PHYSIOLOGY BLOCK 1

Lecture: 8 – Reflexes (Spinal Cord) Date: August 12, 2015

Lecturer: Antonio C. Pasco III, MD, FPSP Trans Team: Advincula, Agapito, Agregado, Alilaen

Topic Outline Note: At the receptor and in the CNS a nonpropagated

I. Objectives graded response occurs that is proportional to the
magnitude of the stimulus. The response at the
II. Introduction
A. Reflex neuromuscular junction is also graded, though under
B. Reflex Arc normal conditions it is always large enough to produce a
C. Bell-Magendie Law response in skeletal muscle. On the other hand, afferent
D. Two Types of Motor Fibers and efferent nerve fibers responses are all-or-none action
E. Three Types of Sensory Fibers potentials.
III. Central Delay vs. Reaction Time
IV. Muscle Sensory Receptors
A. Muscle Spindle C. Bell-Magendie Law
B. Golgi Tendon Organ  In spinal cord:
V. Types of Reflexes  Anterior (Ventral) Spinal Nerve Roots – motor fibers
A. Monosynaptic reflex only
a. Stretch reflex  Posterior (Dorsal) Spinal Nerve Roots – sensory
B. Polysynaptic reflexes
fibers only
a. Golgi Tendon Reflex
b. Flexor/Flexion Reflex  Nerve impulses are conducted in only one direction
C. Other Classification of Reflexes in either case
VI. References
VII. Review Questions D. Two types of Motor (Efferent) Fibers
VIII. Quiz i. Alpha (type Aα)
 Larger, branching, innervates entire motor units
LEGEND  Innervates extrafusal fibers
PPT Trans Audio Trans Book Trans  Causes direct muscle contraction: Whole muscle
contraction
I. Objectives
 Influenced by muscle spindle afferents
 Summarize what a reflex is, its components, and its ii. Gamma (type Aγ)
properties  Smaller, innervates middle of the muscle spindle
 Differentiate a monosynaptic from a polysynaptic reflex  Innervates intrafusal fibers
 Illustrate the functional anatomy and summarize the  Causes indirect muscle contraction: Ends of
function, response of the Muscle spindle and Golgi muscle spindle contract → whole muscle
tendon organ contraction
 Summarize then contrast the neuronal circuitry,  Influenced by higher centers
function, and importance of stretch reflex, inverse
myotatic reflex, flexor or withdrawal and crossed E. Three Types of Sensory (Afferent) Fibers
extensor reflex
i. Type Ia
II. Introduction
A. Reflex  Found in muscle spindle
 Simplest form of motor act controlled by the nervous  Relatively large diameter (fast conduction)
system ii. Type II
 Simple, rapid, automatic, involuntary relatively  Found in muscle spindle
stereotyped motor response to a specific type of  Relatively small diameter (slow conduction)
stimulus iii. Type Ib
 Involves coordination of muscles and neurons  Found in Golgi tendon organ
 Reflex Properties  Relatively large diameter (fast conduction)
 Requires stimulation from “adequate” stimulus III. Central Delay vs. Reaction Time
(Differential sensitivity)  Central Delay
 Stimulus may be mechanical, chemical, thermal etc.  Time taken for reflex activity to traverse the spinal
cord
 Simple & quick
 Depends on neurotransmission
 Involuntary (it doesn’t reach the cerebral cortex)
 Shorter: Ex. 0.6 – 0.9ms (knee jerk reflex)
 Relatively stereotype, but modifiable
 Reaction Time
B. Reflex Arc  Time between the application of the stimulus and the
visible manifestation of the response
 Depends on:
o length and velocity of afferent and efferent fibers
o Number of synapses
 Longer: Ex. 19-24ms (stretch reflex)
IV. Muscle Sensory Receptors
- Provides sensory information to the spinal cord regarding
the functional status of the muscle at each instant

Figure 1. Reflex arc

 Basic unit of integrated reflex activity

 Consists of:
Stimulus → Receptor (Sense organ) → Afferent
neuron (Sensory) → Synapses within a central
integrating station → Efferent neuron (Motor) →
Effector Organ → Response
 Integrating center: Spinal cord (gray matter)

