MOTOR SYSTEM

Part 2
PG- Ophthalmology
22 7 2018

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 Contents
• Nervous system structures in involved in body
movements
• Integration of motor activity in the body
– Cerebral cortical level
– Sub-cortical / Brainstem level
– Spinal level
• The descending pathways that modify the
output of the spinal /cranial motor neuron
• The effects of lesions at various levels of the
motor hierarchy
 CNS intergration
1

2 3

4 5
Different level of integration of motor activity
in the body- hierarchical nature
– Cerebral cortical level
• motor cortical regions in planning and execution
of voluntary activity
– Sub-cortical level/brainstem
• Cerebellum in coordinating and planning
movements
• basal ganglia in the planning and execution of
motor patterns
• Brainstem nuclei maintain tone of muscle
– Spinal level
-spinal reflexes in movements/postural control
• Two major descending pathways
1. Posture/balance (gross movements)
– Proximal/axial muscles
• ventral corticospinal tract
• medial brain stem pathways (tectospinal,
reticulospinal, and vestibulospinal tracts)

2. Skilled voluntary movements (fine movements)

distal limb muscles
lateral corticospinal
lateral brainstem pathway ( rubrospinal)
 Functional levels
• Lower/Spinal Level
– Simple Reflexes

• Upper Levels
– Initiation, Inhibition or Facilitation of Motor
Functions
– Voluntary Motor Movements

Upper level regulate lower level

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 Voluntary movement
• Fine skilled movements

• Carried out by the cerebral cortex at top

with several CNS integration sites (i.e.
basal ganglia, cerebellum, etc)
• Can be initiated with no external stimuli
Motor system organization and the
components

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Organization of CNS
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2 3

4 11
Regions of the Brain divided by Function

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 Primary Motor cortex- ( Muscle Control)

• In the Precentral and paracentral gyrus (frontal lobe).

• Arrange Somatotopically
The arrangement is upside-down (head below,
feet above)
• Control contralateral side of the body

• Have many more motor nerves in face and hand than

others. (represented as functional basis )
• A drawing of the body parts represented in the
postcentral gyrus, scaled to show area, is called a
motor homunculus
• Face represented bilaterally
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Motor Homunculus

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Control of voluntary Movement
 Motor system-organization cont.
1.Plan -cerebral cortex, basal ganglia,cerebellum

2.Relay -brain stem ,spinal cord through alpha /

gamma motor neuron

Transmission - Motor tracts

a.cortical tracts-fine (skilled movements)
b.brainstem tracts
(posture, balance and maintain muscle tone)

Effectors - muscles
Sensory/ feed back -Proprioception
-Muscle spindle 17
-Vision/vestibular
 MOTOR Motor1.Cerebral cortex
• Generates the idea for voluntary movements.
• Issues motor commands via corticospinal and
• corticobulbar tracts.
• Several motor areas are present in cerebral cortex
Primary motor area
Supplementary motor area
Premotor area
Posterior parietal cortex

Primary motor area

Body parts represented in the precentral gyrus
facial area is represented bilaterally, but the rest of
the representation is generally unilateral
control the musculature on the opposite side of the 18
body
 Supplementary motor area
– Most fibers project to to the motor cortex.
– This region also contains a map of the body,
but it is less precise than in M1.
– involved primarily in organizing or planning
motor sequences

Premotor area
– also contains a somatotopic map
– receives input from sensory regions of the
parietal cortex and projects to M1,spinal
cord,brain stem reticular formation.
– involved in control of proximal limb muscles
needed to orient the body for movement. 19
 Posterior parietal cortex
• Provide fibers for corticospinal &
corticobulbar tracts
• Involve in
– executing learned sequences of
movements such as eating with a knife and
fork.
– aiming the hands toward an object and
manipulating it
– concerned with hand–eye coordination.
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 2. Basal ganglia

• Consists of caudate nucleus, putamen, globus

pallidus, subthalamic nucleus, and substantia
nigra

• Maintain background motor activity for

postural support for the movement

• involved in the planning and programming of

movement

• also play a role in some cognitive processes

and language production 21
 3.Cerebellum
• Compare motor plan with performance
• Coordination of movement (rate, range,
force, and direction of movement)
• Afferent via spinocerebellar/olivocerebellar
• Help in motor learning/programming
(i.e. when a given task is performed over and
over motor task is learned and activity in the
brain shifts from the prefrontal areas to the
parietal and motor cortex and the cerebellum.

