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Motor system and Reflex

The document outlines the motor system's structure, including the peripheral and central apparatus, and details the examination methods for assessing motor function, such as tone, power, and reflexes. It differentiates between upper and lower limb assessments and describes pathological reflexes indicative of motor neuron lesions. Additionally, it explains symptoms of both peripheral and central paralysis, highlighting their distinct characteristics.

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alpser893
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4 views

Motor system and Reflex

The document outlines the motor system's structure, including the peripheral and central apparatus, and details the examination methods for assessing motor function, such as tone, power, and reflexes. It differentiates between upper and lower limb assessments and describes pathological reflexes indicative of motor neuron lesions. Additionally, it explains symptoms of both peripheral and central paralysis, highlighting their distinct characteristics.

Uploaded by

alpser893
Copyright
© © All Rights Reserved
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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MOTOR

SYSTEM
REFLEX.
ASMI named S. Tentishev
 The motor system is divided into the
peripheral apparatus, which consists
of the anterior horn cell and its
peripheral axon, the neuromuscular
function, and muscle, and the central
apparatus, which includes the
descending tracts involved in control
(the pyramidal system) and the
systems involved in initiating and
regulating movement (the basal
ganglia and cerebellum).
IT’S SYSTEM WORK BY HELP OF
PYRAMIDAL TRACTS.

 2 types of Pyramidal tracts :


 Corticospinal tracts – supplies the

musculature of the body.


 Corticobulbar tracts – supplies the

musculature of the head and neck


EXAMINATION OF MOTOR SYSTEM

Check-up body
 TONE

 POWER

 REPHLEXIS

 PATOLOGICAL REPHLEXIS
EXAMINATION( VISION)

 Can be
 -Tremor: rhythmic oscillation around a join

 -Fasciculation: involuntary repetitive musle

contraction
UPPER LIMBS
TONE

 Ensure that the patient is relaxed, and assess


tone by alternately flexing and extending the
elbow or wrist.

 Can be : upgraded or reduced


POWER

 Muscle weakness. The degree of weakness is


‘scored’ using the MRC (Medical Research
Council) scale.
 Score 0 – No contraction

 Score 1 – Flicker

 Score 2 – Active movement/gravity

eliminated
 Score 3 – Active movement against gravity

 Score 4 – Active movement against gravity

and resistance
 Score 5 – Normal power
 If a pyramidal weakness is suspect (i.e. a
weakness arising from damage to the motor
cortex or descending motor tracts the
following test is simple, quick, yet sensitive.
 Ask the patient to hold arms outstretched

with the hands supinated for up to one


minute. The eyes are closed (otherwise visual
compensation occurs). The weak arm
gradually pronates and drifts downwards.
 With possible involvement at the spinal root

or nerve level (lower motor neuron), it is


essential to test individual muscle groups
ASK THE PATIENT TO HOLD ARMS
OUTSTRETCHED WITH THE
HANDS SUPINATED FOR UP TO
ONE MINUTE. THE EYES ARE
CLOSED (OTHERWISE VISUAL
COMPENSATION OCCURS). THE
WEAK ARM GRADUALLY
PRONATES AND DRIFTS
DOWNWARDS.
WITH POSSIBLE INVOLVEMENT AT
THE SPINAL ROOT OR NERVE
LEVEL (LOWER MOTOR NEURON),
IT IS ESSENTIAL TO TEST
INDIVIDUAL MUSCLE GROUPS TO
HELP LOCALISE THE LESION.
WHEN TESTING MUSCLE GROUPS,
THINK OF ROOT AND NERVE
SUPPLY.
[NOTE: NOT ALL MUSCLE GROUPS ARE INCLUDED
IN THE FOREGOING, BUT ONLY THOSE REQUIRED
TO IDENTIFY AND DIFFERENTIATE NERVE AND
ROOT LESIONS.]
REPHLEXIS
REFLEX ENHANCEMENT
WHEN REFLEXES ARE DIFFICULT TO ELICIT, ENHANCEMENT
OCCURS IF THE PATIENT IS ASKED TO ‘CLENCH THE TEETH’.
LOWER LIMBS
TONE

 Try to relax the patient and alternately flex


and extend the knee joint. Note the
resistance.
 Roll the patient’s legs from side to side.

Suddenly lift the thigh and note the response


in the lower leg. With increased tone the leg
kicks upwards.
 Can be -Clonus
 Ensure that the patient is relaxed. Apply

sudden and sustained flexion to the ankle. A


few oscillatory beats may occur in the normal
subject, but when this persists it indicates
increased tone.
POWER

 When testing each muscle group, think of


root and nerve supply.
REFLEXES

 Knee jerk: L2, L3, L4 roots.


