Motor neurons and

reflexes
  Reflexes is a subconscious stimulus response
mechanism → which are rapid, predictable and
involuntary
 Reflexes are tested to identify any abnormalities in the

Physiology reflex pathway → may indicates problems within the

CNS or PNS

of Reflexes  Reflex tests include superficial and deep tendon

reflexes
 Reflex does not test limb movement but rather the
contraction of the actual muscles
 Reflex arc is the neural wiring of the single reflex →
involves five steps
Reflex arc ▪ The Law of Bell and Magendie state that all sensory (afferent) fibers
enter spinal cord dorsally and all motor (efferent) nerves leave spinal
cord ventrally
▪ Reflex arc is a neural wiring of a single reflex

▪ The reflex arc of the stretch reflex is as follows:

▪ Afferent limb: This consists of receptors and afferent nerve fibres.

▪ The receptor is the muscle spindle that detect the degree and
muscle stretch rate.
▪ The afferent nerves emerge from the muscle spindle and
travel along the spinal nerve to the spinal cord.
▪ The centre of the stretch reflex is the spinal cord's ventral grey
horn area, where the afferent nerve fibres end and synapses directly
with the alpha motor neurons.
▪ Efferent limb: It consists of efferent fibres and the effector organ.

▪ The axons of the alpha motor neurons leave the spinal cord on
the ventral root → supply the skeletal muscle fibres.
▪ Effector organs: Both the extensor and flexor muscles exhibit
the stretch reflex
 Poly synaptic reflex
Reflexes (watch the video)
 are rapid predictable, involuntary motor responses to stimuli
 can be divided according to complexity into
o Monosynaptic
o Polysynaptic
Function & characteristics
 protection of the body by allowing rapid, pre-programmed responses to stimuli
 serve as immediate protective responses to harmful stimuli
 occur over a neural pathway called reflex arcs
 Classification of reflexes
Function & characteristics of reflexes
 protection of the body by allowing rapid, pre-programmed
responses to stimuli
 serve as immediate protective responses to harmful
stimuli
 occur over a neural pathway called reflex arcs

Reflexes are classified according to the:

▪ Development → whether innate or acquired

▪ Responses → reflect the nature of the results of the motor

response →

→ somatic reflex → involuntary responses to stimuli that

involve muscles

→ visceral reflex → automatic response that involves an

internal organ.

▪ Complexity → complexity of the neural circuit involved →

monosynaptic or polysynaptic reflex
▪ Processing → where the information is being processed →
whether it is spinal cord or the brain
 Innate & acquired reflexes
An innate reflex is an involuntary response to a stimulus that happens without conscious thought. The examples
include:

• Knee-jerk reflex in respond to the tapping of the tendon below the kneecap.

• Blink reflex → in respond to the bright light.

• Sneeze reflex: in respond to the nasal passage irritation.

• Yawn reflex: when body needs more oxygen.

• Cough reflex: in respond to the stimulation of airway.

An acquired reflex is an involuntary action that is developed through learning or training → also known as conditioned
reflexes →example include .

• Playing an instrument: A pianist can read music and play the correct note without thinking.

• Driving: A driver can apply the brakes without consciously thinking about it.

• Typing: A person can type without thinking about each keystroke.

• Swimming: A person can swim without consciously thinking about each stroke.
Monosynaptic  Is the rapid simple reflex with the single synapse

reflex 
between afferent & efferent neurons
Example is the patella reflex
 Stimulus is the tendon hammer hitting the patella tendon
→ stimulate intrafusal muscle
 Stimulate the sensory neurons → carry information to
the spinal cord
 Spinal cord is the information processing site
 Sensory neurons synapses with the motor neurons in
the spinal cord
 Efferent neuron target the extrafusal muscle of the
quadriceps → causing them to contract & completing
the patella reflex/knee jerk
 Patella reflex is:
→ an example of monosynaptic reflex

→ the most frequently used test to evaluate the L4

spinal nerve integrity.
 Polysynaptic reflex
 Produces more complex response → can be any where from two
to hundred of synapses within a poly synaptic arc
 Involves interneurons → inter-segmented distribution along
different areas of the CNS
 Inter neurons enable the sensory neuron to interact with many
other neurons → can be inhibitory or excitatory
 Exhibits a reciprocal inhibition → stimulation of the nerve
supply to one muscle and simultaneous inhibition of the
nerves to its antagonistic muscle
Scenario:
During a neurological examination, the doctor observe that a patient’s arm rapidly
withdraws when a painful stimulus is applied. What type of reflex is this, and which
proprioceptors might be involved?
 This is a withdrawal reflex, which is a protective response to a painful stimulus.
 Proprioceptors involved include nociceptors (pain receptors) and possibly muscle
spindles and Golgi tendon organs, which provide information about muscle position
and tension during the withdrawal.
 Muscle Spindle Structure
➢ Muscle spindle are important in the reflex arc
➢ Are receptors within the muscle
➢ Consist of specialized muscle fibers called intrafusal fibers
muscle spindles → serve as specialized sensory organ that detect
amount and rate of change in the length of the muscle → respond
to stretch → innervated by sensory neurons → afferent neurons
➢ Lie within spindle-shaped connective tissue capsules parallel to
extrafusal fibers → responsible for muscle tone → muscle
contraction & relaxation

