DERMATOME

PARESIS
Definition: weakness of voluntary movement, or partial loss of voluntary movement atau impaired movement.
Types (LIMBS)
- Monoparesis : one leg or one arm
- Paraparesis : both leg
- Hemiparesis : one arm and one leg on either side of the body
- Triparesis : 3 limbs
- Double hemiparesis : all 4 limbs. Tapi one side of the body lebih affected
- Tetraparesis or quadriparesis : all 4 limbs equally affected
Types (OTHER)
- Gastroparesis : impaired stomach emptying
- Spastic paresis : exaggerated tendon reflexes and muscle hypertonia
- Ophthalmoparesis
- Vocal cord paresis

PARALYSIS
Definition: loss of muscle function for one or more muscle. Same as plegia. Can be accompanied by loss of feeling
(sensory loss) di affected area kalo ada sensory damage as well as motor.
Types:
- Monoplegia : one limb. Biasa masih bisa retain control over the rest of the body, tapi gabisa move or feel
sensations di affected limb.  leading cause: cerebral palsy
- Hemiplegia : one arm and one leg on either side of the body. Often begins with sensation of pins and
needles, progresses to muscle weakness, and escalates to complete paralysis.  leading cause: cerebral
palsy
 - Paraplegia : paralysis below the waist, affect both legs, the hips. Cannot walk, move legs, or feel
anything di bawah waist.  leading cause: spinal cord injury
- Quadriplegia / tetraplegia : paralysis below the neck. All 4 limbs as well as torso are typically affected. 
leading cause: spinal cord injury

SENSORY EXAMINATION
2 main afferent pathways:
- Spinothalamic: detect pain, temperature, and crude touch
- Dorsal columns: detect position (proprioception), vibration, and light touch
Five primary sensory modalities: light touch, pain, temperature, vibration, and joint position
1. Light touch
- Stimulating the skin with single, very gentle touches of the examiner’s finger atau dengan gumpalan kapas.
2. Pain
- Using a new pin (pin-prick)
3. Temperature
- Pake tabung reaksi yang diisi cold and warm water
4. Vibration
- Using a 128-Hz tuning form applied to distal phalanx of great toe or index finger just below nail bed.
- By placing a finger on opposite side of joint being tested, examiner compares patient’s threshold of vibration
perception of his or her own.
5. Joint position (proprioception)
- examiner menahan sendi proksimal jari tangan atau kaki, kemudian sendi distal digerakkan dan tanyakan
pasien kearah mana ujung jari tersebut digerakkan.

Stereognosis
- kemampuan untuk mempersepsikan bentuk dari suatu benda tanpa ada visual dan auditorik, jadi
informasinya cuman dari taktil.
- Prosedur: taruh objek kecil yang mudah dikenal (koin, kunci, korek api) di telapak tangan pasien dan tanyain
itu objeknya apa

Graphaesthesia
- Prosedur: pake ujung tumpul dari alat tulis (pensil atau pen) dan gerakin di telapak tangan pasien
membentuk huruf atau angka acak. Terus minta pasien sebut apa yang ditulis.

GIBBUS DEFORMITY
Definition: structural kyphosis biasa di upper lumbar and lower thoracic vertebrae, dimana vertebrae yang
berdekatan jadi kejepit
Gibbus most often develops in young children as result of spinal
tuberculosis dan result of collapse dari vertebral bodies.  spinal
cord compression causing paraplegia.
Causes:
- Pathological disease
- Hereditary
- Congenital conditions  achondroplasia
- Physical trauma (injury)
- Cretinism (childhood form of hypothyroidism)
- Mucopolysaccharidosis (MPS)
Gibbus deformity is marked by sharp angle

UPPER MOTOR NEURON

Main source of voluntary movement.
Found in the brain and carry motor information down the spinal cord  activate lower motor neurons (directly
signal muscles to contract)
Primary motor cortex of precentral gyrus (one of most important areas in frontal lobes). The pyramidal cells of
precentral gyrus also called upper motor neurons.
Fibers of UMN yang nembus keluar dari precentral gyrus ending in
brainstem, dimana dia bakal decussate within lower medulla oblongata to
form lateral corticospinal tract on each side of spinal cord. Fibers yang gak
decussate bakal pass thru medulla and continue to form anterior
corticospinal tracts. UMN descends in spinal cord.
UMN travels in several neuronal pathways thru CNS:
- Corticospinal tract: from motor cortex to LMN in ventral horn of
spinal cord  fine voluntary motor control of limbs
- Corticobulbar tract: from motor cortex to several nuclei di pons and
medulla oblongata  control of facial and jaw musculature,
swallowing, and tongue movements
- Colliculospinal tract (tectospinal tract): from superior colliculus to
LMN  involuntary adjustment of head position in response to
visual information
- Rubrospinal tract: from red nucleus to LMN  involuntary
adjustment of arm position in response to balance information,
support of body
- Vestibulospinal tract: from vestibular nuclei (processes stimuli from
semicircular canals)  adjusting posture to maintain balance
- Reticulospinal tract: from reticular formation  involuntary motor
activities and assists in balance