Figure 2. Innervations of two muscle sensory receptors –

the muscle spindle and Golgi tendon organ

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A. Muscle Spindle (a.k.a. neuromuscular spindle)
Figure 3. Muscle spindle and intrafusal fiber
 Thin, spindle-shaped modified muscle fibers (3-10mm)
enclosed in a capsule
 Receptor for stretch reflex
 Detects muscle length or rate of change in length
 Receives both sensory (type Ia and type II) and motor
(type Aγ) innervation
 Main components:
1) Intrafusal fibers
o About 3-12 narrow, less striated muscle fibers
o Parallel arrangement with extrafusal fibers
(regular contractile units of the muscle)
Figure 4. Muscle spindle showing its relation to the
large extrafusal skeletal muscle fibers
o Central region
 Without actin and myosin
 Does not contract
 Functions as sensory receptor (innervated by
afferent nerve fibers)
o Ends
 With contractile proteins (with actin and
myosin)
 Pointed and attached to muscle
o Two types:
i. Nuclear bag fibers: more sensitive to
dynamic response (contains both primary
and secondary nerve endings) and nuclei
are arranged in clusters in the central
region of the fiber
ii. Nuclear chain fibers: more sensitive to
static response (contains only secondary
nerve ending) and nuclei are arranged in a
straight line
Figure 5. Nuclear bag and Nuclear chain fibers
2) Afferent sensory endings
o Innervates the muscle spindles
o Two types:
i. Primary Ending/Annulospiral Endings
 Group Ia afferent fibers
 Sensitive to both stretch length (static
response) and changes in the rate of
stretch or length (dynamic response)
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BLOCK 1
ii. Secondary Ending/Flower Spray Endings
 Group II afferent fibers
 Respond to the amount of stretch length
only (absolute length)
 Static response only (ensures
continuation of afferent discharge)
3) Efferent motor endings (gamma fibers)
o Motor supply of muscle spindles
o Two types of gamma efferent fibers:
i. Dynamic/gamma-d/plate endings
 Found on nuclear bag fibers
 Shortening of contractile ends of
intrafusal fibers → stretches nuclear bag
region → intiating impulses in sensory
fibers
 Function: enhances dynamic response
ii. Static/gamma-s/trail endings
 Found on nuclear chain fibers
 Function: enhances static response
o Effect:
 Cause ends of muscle spindle to shorten,
elongate the center region, excites afferents
(Indirect muscle contraction)
 Prevents unloading of muscle spindles
(stimulation usually comes from higher
center not the muscle spindle afferents)
o Control:
 Descending tracts from higher centers
(bulboreticular facilitatory region of brain
stem → adjust sensitivity of muscle
spindles to need of postural changes
 Coactivation: gamma motor neurons are
usually stimulated simultaneously when
alpha motor neurons are stimulated →
simultaneous contraction of the extra- and
intrafusal fibers
 Coactivation keeps the muscle spindle
reflex from opposing muscle contraction by
maintaining length of the receptor portion of
muscle spindles constant when the muscle
contracts; also maintains damping function
 Jendrassik’s maneuver: Trying to pull the
hands apart when the flexed fingers are
hooked together facilitates the knee jerk
reflex due to the increased gamma-motor
neuron discharge initiated by afferent
impulses from the hands
Note: Response of the Muscle Spindle
 Static response
 Slow stretch of muscle spindle receptor
 Number of impulses proportional to degree of
stretch
 Both primary and secondary endings activated
 Detects length of muscle
 Dynamic response
 Sudden increase in length of spindle receptor
 Only primary ending activated
 Detects rate of change in length
Note: Discharge of Muscle Spindle
 There is continuous discharge of the muscle spindle
under normal conditions
 Positive signals: Increased rate of firing with stretching
 Either of the whole muscle or just the muscle
spindle
 Activates sensory endings at frequency
proportional to degree of stretching (“loading the
spindle”)
 Negative signals: Decreased rate of firing with
shortening
 Spindle afferents decrease rate of firing when
muscle contracts (“unloading the spindle”)
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 Neuronal circuitry of reflex arc:

 Stimulus = stretch of muscle
 Receptor = muscle spindle
 Afferent limb =
o Type Ia (dynamic phase)
o Type Ia and Type II (static phase)
 Integrating center = spinal cord
 Neurotransmitter = glutamate
 Efferent limb = alpha motor neuron
 Effector = skeletal muscle
 Response = contraction of stretched muscle
 Parts:
 Dynamic Phase
o Period during which muscle length is
changing
o Rapid stretch
o Instantaneous strong reflex contraction
o Opposes sudden changes in muscle length
o Over within a fraction of a second
 Static or Steady State Phase
o When muscle has stabilized at new length
o Weaker
o Continuous for a prolonged period
o Maintains constant degree of muscle
contraction (muscle tone)
 Functions:
Figure 6. Muscle fiber discharge under various conditions  Key reflex in maintaining posture
 Helps avert injury by preventing
B. Golgi Tendon Organ overstretching of the muscle
 Stabilize body position during tense motor
action
o Activation by the higher center of spindles
at both sides of a joint, exciting the
skeletal muscles producing tense muscles
opposing each other → stabilize joint
 Damping function
o A.k.a. Signal averaging function
o Prevents oscillations or jerkiness of
Figure 7. Golgi tendon organ movement (smoothing function)

 Mechanoreceptors for inverse myotactic (stretch) reflex Note: Reciprocal Innervation and Inhibition
 Detects the tendon tension or rate in change of tension  When a stretch reflex occurs, the muscles that
 Terminals of group Ib afferent fibers wrapped about antagonize the action of the muscle involved
bundles of collagen fibers in tendon of muscle (antagonists) relax
 Arranged/connected in series between extrafusal muscle  Impulses in the Ia fibers from the muscle spindles
fibers and tendon of the agonist/protagonist muscle cause
 Activated by muscle stretch (strong) or contraction (more postsynaptic inhibition of the antagonist muscle
effective) motor neurons
 Function:  A collateral from each Ia fiber passes in the
 Provides nervous system instantaneous info of the spinal cord to an inhibitory interneuron that
degree of tension in muscle synapses on a motor neuron supplying the
antagonist muscles
 Detect and respond to changes in muscle tension
caused by passive stretch or muscle contraction
B. Polysynaptic Reflex
 Monitors force in tendon
 Helps control muscle tone
 Protects against excessive tension
 Responses:
 Dynamic (Rate of change in tension)
 Static (Steady firing from muscle tension)

V. Types of Reflexes
A. Monosynaptic Reflex
 Simplest reflex arc
 Single synapse between the afferent and efferent Figure 9. Polysynaptic reflex
neurons
a) Stretch Reflex  Reflex arcs in which interneurons are interposed
 (“what you see is what you contract”) between the afferent and efferent neurons
 Most studied of the reflexes  Almost all reflex arcs are polysynaptic
 Examples:  Interneurons:
 Knee jerk, ankle jerk  In dorsal horns, anterior horns and
intermediate areas between them
 Small, highly excitable
 Exhibits spontaneous activity
 Capable of firing rapidly
 Synapse directly with anterior motor neurons
 Can be either inhibitory or excitatory

Figure 8. Neuronal circuit of stretch reflex

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a) Golgi Tendon Reflex  Importance:

