Cortical Motor Function

Question 1

What is volition?

Answer 1

Motor systems produce movements that are adaptive and accomplish a certain goal

Question 2

Describe the hierarchical organisation of motor control.

Answer 2

Association Cortex
Motor Cortex
Brainstem
Spinal Cord

Question 3

What are postural adjustments and unconscious processing?

Answer 3

Postural Adjustments – the motor system has to compensate for changes in the body’s centre of mass during movements
Unconscious Processing – many of the postural adjustments occur without our awareness

Question 4

What are the three parts of the motor cortex?

Answer 4

Primary Motor Cortex
Premotor Cortex
Supplementary Motor Area

Question 5

What makes up the association cortex?

Answer 5

Frontal Cortex and Parietal Cortex

NOTE: this is not exactly part of the motor pathway but it influences the planning and execution of movements

Question 6

What are the two parts of the pyramidal (descending) system?

Answer 6

Corticobulbar Tract – starts in the cortex then exits and innervates the muscles in the face
Corticospinal Tract – starts in the cortex and exits and innervates the muscles in the arms and legs

Question 7

Describe the side loops of this descending pathway and their role.

Answer 7

The descending pathway also has two side loops that go to the cerebellum and basal ganglia. The cerebellum and basal ganglia check the motor information before it travels to the muscles and has its effect

Question 8

Which lobe are the three parts of the motor cortex found in? Describe their arrangement.

Answer 8

Frontal (anterior to the central sulcus) The primary motor cortex is on the precentral gyrus
The premotor cortex and the supplementary motor area are anterior to the primary motor area

Question 9

What is another name given to the three parts of the motor cortex?

Answer 9

Primary Motor Cortex = Broadmann’s Area 4

Premotor + Supplementary Motor Area = Broadmann’s Area 6

Question 10

What are the most important cells in the primary motor cortex?

Answer 10

Betz Cells (pyramidal cells)

Question 11

Where are Betz cells located within the grey matter and which tracts originate from here?

Answer 11

They are found in the 5th layer of grey matter, the corticospinal tracts originate from here

Question 12

Describe what happens to the upper motor neurones that come from the primary motor cortex.

Answer 12

Travel through brainstem to pyramidal decussation in medulla - 95% of the axons cross midline.
These axons continue down the spinal cord and synapse with a lower motor neurone and exit into a peripheral nerve to the reach the skeletal muscle.
The pathway of the corticobulbar tract similar– Upper motor neurones go down into brainstem and synapse with lower motor neurone and they exit to the facial muscles

Question 13

What are the two types of descending pathway?

Answer 13

Lateral and Medial

Question 14

Which tracts are lateral? Which are medial?

Answer 14

Lateral
Lateral corticospinal tract
Rubrospinal tract

Medial  
Anterior corticospinal tract 
Reticulospinal tract  
Vestibulospinal tract 
Tectospinal tract (Colliculospinal tract)

Question 15

What is the function of lateral and medial pathways?

Answer 15

Lateral = Control of proximal and distal musculature, voluntary movements or arms and legs 
Medial = Control of axial muscles, balance and posture

Question 16

Describe the structure and function of the lateral corticospinal tract.

Answer 16

Lateral corticospinal tract originates in M1 from the Betz cells.
Axons pass through brainstem, decussate at the pyramidal decussation in the medulla.
Then passes down spinal cord and synapses with a lower motor neurone.
It goes onto control mainly the distal musculature.
NOTE: 95% of axons from primary motor cortex decussate at medulla, the 5% that don’t decussate form the anterior corticospinal tract.

Question 17

Where does the rubrospinal tract originate?

Answer 17

Red nucleus of the midbrain

Question 18

What is the function of the rubrospinal tract?

Answer 18

It is an alternative pathway that allows voluntary motor commands to be sent down the spinal cord meaning that the body can compensate for a lesion in the primary motor cortex. It also has a role in movement velocity.

Question 19

Describe the structure and function of the vestibulospinal tract.

Answer 19

The lateral vestibulospinal tract originates at the lateral vestibular nucleus.
The medial vestibulospinal tract originates at the medial vestibular nucleus.
They mediate postural adjustments and head and eye movements

Question 20

Describe the structure and function of the reticulospinal tract.

Answer 20

It originates in the reticular formation in the brainstem then goes down the spinal cord to innervate muscle.

It is involved in complex actions:
Orienting
Stretching
Maintaining a complex posture

Question 21

Describe the structure and function of the tectospinal tract.

