spinal
cord, neurologists test pt by suddenly stretching
M & applying a steady stretching force to it.
M. Spasm Resulting from a Broken Bone

Abdominal M. Spasm in Peritonitis

Muscle Cramps
(1) changes in vascular tone resulting from changes in
local skin heat
(2) Sweating results from localized heat on the surface of
the body
(3) Intestinointestinal reflexes control some motor
functions of gut
(4) Peritoneointestinal reflexes that inhibit
gastrointestinal motility in response to peritoneal irritation
(5) evacuation reflexes for emptying full bladder or colon .
all the segmental reflexes can at times be elicited
simultaneously in form of the so-called mass reflex.
When the spinal cord is suddenly transected in upper neck,
at first, all cord functions, including cord reflexes,
immediately become depressed .
Normal activity of the cord neurons depends on continual
tonic excitation by the discharge of n. f entering the cord
from higher centers, (reticulospinal, vestibulospinal, &
corticospinal tracts).
After a few hours - a few weeks, spinal neurons gradually
regain excitability.
In human beings, return is often delayed for several weeks
& occasionally is never complete; conversely, sometimes
recovery is excessive, with resultant hyperexcitability of
some or all cord functions.
Some of the spinal functions specifically affected during or after
spinal shock are:
1. At onset , arterial blood pressure falls — to as low as 40 mm Hg—
sympathetic nervous system activity becomes blocked .
The pressure returns to normal within a few days.
2. All skeletal m reflexes are blocked during initial stages of shock.
(2 weeks to several months ).
Some reflexes may eventually become hyperexcitable, if few
facilitatory pathways remain intact.
First reflexes to return are stretch reflexes, followed by the
progressively more complex reflexes: flexor reflexes, postural
antigravity reflexes, & remnants of stepping reflexes.
3. Sacral reflexes for control of bladder & colon evacuation are
suppressed for first few weeks after cord transection, but they
eventually return.
divided into 3 subareas:

primary motor cortex

premotor area

supplementary motor area

anterior to central sulcus. ( same as area 4 in
Brodmann’s classification)
Face & mouth region near sylvian fissure
Arm & hand area, in the midportion of primary motor
cortex;
Trunk, near the apex of the brain
Leg & foot areas, in the part of the primary motor cortex
that dips into the longitudinal fissure.
More than one half is concerned with controlling M of the
hands & M of speech
Excitation of a single neuron usually excites a specific
movement rather than one specific muscle.
Lies 1 - 3 cm anterior to the primary motor cortex.
The topographical organization is the same as that of primary motor
cortex.
N. Signals cause much more complex “patterns” of movement than the
discrete patterns generated in primary motor cortex.
The pattern may be to position the shoulders & arms so that hands are
properly oriented to perform specific tasks.
The most anterior part of premotor area first develops a “motor image” of
the total m. movement. Then, in the posterior premotor cortex, this image
excites each successive pattern of m. activity required to achieve the
image..,
Premotor cortex, basal ganglia, thalamus, & primary motor cortex
constitute a complex system for the control of complex patterns of
coordinated m. activity.
Has another topographical organization for control of motor
function.
Contractions elicited by stimulating this area are often
bilateral rather than unilateral.
e.g bilateral grasping movements of both hands
simultaneously.
This area functions with premotor area to provide body-
wide attitudinal movements,
fixation movements of the different segments of the body,
positional movements of the head & eyes, as background for
finer motor control of the arms & hands by premotor area &
primary motor cortex.
Broca’s Area

Premotor Area “word formation” lying

immediately anterior to primary motor cortex &
immediately above sylvian fissure.

Damage to it does not prevent a person from

vocalizing, but it does make it impossible for
person to speak whole words rather than
uncoordinated utterances or an occasional simple
word such as “no” or “yes.”
“Voluntary” Eye Movement Field.
In the premotor area immediately above Broca’s area .
Damage to this area prevents a person from voluntarily
moving eyes toward different objects.
The eyes tend to lock involuntarily onto specific objects .
This frontal area also controls eyelid movements such as
blinking.

Head Rotation Area.

Slightly higher in the motor association area, electrical
stimulation elicits head rotation.
It is closely associated with the eye movement field.

Area for Hand Skills.