➢ Each spindle has its own efferent and afferent nerve supply.
➢ Stretch receptors respond to the stretching of the surrounding muscle & contribute to the
coordinated muscle activity → hence play key role in stretch reflex

➢ When the endpoint of muscle stretches, the spindle send a reflex arc signal to the spinal cord.

➢ This sense organ protects you from overstretching or stretching too fast and hurting yourself.
 muscle spindle pathways
When the muscle is stretched intrafusal muscle fibers are

also stretched

➢ Causing neural response along the afferent nerve fibers (1).

➢ These fibers synapses directly with alpha motor neurons (2)

supplying the same muscle

➢ causing neural response & muscular contraction to extrafusal

muscle fibres that opposes the stretch (stretch reflex pathway)

The parallel descending pathway produces co-activation of both alpha and gamma motor neurons (3) which cause
the intrafusal muscle contraction concurrently with extrafusal muscle fibres
Primary purpose of stretch reflex is to resist tendency for passive stretch of extensor muscles by gravitational
forces when person is standing upright.
 and  co-activation
▪ When the muscle spindle is stretched nerve impulses are
send to the spinal cord more rapidly.

▪ The interaction of sensory neurons with alpha motor

neurons → stimulate the extrafusal muscle fibers to
cause contract of the stretched muscle and resist further
stretching.

▪ Contraction of the extrafusal fibers would cause the

muscle spindle to become slack and stop transmitting
impulses.

▪ To prevent that, the descending fibers of motor

pathways synapse with both alpha and gamma
motor neurons → causing alpha & gamma
coactivation → contracting the intrafusal muscle
fibers as well → hence maintaining the muscle spindle
sensitivity when the extrafusal muscle contracts.
 Golgi Tendon Organ
Golgi Tendon Organ
▪ Is located at the junction between muscle fibers and the tendon
▪ Consists of afferent nerve ending intertwined with the bundle of
connective tissue.
▪ Protect muscle from pulling away from their tendinous point of
attachment to the bone
▪ Primarily  the extrafusal muscle contraction by inhibiting the
alpha motor neural stimulation

➢ Contraction of extrafusal muscle generate tension within the Golgi tendon organ.

➢ Golgi tendon organ detect the strength of muscle contraction although not situated in the muscle fibre
Frequency of firing is directly related to the tension developed → hence the Golgi tendon organs
are most sensitive to tendon tension and hence primarily activates by the tendon tension
changes.
 Joint capsule receptors
▪ Are mechanoreceptors play a central role in proprioception

▪ Detect mechanical stimuli , such as pressure, stretch, and vibration

▪ Monitor the position and movement of the body such as detecting joint
position and movement,

There are several types of joint mechanoreceptors.

▪ Free nerve endings, are widespread and sensitive to mechanical

changes in the joint, like movement and compression

▪ Ruffini Endings, are encapsulated nerve endings that respond to joint

position and slow, sustained stretching.

▪ Pacinian Corpuscles, are rapidly adapting and detect high-frequency vibrations and joint pressure changes.

▪ Golgi Tendon Organs, are located in ligaments and capsules, responding to alterations in joint tension and force →
these mechanoreceptors play a crucial role in sensory input and coordination regulation within joints
 Motor neurons

Is involved in regulating activities in muscles or glands

o divided into upper motor & lower motor neurons → interact with one
another to cause movement & other responses along the
corticospinal & corticobulbar tracts
o Lower motor neurons influence the activities of the muscles or glands

o Divided into: somatic motor neurons

→ Somatic motor neurons → control movement & muscle tone

▪ Subdivided into: alpha, beta & gamma motor neurons

→ Special visceral motor neurons → supply muscles of the head &

neck
→ General visceral motor neurons → involved in the autonomic
nervous system
 Upper motor neurons
There two types of the upper motor neuron tracks

▪ Corticospinal tract → from cortex to the spinal cord

▪ Corticobulbar tract → from cortex to the bulb of the brain stem (to

specific cranial nerve located in the pons and medulla) → lesion of this
tract is called pseudobulbar palsy

The lower motor neuron are the destination/end point of the upper motor
neuron tracts

Upper motor neurons originating in the cortex descend all the way to the
spinomedullary junction where they cross and terminate on the lower
motor neurons in the spinal cord or brain stem
Ipsilateral v/s contralateral
▪ Ipsilateral means the same side, while contralateral means the opposite
side. These terms are used to describe the side of the body that is
involved in a reaction or movement.