 Myotatic or Inverse stretch reflex
 Autogenic inhibition
Figure 10. Neuronal circuit of Golgi tendon reflex
 Neuronal circuitry:
 Stimulus = muscle tension (force on the
tendon)
 Receptor = Golgi tendon organ
 Afferent limb = type Ib afferents
 Integrating center = spinal cord
 Efferent limb = alpha motor neuron
(inhibition)
 Effector = skeletal muscle
 Response = muscle relaxation of the
muscle that develops excessive tension
 Functions:
 Negative feedback mechanism to control
too much muscle tension or stretch by
causing muscular relaxation (lengthening
reaction)
 Protects the tendon (avulsion of
attachments from the bone) and muscle
(tearing) from damage due to excessive
tension
 Equalization of forces in muscle fibers
o Spreading load all over the muscle
prevents damage in isolated areas
 Complementary action on muscle spindle
o Coordinated reflex change
maintenance of posture
 Survival value (Sherrington)
o Flexion of irritated part gets it away from source
of irritation
o Puts the animal away in a position to run away
from offending stimulus
 Characteristics:
 Pre-potent
 Pattern depends on sensory input
o Weak = minimal & quick flexion
o Strong = greater flexion & prolonged flexion
(irradiation of stimulus and recruitment of motor
units)
 Increase in strength of noxious stimuli = shorter
reaction time
 Branches with fewer no. of synapses reach motor
neuron first
 Pattern depends on location of stimulus (local sign)
 Part of this reflex is the crossed-extensor response or
reflex
Crossed Extensor Reflex
 When the stimulus is strong, aside from flexion and
withdrawal from the stimulus there will also be
extension of the opposite limb (Double reciprocal
inhibition)
 0.2 to 0.5 seconds after the flexor reflex pushes the
entire body away from the painful stimulus
Figure 12. Flexor reflex, crossed extensor reflex and
in reciprocal inhibition
Note:
 Reciprocal inhibition: inhibition of an antagonist
muscle ipsilateral (on the same side of the body)
to the protagonist muscle
 Double reciprocal inhibition: inhibition of a muscle
contralateral (on the opposite side of the body) to
the protagonist

 Afterdischarge:
 Results from repetitive discharge circuits
o Immediate afterdischarge: Repetitive firing of
excited interneurons (immediately within 6-8 ms)
Figure 11. Pathway of stretch and inverse stretch reflex o Prolonged afterdischarge: Reverberating circuits
(strong pain = longer afterdischarge)
b) Flexor or Flexion Reflex o Allows the reflex to hold the irritated part away
 Neuronal circuitry: from the stimulus after the irritation is over. This
 Stimulus = pain noxious gives time for other actions of the CNS to move
the entire body away from the painful stimulus
 Receptor = pain receptors (free nerve
endings, thermoreceptors,
mechanoreceptors)
 Afferent limb = flexion reflex afferents
o Cold and pain: Type aδ or group III
o Warm & itch: Type C or group IV
o Merkel’s, Pacinian, Meissner’s, Ruffnini’s:
type aβ or group II
 Integrating center = spinal cord, Figure 13. After discharge
polysynaptic
 Efferent limb = alpha motor neuron C. Other Classification of Reflexes
 Effector = flexor muscles  Whether inborn or acquired
 Response = flexion of limb away from  Location of the center
painful stimulus  Purpose/functional significance
 No. of synapses
Withdrawal Reflex
 Clinical basis
 Most powerful of flexion reflex
 Noxious painful stimulus results in flexor muscle
contraction and inhibition of extensor muscles
 Limb (or other areas) stimulated is flexed (or more
complex actions) and withdrawn from the stimulus
 Functions to protect the limb from further damage

