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Reflexes and methods of examination Reflexes and methods of examination Active movements Active movements Types of paralysis Types of paralysis
Syndromes of movement disturbances Syndromes of movement disturbances Syndromes of lesion of Cortical-Syndromes of lesion of Cortical-
Muscular Tract on different levelsMuscular Tract on different levels
Functions of nervous systemFunctions of nervous system
The main function of nervous systemThe main function of nervous system is is unification and regulation of unification and regulation of
different physiological processes. different physiological processes. That means that nervous system That means that nervous system
unites, integrates and unites, integrates and subordinates all the parts of subordinates all the parts of human body and provides its human body and provides its connection with environmentconnection with environment
Functions of nervous systemFunctions of nervous system
The base of nervous system activity is The base of nervous system activity is reflex principlereflex principle
Reflex – is a reaction of our organism to Reflex – is a reaction of our organism to various outside and inside effects. It is various outside and inside effects. It is provided by nervous systemprovided by nervous system
Reflex consists of:Reflex consists of:
afferent part (which accepts information)afferent part (which accepts information)
central part (that keeps information)central part (that keeps information)
efferent part (that creates response)efferent part (that creates response)
As a result we have a circle – like structure As a result we have a circle – like structure - receptor (primary information centre) – - receptor (primary information centre) – programme centre – executive apparatus programme centre – executive apparatus
Reflex archReflex arch
Reflexes are divided into:Reflexes are divided into:
simple and complexsimple and complex
inborn and trainedinborn and trained
conditioned and unconditioned conditioned and unconditioned
Unconditioned reflexes:Unconditioned reflexes:
They are inborn onesThey are inborn ones
They are phylogenetically old, that means they They are phylogenetically old, that means they were formed in course of phylogenesiswere formed in course of phylogenesis
They are based on certain anatomic structures They are based on certain anatomic structures (segments of spinal cord or brain stem)(segments of spinal cord or brain stem)
They exist even without brain cortex influenceThey exist even without brain cortex influence
They are inheritedThey are inherited
They can be regulated by brain cortexThey can be regulated by brain cortex
They are basis for the conditioned reflexesThey are basis for the conditioned reflexes
Conditioned reflexes:Conditioned reflexes:
They are the result of the individual experience They are the result of the individual experience and are formed during ontogenesisand are formed during ontogenesisThey are unstable, that means they need They are unstable, that means they need constant supportconstant supportThey aren’t based on certain anatomic They aren’t based on certain anatomic structuresstructuresThey are fixed in brain cortexThey are fixed in brain cortex
There are such conditioned reflexes as speaking, There are such conditioned reflexes as speaking, writing, reading, calculation, practicewriting, reading, calculation, practice
Unconditioned reflexes Unconditioned reflexes are divided into:are divided into:
Superficial and deepSuperficial and deep
Simple and complexSimple and complex
Unconditioned reflexes are divided Unconditioned reflexes are divided into:into:
Proprioceptive (stretch, periosteal, joint)Proprioceptive (stretch, periosteal, joint)
Exteroceptive (dermal, from mucose Exteroceptive (dermal, from mucose membrane)membrane)
Interoceptive (from mucosa membrane of Interoceptive (from mucosa membrane of internal organs – for example urination in internal organs – for example urination in case of internal sphincter irritation)case of internal sphincter irritation)
Motor SystemMotor SystemMotor SystemMotor System
Motor systemMotor system
Provides conduction of nervous impulse from Provides conduction of nervous impulse from brain cortex to muscles. brain cortex to muscles.