LOWER MOTOR NEURON

Motor neuron located in either the anterior grey column, anterior
nerve roots (spinal lower motor neurons) or the cranial nerve nuclei of
the brainstem, and cranial nerves with motor function (cranial nerve
LMN).
All voluntary movement relies on spinal LMN, which innervate skeletal
muscle fibers and act as a link between UMN and muscles.
Cranial nerve LMN control movements of eyes, face, and tongue, and
contribute to chewing, swallowing, and vocalization
Classifications  based on type of muscle fiber they innervate:
- Alpha motor neurons (α-MNs)  innervate extrafusal muscle
fibers: involved in muscle contraction
- Beta motor neurons (β-MNs)  innervate intrafusal fbers of
muscle spindles with collaterals to extrafusal fibers (type of
slow twitch fibers)
- Gamma motor neurons (γ-MNs)  innervate intrafusal muscle
fibers, which together with sensory afferents compose muscle spindles: sensing body position
(proprioception)

SENSORY AND MOTOR TRACTS OF SPINAL CORDS

Communication to and from the brain involves tracts:
- Ascending tracts: sensory  deliver information to
the brain
- Descending tracts: motor  deliver information to
the periphery

Sensory tract (ascending tract)

3 major sensory tracts:
- Posterior column tract
o Consist of:
 Fasciculus gracilis: transmit info coming
from areas inferior to T6
 Fasciculus cuneatus: transmit info
coming from areas superior to T6
 - Spinothalamic tract: transmits pain and
temperature sensations to thalamus and then to
cerebrum
- Spinocerebellar tract: transmits proprioception
sensations to cerebellum
Chains of neurons:
1. First order neuron
- Delivers sensations to CNS
- Cell body is in dorsal or cranial root ganglion
2. Second order neuron
- Interneuron with cell body in the spinal cord or brain
3. Third order neuron
- Transmit information from thalamus to cerebral cortex
Neurons in sensory tracts are arranged according to 3 anatomical principles:
- Sensory modality: fine touch sensations are carried in one sensory tract
- Somatotropic: ascending tracts are arranged according to site of origin
- Medial-lateral rule:
o sensory neurons yang masuk di low level of spinal cord  lebih medial
o sensory neurons yang masuk di higher level of spinal cord  lebih lateral

Motor tracts (descending tract)

CNS transmits motor commands in response to sensory information
Motor commands delivered by:
- somatic nervous system (SNS): direct contraction of skeletal muscle
- autonomic nervous system (ANS): direct activity of glands, smooth muscle, and cardiac muscle
- Merupakan descending tracts. Major:
o corticospinal tract: conscious control of skeletal muscle
o subconscious tract: subconscious regulation of balance, muscle tone, eye, hand, and upper limb
position
1.

Corticospinal tracts
- Corticobulbar tracts: conscious control over eye, jaw, and face muscle
- Lateral corticospinal tracts: conscious control over skeletal muscle
- Anterior corticospinal tracts: conscious control over skeletal muscle
2. Subconscious motor tracts
- Vestibulospinal tracts
o Send information from inner ear to monitor position of the head
o Vestibular nuclei respond by altering muscle tone, neck muscle contraction, and limbs for posture
and balance
- Tectospinal tract
o Send information to head, neck, upper limbs in response to bright and sudden movements and loud
noises
o Tectum area: superior and inferior colliculi
 Superior colliculi: receives visual information
 Inferior colliculi: receives auditory information
- Reticulospinal tract
o Send information to cause eye movements and activate respiratory muscles
- Rubrospinal tract
o Send information to flexor and extensor muscles
SPINOCEREBELLAR TRACTS
Carries unconscious proprioceptive information (mis. Tangan kita digerakin orang ke kanan kita galiat tapi kita tau
itu ngarah ke kanan)
Terbagi 3:
- dorsal spinocerebellar tract
- ventral spinocerebellar tract
- cuneocerebellar tract