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Additional info:
1. Scratch Reflex
 Cord reflex in some animals
 Initiated by itch and tickle sensation
 Functions:
o Position sense – allows paw to find exact
location of irritation due to the high
sensitivity
o To-and-fro movement – involves
reciprocal innervation circuits that cause
oscillation
2. Spinal Cord Reflexes That Cause Muscle Spasms
 Broken bones
o Results from pain impulses initiated from
the broken edges of the bone -> causes
muscles to contract tonically
 Peritonitis (inflammation of serosal
membrane[lines abdominal cavity])
o Results from irritation of parietal
peritoneum
o Relief of pain caused by peritonitis allows
muscle spasms to relax
 Muscle Cramps
o Caused by any local irritating factor or
abnormal metabolic activity
o Muscle contractions stimulate sensory
receptors even more -> causes spinal cord
to cause intensity of contraction
3. Autonomic Reflexes in the Spinal Cord
 Ex.:
o Changes in vascular tone -> changes from
local skin heat
o Sweating -> localized heat from surface of
body
o Intestinointestinal reflexes (control some
motor functions of gut)
o Peritoneointestinal reflexes – inhibits
gastrointestinal mobility due to
peritoneal irritation
o Evacuation reflexes (emptying of bladder
or colon)
4. Spinal Cord Transection and Spinal Shock
 Spinal shock – when cord reflexes becomes
depressed to the point of total silence
 Affected spinal actions:
o Artrial blood pressure drastically falls in
an instant
o Blockage of skeletal muscle reflexes that
are integrated in the spinal cord
o Suppression of sacral reflexes (control of
bladder and colon evacuation)
o 2. If the reaction time depends number of synapses on
VI. References
 Sir Pasco’s lecture
 Guyton’s Medical Physiology (13th edition) Chapter 55
 Ganong’s Review of Medical Physiology (24 th edition)
VII. Review Questions
1. Deep tendon reflexes
 Ankle jerk, biceps, triceps, wrist reflex
 Knee jerk or patellar reflex
 Grade
o 0 (absent)
o 1+ (hypoactive)
o 2+ (brisk, normal)
o 3+ (hyperactive without clonus)
o 4+ (hyperactive with mild clonus)
o 5+ (hyperactive with sustained clonus)
 Determine the background excitation influence from
the brain to the spinal cord
 Assess spinal cord function
 Assess degree of facilitation of alpha motor neuron
o Absence or abrogation of reflex (abnormality within
reflex arc: muscle spindle, afferent, efferent)
o Hyperactive or exaggerated (interruption of
corticospinal tract)
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2. Flaccid Paralysis/Hypotonic Muscle
 Joint offers no resistance to passive movement
 Loss of muscle stretch reflex (areflexia)
 Low rate of gamma motor neuron discharge
3. Spastic Paralysis/Hypertonic Muscle
 Increased joint resistance when bent
 Increased muscle tone
 Positive clonus
 Clasp-knife effect (sequence of resistance is followed
by a give when limb is moved passively; named
because of similarity to closing a pocket knife)
4. Clonus
 Alternating contraction of agonist and antagonist
muscles around a joint after quick passive flexion of
joint
 Increased gamma motor neuron discharge
 Regular repetitive rhythmic contractions of a muscle
subjected to sudden, maintained stretch
o E.g. ankle clonus
 Hyperactive spindles
 Disruption of descending cortical input to
Renshaw cells (spinal glycinergic inhibitory
interneuron)
 Inhibition of antagonist muscles is absent
5. Decerebration
 Transecting midbrain at collicular level
 Interruption of descending pathways from cortex but
from the brainstem still intact
 Change in balance of excitatory and inhibitory control
system
o Stretch reflex is exaggerated
 Decerebrate rigidity ("exaggerated standing")
6. Explain this Result
Figure 14. Result of flexor contraction
 While a flexor reflex is elicited in one limb, a stronger
flexor reflex is elicited at the opposite limb
VIII. QUIZ
1. Fill in the blanks. Reflex arc consists of stimulus,
receptor, _______, CNS , efferent neuron and _______
length and velocity of afferent and efferent fibers, the
central delay solely dependent on?
3. What is the receptor for stretch reflex?
4. A type of intrafusal fiber which is more sensitive to static
response?
5. It is a monosynaptic reflex that is most studied of the
reflexes and examples are knee jerk, ankle jerk
6. Also known as inverse stretch reflex that protects the
muscle and the tendon from tearing from excessive
tension
7. Most powerful of flexion reflex that results in flexor
muscle contraction and inhibition of extensor muscles
when noxious painful stimulus is applied
Answers:
1. Afferent neuron, response
2. Neurotransmission
3. Muscle spindle
4. Nuclear chain fibers
5. Stretch Reflex
6. Golgi Tendon Reflex
7. Withdrawal Reflex