 Ensure that the patient’s leg is relaxed by

resting it over examiner’s arm or by hanging


it over the edge of the bed. Tap the patellar
tendon with the hammer and observe
quadriceps contraction. Note impairment or
exaggeration
 Ankle jerk: S1, S2 roots.
 Externally rotate the patient’s leg. Hold the
foot in slight dorsiflexion. Ensure the foot is
relaxed by palpating the tendon of tibialis
anterior. If this is taut, then no ankle jerk will
be elicited.
 Tap the Achilles tendon and watch for calf

muscle contraction and plantarflexion.


 Reflex enhancement

 When reflexes are difficult to elicit, they may

be enhanced by asking the patient to clench


the teeth or to try to pull clasped hands apart
(Jendrassik’s manoeuvre).
PLANTAR RESPONSE

 Check that the big toe is relaxed. Stroke the


lateral aspect of the sole and across the ball
of the foot. Note the first movement of the
big toe. Flexion should occur. Extension due
to contraction of extensor hallucis longus (a
‘Babinski’ reflex) indicates an upper motor
neuron lesion. This is usually accompanied
by synchronous contraction of the knee
flexors and tensor fasciae latae.
 Elicit Chaddock’s sign by stimulating the

lateral border of the foot. The big toe extends


with upper motor neuron lesions.
TO AVOID AMBIGUITY DO NOT TOUCH THE INNERMOST
ASPECT OF THE SOLE OR THE TOES THEMSELVES.
ON EXAMINATION, THE TENDON
REFLEXES CAN BE GRADED USING
FOLLOWING SCALE (FULLER G.,
2004):
 0 = absent tendon reflex
 ± = present only with reinforcement

 1+ = present but depressed

 2+ = normal

 3+ = increased

 4+ = drastically increased, with clonus


PATOLOGICAL REPHLEXIS
 TYPES OF ABNORMAL REFLEXES
 1. Increased reflexes - hyperreflexia.

 2. Decreased reflexes - hyporeflexia.

 3. Loss of reflexes - areflexia.

 4. Uneven reflexes - anisoreflexia.


 Pathologic reflexes (Babinski, Chaddock,
Oppenheim, snout, rooting, grasp) are
reversions to primitive responses and
indicate loss of cortical inhibition.
 Babinski, Chaddock, and Oppenheim

reflexes all evaluate the plantar response.


 The normal reflex response is flexion of the

great toe. An abnormal response is slower


and consists of extension of the great toe
with fanning of the other toes and often knee
and hip flexion.
 For Babinski reflex, the lateral sole of the foot
is firmly stroked from the heel to the ball of
the foot with an end of a reflex hammer.
 For Chaddock reflex, the lateral foot, from

lateral malleolus to small toe, is stroked with


a blunt instrument.
 For the Oppenheim reflex, the anterior tibia,

from just below the patella to the foot, is


firmly stroked with a knuckle.
 The Oppenheim test may be used with the

Babinski test or the Chaddock test to make


withdrawal less likely.
SYMPTOMS OF PERIPHERAL PARALYSIS
 Peripheral (flaccid) paralysis and paresis develop
due to peripheral motor neuron lesion (anterior
horn cells of the spinal cord or their analogues -
motor nuclei of cranial nerves, as well as the
anterior roots, plexus, peripheral nerves).
 Symptoms of peripheral paralysis or paresis:

 1. Reduced muscle strength;

 2. Muscle atonia or hypotension;

 3. The absence or decrease in tendon reflexes;

 4. Muscle atrophy;

 5. Fibrillation and fasciculation;

 6. Damage in muscle electro-excitability.


SYMPTOMS OF CENTRAL PARALYSIS

 Central (pyramidal, spastic) paralysis and


paresis develops due to lesions of the central
motor neuron-the anterior/pre central gyrus and
the pyramidal tract - from cortex to anterior horn
cells of the spinal cord or motor nuclei of the
cranial nerves. Lesion of the central neuron is not
characterised by paralysis of individual muscles
but of the entire group. Also typical symptom is
disinhibition/increase of deep reflexes. These
include increased muscle tone (emergence of
spasticity), therefore it is called spastic paralysis.
SYMPTOMS OF CENTRAL PARALYSIS

 Reduced muscle strength;


 Increased muscle tone of spastic type;

 Increased tendon reflexes;

 Appearance of pyramidal pathological

reflexes.
 No changes in electro-excitability and

degeneration on Electroneuromyography
(ENMG).

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