The way of this impulse is known as The way of this impulse is known as motorwaymotorway
or or tractus corticomuscularistractus corticomuscularis
It consists of two neurons: It consists of two neurons:
Central – Central – upper motor neuron (UMN)upper motor neuron (UMN)
Peripheral – Peripheral – lower motor neuron (LMN)lower motor neuron (LMN)
Upper and lower extremities, neck, trunk Upper and lower extremities, neck, trunk and perineum musclesand perineum muscles’’ innervation innervation
The The first (central) neuronfirst (central) neuron ((upper motor neuronupper motor neuron) ) is called is called Corticospinal tractCorticospinal tract tractus corticospinalistractus corticospinalis
The The second (peripheral) neuronsecond (peripheral) neuron ((lower motor neuronlower motor neuron)) is called is called Spinomuscular tractSpinomuscular tract tractus spinomuscularistractus spinomuscularis
Tractus corticomuscularisTractus corticomuscularis
Motor HomunculusMotor HomunculusMotor HomunculusMotor Homunculus
Upper Motor Neuron Corticospinal TractUpper Motor Neuron Corticospinal Tract Upper Motor Neuron Corticospinal TractUpper Motor Neuron Corticospinal Tract
Lower Motor NeuronLower Motor Neuron
cell body: anterior horncell body: anterior horn
axon: axon: anterior root,anterior root,
spinal nervespinal nerve
axon terminal:axon terminal:
neuromuscularneuromuscular
junctionjunction
Effector:Effector:skeletal muscleskeletal muscle
Lower Motor NeuronLower Motor Neuron
cell body: anterior horncell body: anterior horn
axon: axon: anterior root,anterior root,
spinal nervespinal nerve
axon terminal:axon terminal:
neuromuscularneuromuscular
junctionjunction
Effector:Effector:skeletal muscleskeletal muscle
Spinal nerve gives 4 branches:Spinal nerve gives 4 branches:
ramus anterior ( together they form plexus ramus anterior ( together they form plexus – cervical, brachial, lumbar and sacral)– cervical, brachial, lumbar and sacral)
ramus posterior (it is spinal nerve, which ramus posterior (it is spinal nerve, which innervates posterior trunk muscles)innervates posterior trunk muscles)
ramus meningeusramus meningeus
ramus comunicante albiramus comunicante albi
Conclusions:Conclusions:
The muscles of upper and lower The muscles of upper and lower extremities have unilateral cortical extremities have unilateral cortical innervation from contralateral hemisphere innervation from contralateral hemisphere
The muscles of neck, trunk and pelvic The muscles of neck, trunk and pelvic organs have bilateral innervation from both organs have bilateral innervation from both hemispheres. In case of unilateral hemispheres. In case of unilateral pathologic focus these structures do not pathologic focus these structures do not suffersuffer
Extremities, neck, trunk and Extremities, neck, trunk and perineum musclesperineum muscles’’ innervation innervation
Neurons of С1-С4 anterior roots – innervate neck musclesС5-Th1 – muscles of upper extremities Th2-Th12 – muscles of trunk L1-S2 – muscles of legs S3 – S5 – muscles of perineum
Face, tongue and pharynx Face, tongue and pharynx muscles innervationmuscles innervation
This way is called This way is called tractus corticomuscularistractus corticomuscularis
The The firstfirst central neuron central neuron
((upper motor neuronupper motor neuron))
is called is called tractus corticonuclearistractus corticonuclearis
((Corticobulbar TractCorticobulbar Tract))
The The secondsecond peripheral neuron peripheral neuron
((lower motor neuronlower motor neuron))
is called is called tractus nucleomuscularistractus nucleomuscularis
Face, tongue and pharynx muscles Face, tongue and pharynx muscles innervationinnervation
We can make the following conclusions:We can make the following conclusions:
The The face muscles have bilateral cortex face muscles have bilateral cortex innervationinnervation except the mimic muscles and except the mimic muscles and tongue muscles that have unilateral tongue muscles that have unilateral innervation from the opposite hemisphereinnervation from the opposite hemisphereThe muscles of The muscles of upper and lower extremities, upper and lower extremities, lower mimic muscles and tongue muscles lower mimic muscles and tongue muscles have unilateral cortical innervationhave unilateral cortical innervationAll the other muscles All the other muscles (the muscles of neck, (the muscles of neck, trunk, perineum, m. oculomotorial, m. trunk, perineum, m. oculomotorial, m. masseter, pharyngeal and palatal muscles) masseter, pharyngeal and palatal muscles) have bilateral cortical innervationhave bilateral cortical innervation