• balance of the body and eye movement

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 4.Brain stem

• Major relay station for all motor commands

except fine movements through extra
pyramidal pathways

• Maintain normal body posture during motor

activity via brainstem pathways

• Maintain muscle tone

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5. Spinal cord
common pathway for descending/ascending tracts
Final relay station for descending motor tracts
Contains lower motor neurons

6. Receptors
Provides sensory feedback.
Spatial orientation is dependent on input from
vestibular receptors, visual cues, proprioceptors
in joint capsules, and cutaneous touch and
pressure receptors.
 CONTROL OF MOVEMENT –motor tracts
Two pathways:
1.Cortical motor pathways
• They are corticospinal (also called pyramidal
system) and corticobulbar tracts
• Fine movemnts in distal muscles
2.Brain stem pathways (also called extra-
pyramidal tracts
• importance for posture/balance (proximal
muscles)
• Originate in the brainstem
• E.g. reticulospinal, vestibulospinal, tectospinal,
rubrospinal.
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Descending corticospinal
motor tracts

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Descending corticospinal
motor tracts

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 Descending /motor tracts in cerebral cortex

Pyramidal Motor pathway

Corona radiata

Internal capsule

Motor decussation in medulla oblongata

Corticospinal tracts
Lateral corticospinal tract
Anterior corticospinal tract
(travel with brain stem pathways)
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 Origin of corticospinal tracts

1.Primary motor cortex (M1- Brodmann's area 4)

• Precentral gyrus and rostral part of paracentral lobules.
• Arises both corticobulabr/corticospinal tracts (31% of C.S)
• Organized somatotopically. i.e. feet at the top of the gyrus &
face at the bottom.

2.Area 6,8 – premotor and supplementary

• 29% of corticospinal arises (coordinate proximal/axial muscles.
• Supplementary motor area on the motor surface of the area 6.
• Generate the plan for motion.

3.Somatic sensory area

• Parietal lobe (Brodmann's area 5, 7) and primary
• somatosensory area (1, 2 & 3 areas) constitute 40% of
C.S.fibers. 30
 INTERNAL CAPSULE
I/ Afferent and efferent fibers from all parts of
the cerebral cortex converge towards
brainstem forming corona radiata.

II/ In diencephalons fibres form the internal

capsule – i.e. A broad compact band
separating lenticular nucleus laterally from
the caudate nucleus & thalamus medially

III/. V SHAPED
Anterior limb, Genu, Posterior limb 31
Internal capsule
 THE INTERNAL CAPSULE

Descending fibers of cortical fibers:

Grouped together at the Genu and
anterior 2/3rd of posterior limb.
Genu:
Cortico bulbar for the movement of the
muscles of the head.
Anterior limb:
Fibers passing from & to the frontal lobe.
Posterior part of the posterior limb:
Sensory fibers from parietal lobe followed by
auditory and optic radiation.
 INTERNAL CAPSULE cont’

• The posterior limb of the internal capsule

contains corticospinal fibers and sensory
fibers from the body.
• The genu contains corticobulabar fibers
• A small lesion in the posterior limb of the
internal capsule results contralateral
hemiparesis/hemiplagia
• This is a type of decorticate rigidity
(Removal of the cerebral cortex)
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Internal capsule fiber arrangement
 INTERNAL CAPSULE cont’