Answer 21

It originates in the superior colliculus (brainstem) Its function is not known but is most likely involved in reflexive turning of the head to orient to visual stimuli.

Question 22

Describe the structure and function of the anterior corticospinal tract.

Answer 22

The anterior corticospinal tract is made up of the upper motor neurone axons coming from the primary motor cortex that do not decussate at the pyramidal decussation. These fibres cross the midline at the level of the spinal cord It controls proximal musculature.

Question 23

What diagram depicts the somatotopic organisation of the primary motor cortex?

Answer 23

Penfield’s Motor Homunculus (CORTICAL)

Question 24

How can the cortical representation of a muscle in the motor cortex change?

Answer 24

The more we use a muscle, the bigger the representation of that muscle in the cortex.

Question 25

What is the function of the premotor cortex?

Answer 25

Plans movements and assembles movements into coordinated actions NOTE: premotor cortex is anterior to the primary motor cortex

Question 26

What is the function of the supplementary motor area?

Answer 26

Planning complex internally driven voluntary movements e.g. speech It also becomes active when you are thinking about movement before movement (e.g. rehearsing a dance)

Question 27

What are the two parts of the association cortex that are involved in motor control? State their functions.

Answer 27

Posterior Parietal Cortex – ensures movements are targeted accurately to objects in external space Prefrontal Cortex – involved in the selection of appropriate movements for a particular course of action

Question 28

Describe the features of upper motor neurone lesions.

Answer 28

Initially you get loss of function of the motor neurones leading to:
Paresis = graded weakness of movement
Paralysis = complete loss of muscle activity

After a few weeks, the loss of descending inhibitory pathways leads to increased abnormal motor activity such as:
Spasticity (increased muscle tone)
Hyperreflexia (exaggerated reflexes)
Clonus (abnormal oscillatory muscle contraction)
Babinski’s Sign
Little muscle atrophy

Question 29

What is Babinski’s Sign?

Answer 29

You stroke the plantar surface of the foot and in a normal subject you will see flexion of the toes (they curl downwards) In the case of upper motor neurone lesions, the patient will show an EXTENSOR PLANTAR RESPONSE where their toes fan out and their big toe lifts up.

Question 30

Why is muscle atrophy not seen in upper motor neurone lesions?

Answer 30

The lower motor neurones are still intact and they have a role in providing nutrients to the muscle. There will still be partial atrophy due to muscle disuse.

Question 31

Define apraxia.

Answer 31

A disorder of skilled movement not caused by weakness, abnormal tone or posture or movement disorders (tremors or chorea). It is caused by the loss of information on how to perform skilled tasks rather than loss of motor command to the muscles.

Question 32

Lesions in which part of the brain tend to cause apraxia?

Answer 32

Inferior parietal lobe Frontal lobe (premotor cortex and supplementary motor area)

Question 33

What are the two most common causes of apraxia?

Answer 33

Stroke and Dementia

Question 34

Describe the features of lower motor neurone lesions.

Answer 34

It is generally the opposite of upper motor neurone lesions.
Hypotonia
Hyporeflexia
Weakness
Muscle Atrophy– the metabolic trophic support to the muscles is lost
FASCICULATIONS– damages motor units produce spontaneous action potentials, resulting in a visible twitch
Fibrillations – twitch of individual muscle fibres (aren’t visible to the naked eye but are picked up on EMG)

Question 35

What is motor neurone disease?

Answer 35

A progressive neurodegenerative disorder of the motor system – it is a spectrum of disorders. MND can affect upper motor neurones, lower motor neurones or both

Question 36

`What is the term given for upper AND lower motor neurone disease?

Answer 36

Amyotrophic Lateral Sclerosis (ALS)

Question 37

Describe how the symptoms of ALS change as the disease progresses.

Answer 37

Some patients may present with only upper motor lesion symptoms or only lower motor lesion symptoms but as the disorder progresses, both upper and lower motor neurone signs will be coexistent.

Question 38

List some signs of ALS.

Answer 38

Increased muscle tone (spasticity in the limbs and tongue)
Brisk limb and jaw reflexes (hyperreflexia)
BABINSKI’s SIGN
Loss of dexterity
Dyarthria – difficulty speaking
Dysphagia – difficulty swallowing

Question 39

Which lower motor neurone controls the tongue?

Answer 39

Hypoglossal Nerve (CN XII)

Question 40

What might you see in the tongue of an MND patient?

Answer 40

Fasciculations and spasticity