UMN and LMN Syndrome - ParalysisUMN and LMN Syndrome - ParalysisUMN and LMN Syndrome - ParalysisUMN and LMN Syndrome - Paralysis
ParalysisParalysisParalysis Paralysis (plegia)(plegia) - means the absence of - means the absence of active movements. It occurs in case of active movements. It occurs in case of complete lesion of complete lesion of motor waymotor way (tractus (tractus corticomuscularis) corticomuscularis)
ParesisParesis occurs in case of incomplete occurs in case of incomplete lesion of motor way. That means disorders lesion of motor way. That means disorders of active movementsof active movements
Clinically can be – hemi-, tetra-, mono-, tri- Clinically can be – hemi-, tetra-, mono-, tri- and paraparesisand paraparesis
Paralysis is divided into:Paralysis is divided into:
Central (spastic)Central (spastic)Peripheral (flaccid)Peripheral (flaccid)
CentralCentral or spastic paralysis is caused by the or spastic paralysis is caused by the lesion of central neuron and its fibers (tr. lesion of central neuron and its fibers (tr. corticospinalis or tr. corticonuclearis)corticospinalis or tr. corticonuclearis)
PeripheralPeripheral or flaccid paralysis is caused by or flaccid paralysis is caused by the lesion of peripheral neuron (tractus the lesion of peripheral neuron (tractus spinomuscularis or tractus spinomuscularis or tractus nucleomuscularis)nucleomuscularis)
Features of central (spastic) Features of central (spastic) paralysis are:paralysis are:
1.1. HyperreflexionHyperreflexion of Deep Tendon reflexes of Deep Tendon reflexes 2.2. SpasticitySpasticity of skeletal muscles of skeletal muscles 3.3. Pathologic reflexesPathologic reflexes. They are considered . They are considered
to be reliable signs of central paralysis to be reliable signs of central paralysis 4.4. It is a diffuse paralysisIt is a diffuse paralysis5.5. Protective reflexes (the reflexes of spinal Protective reflexes (the reflexes of spinal
automatism)automatism)6.6. Pathologic synkinesisPathologic synkinesis is involuntary is involuntary
movements in paralysed extremity movements in paralysed extremity
Spastic hypertonus (Vernike-Mann posture)Spastic hypertonus (Vernike-Mann posture)
Spastic hypertonus features:Spastic hypertonus features:
Tonus is increased in the group of flexors Tonus is increased in the group of flexors in upper extremities and in the group of in upper extremities and in the group of extensors in lower extremitiesextensors in lower extremities
““Clasp – knife“ Clasp – knife“ Phenomenon
in course of evaluation tonus decreasesin course of evaluation tonus decreases
Spastic hypertonus in legSpastic hypertonus in leg
Planter responseNormalNormal Pathologic Pathologic
Features of peripheral paralysisFeatures of peripheral paralysis
1. 1. AreflexionAreflexion or hyporeflexion or hyporeflexion
2. 2. AtoniaAtonia or hypotonia or hypotonia
3. Muscular 3. Muscular atrophyatrophy
4. Fasciculation of muscles4. Fasciculation of muscles
5. It is limited paralysis 5. It is limited paralysis
6. There is reaction of degeneration6. There is reaction of degeneration
Global Global wasting of wasting of the left arm the left arm in a post-in a post-traumatic traumatic brachial brachial
plexopathyplexopathy
Muscular AtrophyMuscular AtrophyMuscular AtrophyMuscular Atrophy
Wasting of the tongueWasting of the tongue
Note any of the following common gait disorders:
Hemiplegic gait with one-sided weakness - a possible sign of cerebral stroke
Spastic gait - a possible sign of cerebral palsy
Ataxic gait - a possible indication of cerebellar dysfunction
Festinating gait - a possible sign of Parkinson's disease
Bare test (upper)Bare test (upper)
Bare test (upper)Bare test (upper)
Bare test (lower)Bare test (lower)
Mandibular reflexMandibular reflex
Palatal reflexPalatal reflex
Biceps reflexBiceps reflex
Triceps reflexTriceps reflex
Carpo-radial reflexCarpo-radial reflex
Knee reflexKnee reflex
Ankle reflexAnkle reflex