1. Dorsal spinocerebellar tract

- First order neuron: proprioception, touch and pressure information bakal masuk ke dorsal root ganglion of
spinal cord.
- Second order neuron: info itu bakal masuk ke di nucleus antara C8-L2 column (Clarke’s column) dan ada
specific nucleusnya yaitu Clark’s nucleus(ada di rax lamina). Terus pindah ke ipsilateral lateral white column
bagian posterior/dorsal.  ascend ke medulla
- Third order neuron: infonya bakal keluar ke inferior cerebellar peduncle ke cerebellar cortex
2. Ventral spinocerebellar tract
- First order neuron: Carrying information below L2/L3 to coccygeal.  masuk ke dorsal root ganglion
- Second order neuron: info masuk ke dorsal grey horn, dia move contralateral ke sebrang dan ascend upward
sampe ke midbrain terus keluar ke superior cerebellar peduncle, dia pindah ke belakang (muterin) terus ke
opposite cerebellar side (BALIK KE SISI AWAL) = CROSSES 2X
- Third order neuron: dia keluar ke cerebellar cortex
3. Cuneocerebellar tract
- First order neuron: carry information dari above C8 (dari upper limbs, head, neck structures) ke dorsal root
ganglion
- Second order neuron: masuk ke dorsal grey horn terus move upwards ipsilaterally dia masuk ke nucleus (di
medulla) namanya accessory cuneate nucleus
- Third order neuron: fibers namanya externa arcuate fibers move thru inferior cerebellar peduncles dan
terminates di cerebellar cortex

**Spino olivary tract

- First order neuron: Info masuk ke dorsal root
ganglion dia
- Second order neuron: masuk ke dorsal grey horn
terus cross over ke contralateral side terus move
upwards dia synapse di nucleus namanya inferior
oiivary nucleus
- Third order neuron: setelah synapse fibers
namanya climbing fibers cross the midline buat
balik ke sisi awal terus masuk lewat inferior
cerebellar peduncle
REFLEX PHYSIOLOGY
Reflexes are autonomic, subconscious response to changes within or outside of body.
Reflex arc
- Yang ngatur operation of reflexes.
- Reflex arcs ada di seluruh tubuh ranging from skeletal muscle to smooth muscle in glands.
- Initiated by excitation or stimulation of specific sensory cells yang directly connected ke motor neurons 
enable motor nerve impulses passed on ke muscle
- 2 main types of reflex system:
o autonomic: control and regulate smooth muscle cells, cardiac muscle cells, and glands.  have
ability to both stimulate or inhibit smooth muscle
o somatic: control skeletal muscle. Different types: scratching reflexes, withdrawal reflexes, stretch
reflexes, and tendon reflexes.
- Parts of reflex arc:
o Receptor: detect stimulus
o Sensory neuron: conveys sensory info to brain or spinal cord
o Interneuron: relay neurons. Conducts nerve impulses from sensory neuron ke motor neuron
o Motor neuron: conduct motor output to periphery. Transmits nerve impulse from the brain or spinal
cord to effecter
o Effecter: response to stimulation by motor neuron and produces reflex or behavioral action

Muscle spindles
- Composed of few intrafusal muscle fibers that lack of actin
and myosin in central regions  noncontractile
- Wrapped in 2 types of afferent endings:
o Primary sensory endings of type Ia fibers
o Secondary sensory endings of type II fibers
o These regions are innervated by gamma () efferent
fibers
** contractile muscle fibers are extrafusal fibers dan
innervated by alpha () efferent fibers.
- Stretching the muscles activates muscle spindle  increased
rate of action potential in Ia fibers
- Contracting the muscle reduces tension muscle spindle 
decreased rate of action potential on Ia fibers
Stretch reflex
- stretching muscle activates muscle spindle
- excited gamma motor neurons of spindle bikin stretched muscle buat contract
- afferent impulses from result in inhibition of the antagonist
- example: patellar reflex

Golgi tendon reflex

- opposite of stretch reflex
- contracting muscle activates golgi tendon organs
- afferent golgi tendon neurons are stimulated  neurons
inhibit the contracting muscle  antagonistic muscle is
activated  contracting muscle reflaxes and antagonistic
muscle contracts

Withdrawal reflex
- automatically withdraws any area of
the body that experiences pain or
discomfort
- commonly used as a check for depth of
anesthesia or surgery patients