Motor Function Overview

The nervous system processes sensory information and generates motor responses, which
occur at different levels:

● Simple Reflexes: Processed in the spinal cord.

● Complex Motor Skills: Controlled by the cerebrum and brainstem.

The structures responsible for motor control include:

● Spinal Cord: Essential for muscle movements through simple reflex arcs and
transmission of signals to/from the brain.
● Brainstem: Manages posture and basic motor functions.
● Cerebellum: Coordinates fine movements and balance.
● Basal Ganglia: Modulates voluntary movements and ensures smooth execution.
● Cerebral Cortex: Directs voluntary, complex motor tasks.

Spinal Cord Motor Functions

The spinal cord is the primary pathway for communication between the brain and peripheral
muscles. It has five levels:

1. Cervical (8 segments)
2. Thoracic (12 segments)
3. Lumbar (5 segments)
4. Sacral (5 segments)
5. Coccygeal (1 segment)

Each segment contains:

● Sensory Relay Neurons: Receive and transmit sensory input to higher brain centers.
● Anterior Motor Neurons:
○ Alpha Motor Neurons: Innervate extrafusal muscle fibers, responsible for
muscle contraction.
○ Gamma Motor Neurons: Regulate muscle tone by controlling intrafusal fibers in
muscle spindles.
● Interneurons: Facilitate communication between sensory and motor neurons, crucial for
reflex arcs.

Spinal Cord Structure

● Gray Matter: Located centrally, divided into three horns:

○ Dorsal Horn: Processes incoming sensory information.
 ○ Lateral Horn: Contains preganglionic sympathetic and parasympathetic neurons.
○ Ventral Horn: Contains motor neurons and processes motor output.
● White Matter: Contains ascending and descending tracts for sensory and motor signals.

Clinical Relevance:

Damage to specific regions of the spinal cord can lead to various motor dysfunctions, depending
on the level of the injury. For example:

● Cervical cord injuries: Can result in quadriplegia, affecting motor control in both arms
and legs.
● Thoracic cord injuries: May cause paraplegia, impairing motor function in the lower
limbs.

Lower Motor Neurons (LMNs)

LMNs are located in the ventral horn of the spinal cord and motor nuclei of the brainstem. Their
axons exit the central nervous system (CNS) to form the peripheral nervous system (PNS).
They innervate muscle fibers directly, forming motor units (LMN + muscle fiber).

● Types of LMNs:
○ Alpha Motor Neurons: Responsible for muscle fiber contraction.
○ Gamma Motor Neurons: Regulate the sensitivity of muscle spindles for tone
adjustment.

LMN Signs and Clinical Syndromes:

Damage to LMNs results in LMN Syndrome, characterized by:

● Hyporeflexia/Areflexia: Reduced or absent stretch reflexes.

● Hypotonia/Atonia: Reduced muscle tone.
● Fasciculations: Involuntary muscle twitches due to spontaneous firing of damaged
neurons.
● Muscle Atrophy: Loss of muscle mass due to degeneration of motor neurons.

Clinical Example: Spinal Muscular Atrophy (SMA) is a genetic disorder that leads to the
degeneration of motor neurons in the spinal cord and brainstem. Symptoms include severe
muscle weakness, hypotonia, and hyporeflexia. SMA has four types, with SMA I being the most
severe, often resulting in death before age 2.

● SMA Type I (most severe): Symptoms present before 6 months of age, and most
patients do not live past age 2.
● SMA Type IV (least severe): Onset occurs in adulthood, with slower progression and a
normal life expectancy.
 Upper Motor Neurons (UMNs)

UMNs originate in the primary motor cortex or brainstem and are responsible for the initiation
and control of voluntary movement. They synapse with LMNs to transmit motor commands.

● Corticospinal Tract: Controls precise, fine motor movements, especially of the hands
and fingers.
● Corticobulbar Tract: Controls muscles of the face, head, and neck by synapsing with
cranial nerve nuclei.
● Reticulospinal & Vestibulospinal Systems: Regulate posture and muscle tone by
controlling trunk muscles.

UMN Signs and Clinical Syndromes:

Damage to UMNs results in UMN Syndrome, which includes:

● Hyperreflexia: Exaggerated reflexes due to a lack of inhibitory control from UMNs.

