Upper motor control - Part II Flashcards
Where is the lesion for decorticate posturing?
above red nucleus (superior colliculus and midbrain)
- FLEXED (ELBOWS) PATTERN
Where is the lesion for decerebrate posturing?
Below the red nucleus (midbrain, at level of cerebral peduncle)
- EXTENSOR PATTERN
- MORE “E’s”
What body parts have poor fine motor control recovery due to their less concentrated representation on M1?
toes, fingers, and tongue
How many symmetric concentric topographic representations are there on M1?
3
____ is still strictly represented in homunculus
S1
There is a chimeric distribution of ___
M1
- mixture of columnar units
What are the functions of M1 in motor control?
- 1st stimulated, faster response, these UMN can directly control our LMN in the spinal cord
What is the delay of M1?
5-100 msec delay
- PM is 1/2 second due to more pathways, each step takes time
What kind of synapse is formed with LMN from M1?
direct monosynaptic LMN control
- directly form a synapse with LMN without interneurons
- if interneurons are needed (2+) = disynaptic
What are the roles of M1 for motor control?
- the intention/direction of the movement
- the preferred direction of movement
- the force/speed of movement
- the extent of movement: proprioception mediated
Where is the strongest activity of M1?
like 360 degrees, 4 oclock to 8 oclock is strongest activity that a motor neuron works
Which cerebral lobe doesn’t have mirror neurons?
Occipital lobe, mainly for visual stimuli
When are monosynaptic M1 neurons developed?
postnatally
Where are monosynaptic neurons located?
caudal M1, anterior bank of central sulcus
What do monosynaptic M1 neurons directly synapse with? Why?
LMN: fine motor control
Why do reflexes reappear stroke?
- integrated, disappear as time goes on after we are born, maturation of system caudal M1 axons descend to the spinal cord, will inhibit these reflexes
- why after stroke, with functions lost, pts will present with spinal reflexes again, such as Babinski and Hoffman
When are level 3 and 4 disynaptic UMNs developed?
prenatally
How do levels 3 and 4 disynaptic UMNs synaps with LMN? Where?
through interneurons
- rostral M1
- Dorsal and vental PM, SMA: Brodmann area 6
- two from cingulate gyrus: RCZ, CCZ
- posterior parietal lobe: Brodmann area 5
What tracts do levels 3 and 4 UMNs not contribute much to?
human corticcobulbar and corticospinal tracts
What is unique about cortical descending projection fibers?
ROTATE DURING DESCENDING 180 degree until to pons
- at the posterior limb of the internal capsule
What happens with cortical descending projection fibers below the pons?
disperse out, mix together
- NO MORE SOMATOTOPY
What is maintained with cortical descending projection fibers above the pons?
gross topography maintained above the pons
What are the cortical desscending projection fibers?
- corticobulbar
- corticospinal
Where are 2/3 of the tracts in the internal capsule from?
frontal lobe
Where are the target motor nuclei for the corticobulbar tracts?
in the brainsetm
What cranial nerves DO NOT have motor nuclei?
III, IV, VI
Which CN is the only one entirely by contralateral control?
CN XII
What can happen with a R MCA stroke?
L CN XII compromised, tongue shifts L with tongue protrusions
- tongue will deviate to weaker side
What CN have contralateral control?
CN VII ventral nuclei, CN XII
Which CN have bilateral control?
All other CNs
What level has brainstem motor control functions for the corticobulbar tract?
Level 2
What is in the brainstem motor control level 2 of corticobulbar tracts?
red/reticular/vestibular nuclei
- inhibition vs activation
What percentage of the corticospinal tracts decussate in the pyramid?
70-90% for contralateral body control
Where do the corticospinal tracts that decussate in the pyramid descend?
in the lateral funiculus
Where do the corticospinal tracts that do not cross over descend?
anterior funiculus and ipsilateral lateral funiculus
Why do patients who have the nondecussated tracts stroke recover better?
- more function and fine motor control
Where does motor decussation occur?
in the caudal medulla
What are the 3 tracts in the pons ?
- pontine reticulospinal tract
- vestibulospinal tract (lateral and medial)
What is the tract in the medulla?
medullary reticulospinalt ract
What tract is in the midbrain?
rubrospinal tract
What are the functions of the monosynaptic M1 neurons?
directly innervate LMN - direction speed and extension of a selected movement
What are the functions of the red nucleus for UE fine motor control?
Flexors
- decussation in midbrain
- descending in the lateral funiculus of the spinal cord
Where does the UE fine motor control of the red nucleus end?
Upper thoracic region
What is the red nucleus important for?
New Skill Learning
- through red nucleus- inferior olivary nucleus
- cerebellum circuitry
Where does the pontine reticulospinal tract run? What does it control?
- all spinal levels
- controls extensors
Where does the pontine reticulospinal tract project?
bilateral projection, anterior funiculus
Where does the medullary reticulospinal tract run? What does it control?
all spinal levels/whole spinal cord
- controls flexors
Where does the medullary reticulospinal tract project?
ipsilateral projection, lateral funiculus
Where does the lateral vestibulospinal tract run? What is its function?
- ipsilateral anterior funiculus for proximal extremity extensors
- WHOLE SPINAL CORD
Where does the medial vestibulospinal tract run? What is its function?
- Ends at upper level of thoracic region
- bilateral anterior funiculus for neck/upper trunk extensors
What motor control reflexes help with balance?
- vestibulocular reflex
- vestibulocervical reflex
- vestibulospinal reflex
What tracts that control extensors run the whole spinal cord?
- Pontine reticulospinal tract (pRST)
- lateral vestibulospinal tract (lVST)
What extensor tract ends in the neck?
medial vestibulospinal tract (mVST)
What flexor tract ends in the UE?
Rubrospinal tract (RuST)
What flexor tract runs the whole spinal cord?
Medullary reticulospinal tract (mRST)
What pathology is BELOW the red nucleus?
decerebrate
What is unique about decerebrate posturing?
NO corticospinal/rubrospinal functions
- extremities in EXT
What pathology is above the red nucleus?
Decorticate
What are the tracts responsible for decorticate posturing?
- Functional rubrospinal tract: UE in FLX
- Active vestibulospinal tracts: BLE in extension
Which level 2 motor contro systems in the brainstem?
- Rubrospinal tract (midbrain)
- reticular: pontine vs medullary (pons)
- Vestibular: lateral vs medial (pons)
Which level 2 motor control tracts end in the whole spinal cord, and which stop at the upper thoracic region?
- Whole spinal cord: pontine and medullary reticulospinal tracts, lateral vestibulospinal tract
- Upper thoracic region: rubrospinal tract and medial vestibulospinal tract
What controls reflexes?
Caudal M1