In the premotor area immediately anterior to the primary
motor cortex for hands & fingers is important for “hand skills.”
when tumors or other lesions cause destruction in this area,
hand movements become uncoordinated & nonpurposeful, a
condition called motor apraxia.
Most important output pathway from motor cortex.
Originates :
30% from primary motor cortex,
30% from premotor & supplementary motor areas
40% from somatosensory areas posterior to central sulcus.
After leaving the cortex, it passes through posterior limb of internal
capsule (between caudate nucleus & putamen of basal ganglia) &
then downward through brain stem, forming pyramids of medulla.
Then cross in the lower medulla to opposite side &
descend into lateral corticospinal tracts of the cord,
finally terminating on interneurons in the intermediate regions of
cord gray matter.
A few of the fibers pass ipsilaterally down the cord in ventral
corticospinal tracts.
large myelinated fibers with a mean diameter of 16
micrometers.
These fibers originate from giant pyramidal cells, (Betz),
found only in primary motor cortex.
Betz cells are about 60 micrometers in diameter, & their
fibers transmit N impulses to spinal cord at a velocity of 70
m/sec, most rapid rate of transmission of any signals from
brain to SC.
There are about 34,000 of Betz cell fibers in each
corticospinal tract.
Total number of fibers in each corticospinal tract is more
than 1 million, so these fibers represent only 3% of the total.
97 % are mainly fibers smaller than 4 micrometers in
diameter conduct background tonic signals to motor areas
of the cord.
Located in mesencephalon, functions in close association with
corticospinal tract.
It receives a large number of direct fibers from primary motor cortex
through corticorubral tract.
These fibers synapse in lower portion of red nucleus,
magnocellular portion, which contains large neurons similar in size
to Betz cells .
These large neurons give rise to rubrospinal tract, which crosses
to opposite side in lower brain stem and follows a course
immediately adjacent to corticospinal tract into lateral columns of
SC.
Rubrospinal fibers terminate on interneurons of intermediate cord
gray matter, along with corticospinal fibers.
Magnocellular portion of red nucleus has a somatographic
representation of all muscles .
stimulation of a single point causes contraction of
a single M or a small group of muscles.
Corticorubrospinal pathway serves as an accessory route
for transmission of signals from motor cortex to SC.
When corticospinal fibers are destroyed but the
corticorubrospinal pathway is intact, discrete movements
can still occur, except movements for fine control of the
fingers and hands are considerably impaired.
Wrist movements are still functional .
Rubrospinal tract lies in the lateral columns of
SC, with corticospinal tract
terminates on the interneurons & motor
neurons that control more distal muscles of
the limbs.

Corticospinal and rubrospinal tracts together

are called lateral motor system of the cord

Vestibuloreticulospinal system, which lies

medially in the cord & is called
medial motor system of the cord .
Cells in somatosensory cortex and visual cortex are
organized in vertical columns of cells.
Cells of motor cortex are organized in vertical columns
a fraction of a mm in diameter,
Thousands of neurons in each column.
Each column of cells functions as a unit, usually
stimulating a group of synergistic muscles, but
sometimes stimulating just a single M.
Each column has six distinct layers of cells.
Pyramidal cells that give rise to corticospinal fibers lie in 5th
layer of cells from cortical surface.

Input signals all enter by way of layers 2 through 4.

6th layer gives rise to fibers that communicate with other

regions of cortex

Stimulation of a single pyramidal cell can seldom excite a

muscle.

Usually, 50 - 100 pyramidal cells need to be excited

simultaneously or in rapid succession to achieve definitive M
contraction
Caused by a ruptured blood vessel that
hemorrhages into brain or by thrombosis of
one of major arteries.

The result is loss of blood supply to cortex or

to corticospinal tract where it passes through
the internal capsule between caudate nucleus
and putamen.
causes varying degrees of paralysis of represented
muscles.
If caudate nucleus and adjacent premotor & supplementary
motor areas are not damaged, gross postural & limb
“fixation” movements can still occur, but there is loss of
voluntary control of discrete movements of distal segments
of the limbs, especially of hands and fingers.
This does not mean that hand and finger muscles
themselves cannot contract; rather, the ability to control the
fine movements is gone.
We can conclude that area pyramidalis is essential for
voluntary initiation of finely controlled movements, especially
of hands and fingers.
Primary motor cortex normally exerts a continual tonic stimulatory effect on
motor neurons of SC; when this stimulatory effect is removed, hypotonia
results.
Most lesions , especially stroke, involve not only primary motor cortex but
also basal ganglia.
M spasm occurs in the afflicted M areas on opposite side of the body
Spasm results from damage to accessory pathways from nonpyramidal
portions of motor cortex.
These pathways normally inhibit vestibular & reticular brain stem motor
nuclei.
When these nuclei cease their state of inhibition (i.e., are “disinhibited”),
they become spontaneously active and cause excessive spastic tone in the
involved muscles.
Extension of SC upward into the cranial cavity,
many special control functions, such as:
1. respiration
2. cardiovascular system
3. Partial control of gastrointestinal function
4. many stereotyped movements of the body
5. equilibrium
6. eye movements
Finally, brain stem serves as a way station for
“command signals” from higher neural centers.
divided into 2 major groups:

(1) pontine : located posteriorly and laterally in the

pons and extending into mesencephalon

(2) medullary : extend through the entire medulla,

lying ventrally & medially near midline.

function antagonistically to each other,

pontine exciting the antigravity muscles

medullary relaxing these muscles.
Function in association with pontine reticular nuclei to control
antigravity M.
Transmit strong excitatory signals to antigravity M by way
of lateral & medial vestibulospinal tracts in anterior columns
of SC .
Without this support of vestibular nuclei, pontine reticular
system would lose much of its excitation of axial antigravity
M.
Specific role of vestibular nuclei,, is to selectively control
excitatory signals to the different antigravity M to maintain
equilibrium in response to signals from vestibular apparatus.
Destruction of vestibular apparatus, & even after loss of
most proprioceptive information , a person can still use
visual mechanisms reasonably effectively for maintaining
quilibrium.
Slight linear or rotational movement of the body
instantaneously shifts visual images on retina, & this
information is relayed to the equilibrium centers.
Bilateral destruction of the vestibular apparatus have normal
equilibrium as long as eyes are open and all motions are
performed slowly.
But when moving rapidly or when eyes are closed,
equilibrium is immediately lost.
Most of vestibular N fibers terminate in brain stem in vestibular nuclei,
at junction of medulla & pons.
Some fibers pass directly to brain stem reticular nuclei without synapsing &
also to cerebellar fastigial, uvular, and flocculonodular lobe nuclei.
Fibers that end in brain stem vestibular nuclei synapse with second-
order neurons that send fibers into cerebellum, vestibulospinal tracts, MLF,
& reticular nuclei.
Primary pathway for equilibrium reflexes begins in vestibular nerves,
where the nerves are excited by the vestibular apparatus.
The pathway then passes to the vestibular nuclei & cerebellum.
Next, signals are sent into reticular nuclei of brain stem, as well as down
the SC by way of vestibulospinal & reticulospinal tracts.
That control interplay between facilitation & inhibition of many antigravity
M , thus automatically controlling equilibrium.
Flo c c ulo no dular lobe s of ce re be llum a re e s pe cia lly conce rne d
with dyna mic e quilibrium s igna ls from s e micircula r ducts .

De s truction of the s e lobe s re s ults in s a me clinica l s ymptoms a s

de s truction of s e mic irc ular ducts ( los s of dyna mic e quilibrium
during ra pid cha nge s in dire ction of motion ) .

Uvula of ce re be llum pla ys a role in s tatic e quilibrium.

S igna ls tra ns mitte d upwa rd in bra in s te m from both ve s tibula r nucle i
& ce re be llum by wa y of MLF ca us e c o rre c tive move me nts of the
e ye s e ve ry time the he a d rota te s , s o tha t the e ye s re ma in fixe d on a
s pe cific vis ua l obje ct.
S igna ls a ls o pa s s upwa rd to ce re bra l corte x, te rmina ting in a
primary c o rtic al c e nte r fo r e quilibrium in pa rie ta l lobe de e p in
the s ylvia n fis s ure on oppos ite s ide of the fis s ure from the a uditory
a re a of s upe rior te mpora l gyrus .
The s e s igna ls a ppris e the ps yche of e quilibrium s ta tus of the body.
A ba by is born without bra in s tructure s a bove me s e nce pha lic
re gion ( ane nc e phaly ).
S ome ha ve be e n ke pt alive for ma ny months .
The y a re a ble to pe rform s ome s te re otype d move me nts for
fe e ding, s uch a s s uckling, e xtrus ion of unple a s a nt food from
mouth, & moving ha nds to the mouth to s uck finge rs .
The y ca n ya wn & s tre tch. The y ca n cry a nd follow obje cts with
move me nts of e ye s a nd he a d. Als o, pla cing pre s s ure on the
uppe r a nte rior pa rts of the ir le gs ca us e s the m to pull to the s itting
pos ition.