• Due to hemorrhages or thromboses in the

internal capsule (stroke/CVA)
• the small arteries in the internal capsule are
especially prone to rupture or thrombotic
obstruction
• this type of decorticate rigidity very common
• 60%intracerebral hemorrhages in internal
capsule, 10% in the cerebral cortex, 10% in
the pons, 10% in the thalamus, and 10% in the
cerebellum.
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 Stroke/CVA
• The signs and symptoms due to interruption of
blood supply to a part of the brain resulting
ischemia damages or cell death in the area
• Two general types: hemorrhagic & ischemic.
Hemorrhagic stroke due to cerebral artery or
arteriole ruptures
• Ischemic stroke due to reduce blood flow
( thrombi)
• Lacunar stroke - small subcortical infarcts in the
territory of the deep penetrating arteries)
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 Upper motor neurons
A common name given to all the descending
motor tracts coming down from brain/ brain
stem and synapse with cranial and spinal motor
neurons
1.Cortical pathway-Pyramidal pathway
2.Brain stem pathway –extra pyramidal pathway

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 Upper motor neurons cont’
1. Cortical pathways
Motor neurons are in cerebral cortex

i. Cortico-spinal: motor cortex to spinal

nerves
ii. Corticobulbar: synapse with motor cranial
nerves in brainstem

( responsible for fine voluntary movements)

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 Upper motor neurons cont’
2. Brain stem pathway

Motor neurons are in thebrain stem

Important for posture and balance
Also called extra-pyramidal tracts

Two pathways-Medial and lateral brain

stem pathways
Medial brain stem pathways
lateral brain stem pathways 41
 2. Brain stem pathway cont’
Medial brain stem pathways
– Tectospinal – Superior Colliculus to lower motor
neurons. Involuntary correction of head to visual
stimuli
– Vestibulospinal: vestibular nuclei- responsible for
adjusting posture to maintain balance.
– Reticulospinal: reticular formation – balance

lateral brain stem pathways

– Rubrospinal: red nucleus to LMN

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. Corticospinal tracts

Lateral corticospinal tract

80% of fibers in pyramidal tract cross in medulla
End directly on motor neurones.
Responsible for control of distal muscles and fine
and skilled movements (Fingers, Toes, Forearm)

Ventral or anterior corticospinal tract

20% remaining fibers that do not cross
Mainly concern with a proximal muscles and for
posture (Control Axial and Girdle Muscles)

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 Corticospinal tracts
• Descending motor commands
– Cell body in cerebral cortex
– Axon descends through
• internal capsule
• cerebral peduncle,
• pyramids of the medulla, where it
crosses the midline (most) to form the lateral
corticospinal tract
OR
• doesn’t cross (some) to form the anterior
corticospinal tract (probably cross right before
synapsing) 44
 Corticobulbar Tract

• Axons that are homologous to corticospinal

fibers, but terminate in the motor nuclei of
cranial nerves in the brain stem
• Thus, they are the axons of the upper motor
neurons that synapse on the lower motor
neurons of the cranial nerves.
• The corticobulbar fibers accompany the
corticospinal axons through the internal capsule
and gradually leave to terminate in the different
cranial nuclei.
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 Examples for corticobulbar tracts and
their innervations
• facial muscles; bilateral input to motor neurons
controlling muscles in upper face, but contralateral
input to motor neurons controlling lower face
• muscles of mastication: motor to trigeminal
• Tongue muscles: hypoglossal
• control over swallowing reflexes & articulation
 Corticobulbar Tract con’t
• The lower motor neurons of the brain stem receive
bilateral corticobulbar input.
• Therefore, unilateral corticobulbar tract lesions usually
produce no clinical effect on head and neck muscles
with two exceptions:
• Facial nucleus (VII):
The neurons that innervate the muscles of the lower face
(below the forehead) receive mainly crossed input from
the opposite motor cortex.

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All theses descending tracts (cortical and extra-
pyramidal brainstem tracts) are called “upper
motor neuron”
• They have different functions in controlling
the muscles
• For example when you are writing while
sitting on a chair.
• Cortical pathways are importance for writing
• Extrapyramidal/brain stem pathways are
importance for maintaining balance and
posture in sitting position (trunk and leg
muscles)
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• Upper motor neurons cont;

Lesions :
Above motor decussation – Sings &
symptoms on the opposite side of the body.
• Below the crossing – Ipsilateral, same side.