● Hypertonia: Increased muscle tone and stiffness due to continuous firing of alpha and
gamma motor neurons.
● Spasticity: Muscle stiffness and increased resistance to passive movement.
● Positive Babinski Sign: Upward movement of the big toe when the sole is stroked,
indicating a lesion in the corticospinal tract.

Clinical Example: Strokes often damage UMNs, especially in the motor cortex, leading to
significant motor deficits on the contralateral side of the body.

● Stroke affecting the motor cortex or internal capsule commonly results in UMN signs.
Depending on the location of the stroke, contralateral hemiplegia (paralysis on the
opposite side) and motor deficits are often observed. The Babinski sign is frequently
positive following corticospinal tract damage.

Descending Motor Pathways

Motor pathways transmit signals from the brain to the muscles, controlling voluntary and
involuntary movements. They are divided into:

Pyramidal Tracts:

● Corticospinal Tract: Originates in the motor cortex and terminates in the spinal cord.
Controls voluntary movement of body musculature.
○ Lateral Corticospinal Tract: Controls fine, precise movements of distal limbs.

Babinsin
 ○ Ventral (Anterior) Corticospinal Tract: Controls axial and proximal limb
muscles.
● Corticobulbar Tract: Controls muscles of the face, head, and neck by synapsing with

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cranial nerve nuclei.

Extrapyramidal Tracts:

● Originate in the brainstem and control involuntary and automatic movements, such as
posture and balance.
○ Rubrospinal Tract: Controls distal muscle groups.
○ Vestibulospinal Tract: Controls balance and head positioning.
○ Reticulospinal Tract: Regulates posture and gait.

Basal Ganglia in Motor Control

The basal ganglia are involved in regulating voluntary movement and muscle tone. They
influence the cortex through two pathways:

Direct Pathway:

● Activation of the striatum inhibits the globus pallidus internal (GPi), reducing its inhibition
of the thalamus, leading to increased cortical activity and facilitating movement.

Indirect Pathway:

● The striatum inhibits the globus pallidus external (GPe), disinhibiting the subthalamic
nucleus (STN), which excites the GPi. This increases inhibition of the thalamus, thus
reducing cortical activity and inhibiting movement.

Clinical Relevance:

● Parkinson’s Disease: Degeneration of dopaminergic neurons in the substantia nigra

disrupts the balance of the direct and indirect pathways, resulting in rigidity,
bradykinesia, and tremors.
● Huntington’s Disease: Progressive loss of striatal neurons, especially in the indirect
pathway, leads to involuntary movements (chorea) and cognitive decline.

Cerebellar Motor Control

The cerebellum is crucial for fine-tuning voluntary movements, maintaining balance, and
coordinating eye movements. It consists of three lobes:
 ● Anterior Lobe: Controls lower limb movements.
● Posterior Lobe: Involved in coordinating voluntary movements.
● Flocculonodular Lobe: Important for balance and eye movements.

Cerebellar Circuitry:

● Purkinje Cells: The major inhibitory output from the cerebellum, targeting deep
cerebellar nuclei.
● Mossy Fibers: Excite granule cells and influence simple spikes in Purkinje cells.
● Climbing Fibers: Elicit complex spikes in Purkinje cells and are essential for motor
learning via long-term depression (LTD).

Clinical Relevance:

Damage to different cerebellar regions causes distinct syndromes:

● Anterior Lobe Syndrome: Stiff-legged gait due to damage in the anterior vermis.
● Posterior Lobe Syndrome: Dysmetria, tremor, and ataxia from posterior lobe damage.
● Flocculonodular Lobe Syndrome: Truncal ataxia affecting balance.

Eye Movement Control

Eye movements are controlled by six extraocular muscles, organized into three
agonist-antagonist pairs. Eye movement is crucial for focusing on objects and maintaining gaze.

Types of Eye Movements:

● Saccades: Rapid eye movements that shift focus from one point to another. Controlled
by the superior colliculus (SC) and frontal eye fields (FEF).
● Smooth Pursuit: Keeps moving objects in focus. Initiated in the visual cortex and
controlled via the cerebellum and vestibular system.

somatotopic organization is represented as a

motor homunculus