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 Signs of lesion to brain stem pathways
(extra-pyramidal tracts)`
1. spasticity
2. Clasp knife rigidity
3. clonus)
4. exaggerated muscle reflex

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Signs of lesion to the pyramidal tracts
• Positive Babinski sign (extensor planter
response). Great toe & other toes fan outward
(extension) in response to scratching the skin
along the lateral aspect of the sole of the foot.
– The normal response is plantar flexion of all toes.
• Absent superficial abdominal reflexes. The
abdominal muscles fail to contract when the
skin of the abdomen is scratched.
• Absent cremasteric reflex.. The cremaster
muscle fails to contract when the skin on the
medial side of the thigh is stroked.
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• In summary, a lesion involving all of the
corticospinal and corticobulbar fibers from
the left cerebral cortex produces following
motor defects.
1.Muscle paralysis
• Right hemiparesis/heiplegia (weakness of
the right upper and lower limbs).
• Weakness of the right face below the
forehead.
• Deviation of the tongue to the right upon
protrusion.
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 Lower motor neuron (LMN)

• Lower motor neurons are neurons that

directly innervate skeletal muscle.
• The cell bodies of these neurons are
located within the ventral horns of the
spinal cord or within brainstem motor
nuclei.

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 Lower motor neuron (LMN)

This include
I. Spinal motor neuron - alpha motor neuron
– Cell body in anterior horn of spinal cord
– Axon leaves through anterior roots to innervate muscle

2.Cranial nerve innervating muscles

- all motor cranial nerves

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 Lower motor neuron (LMN)
 Cell body in anterior horn of spinal cord/motor
nuclei of C.N.

 Axon leaves through anterior roots /motor cranial

nerves to innervate muscle

 Final Path for Efferent Impulses

 Final Common Pathway to Muscles

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 LMN cont’
LMN is Influenced by
• cortical tracts
• brain stem pathways
• Muscle spindle

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 Upper Motor Neuron
(UMN)

• Corticospinal tracts (Pyramidal tracts)

• Corticobulbar tracts (for cranial nerves)
• Brain stem tracts

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Upper motor neuron and muscle spindle
• Even during at rest muscle is partially contracted
due to continuously stimulating the muscle
spindle resulting tone in the muscle
• Reflex arc maintain tone of the muscle at rest
• In lower motor neuron damage reflex arc
interrupted and loss of muscle spindle activity
results loss of tone (hypotonia)
• Upper motor neuron keep inhibiting muscle
spindle through gamma motor neuron.
• When upper motor neurons damage muscle
spindle release from inhibition and become
hyperactive leading to hypertonic muscles

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 Upper motor neurons and gamma
motor neuron
• Higher centers in brain usually exert an
inhibition on g efferent.

• When g efferent is release from higher

centers like in upper motor neuron
lesions discharge rate will be increases
causing increased muscle spindle
sensitivity to stretch (exaggeration of tone
and reflexes)
 Signs & symptoms of UMN lesions
(damage to pyramidal & extrapyramidal)

• Spastic paralysis or paresis of movement

• Increase of tone ( spasticity or hypertonia)
• Increased tendon reflexes
• Loss of superficial abdominal reflexes.
• Extensor planter reflex –( Babinski sign)
• Clonus- a sustained series of rhythmic jerks in
a muscle
• No atrophy of muscle
• Normal electrical excitation and conduction in
peripheral nerves
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 Spastic paralysis
• an increase in muscle tone with an
associated inability to voluntarily control
the muscle
• Rigidity is the spasticity of both agonist
and antagonist (in parkinson disease)

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 Knee reflex

Normal Hyperreflexia

Exaggerated response 62
Plantar Reflex
 Signs & symptoms of LMN lesions
(Damage to anterior horn cell , ventral root or
peripheral nerve)
• Localized flaccid paralysis
• Muscle atrophy /wasting (reduce muscle bulk)
due to lack of innervation
• Absence of reflexes/Loss of tone / Hypotonia
• Fasciculations (spontanteous, irregular muscle
twitching)
• Change in electrical excitability – Fibrillation
potentials
• Electrophysiological evidence of denervation &
impaired nerve conduction.
• Trophic changes 64
 Trophic changes
• Loss of sweating (Anhydrosis)
• Skin dry, wrinkled and shiny
• Loss of hair
• Destruction of nails
• Injuries/ulcers in the skin

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• References
• Ganong 24e

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