Examples

▪ Ipsilateral movement: Moving muscles on the same side of the body.

▪ Contralateral movement: Moving muscles on opposite sides of the body

▪ Contralateral paralysis: Paralysis on the opposite side of the body, such

as paralysis of the left leg after a stroke on the right side of the brain

▪ Hemiparesis is weakness or the inability to move on one side of the body

→ hemiplegia refers to complete paralysis, while hemiparesis refers to
partial weakness.
 Motor pathways: Pyramidal system
 Pyramidal system is the system of voluntary movement

 Important tracts in the pyramidal system are:

▪ Lateral corticospinal tract

▪ Anterior corticospinal tract

 Target organs of the motor neurons are the skeletal muscle

cells

 Upper motor neurons from the right primary motor cortex

pass through internal capsule → thru brain stem passing
thru the area called pyramid hence it is called pyramidal
system.

 Majority of the upper motor neurons are contained in the

lateral corticospinal tracts

 Neurons that travels through the lateral corticospinal tract

crosses over at the medulla/pyramids of the brain stem
Motor pathways: Pyramidal
system (Cont.)
 Once upper motor reaches the spinal cord it will synapses
with the lower motor neuron at the anterior horn of spinal
cord

 Lower motor neuron will then target the skeletal muscle for
the movement of that body part involved

 Some of the motor neurons that project to the proximal

muscle travels in the anterior corticospinal tract and cross
over when they reach the levels of the spinal cord

 The distal muscles are those farther from the center of the
body and include the muscles of the lower arms and legs and
the hands and feet.

 The proximal muscles are the muscles closest to the center of

the body such as the muscles of the shoulder, pelvis, and
upper arms and legs.
Motor pathways: Rubro-spinal
tract
▪ Originate in the red nucleus of the mid brain

▪ It crosses over and descend in the lateral aspect of the spinal cord

▪ Target lower motor neurons which facilitate muscle flexion & inhibit
neurons in the muscle extension

▪ Plays an important role in flexor reflex activity (withdrawal reflex),

→ withdrawing hand after touching a hot object,

Summary

▪ Upper motor neuron transmits information from the brain to the

brain stem or spinal cord.

▪ Lower motor neuron transmits information from the brain stem or

spinal cord to the skeletal muscles.
 Damage to the corticospinal tract anywhere along its course, from the
cerebral cortex to the spinal cord, it is referred to as an upper motor
neuron lesion.

 The following features will be present in a neurological examination of a

patient with an upper motor neuron lesion,
o Weak or absent voluntary movement of the muscles
o Increased muscle tone called spasticity
o Babinski sign
→ Normally stroking the lateral aspect of the sole of the foot will
result in plantar flexion of the great toe
Upper Motor
→ With the Babinski sign, the great toe dorsiflexes. Neuron
o Suppression of the superficial reflexes, i.e. abdominal and Lesion
cremasteric reflexes.
→ Normally, stroking of the abdomen will result in contraction of the
abdominal musculature.
→ an upper motor neuron lesion → suppresses these reflexes.
o Withdrawal of the ipsilateral testis .
→ if the medial side of the thigh is touched gently, the ipsilateral
testis will withdraw.
→ an upper motor neuron lesion suppresses the ipsilateral
testicular withdrawal in the male.
 Causes of the upper motor neuron lesion
o Stroke

o Axons demyelinating conditions of the upper motor neuron

▪ Multiple sclerosis

▪ Fredericks ataxia

▪ B12 deficiency

o Amyotrophic lateral sclerosis

o NB: Cremasteric reflex is absent in an upper motor neuron lesion

Causes of the lower motor neuron
lesion
o Polio myelitis

o West Nile virus

o Spinal muscular atrophy

o Any kind of neuropathy

▪ Cauda equina syndrome

▪ Guillain-Barre syndrome → most common cause of acute flaccid neuromuscular

paralysis
▪ Diabetic neuropathy

o Botulinum toxin (Botulism) inhibit acetylcholine release at the axon terminal

o Amyotrophic lateral sclerosis

[Link] (Guillian barre syndrome )

 Corticobulbar motor neuron lesion

 Damage to the corticobulbar pathway produces a specific type of upper motor lesion called
Pseudobulbar palsy

 Damage to the destination of the corticobulbar tract to the cranial nerve nuclei this lower

motor lesion called Bulbar palsy

 Characteristic that differentiate upper
and lower motor neuron lesions
Motor neuron lesions affects the following
▪ MASS → is a decrease in size of the muscle atrophy → also referring to the muscle mass.
▪ FASCICULATION → most characteristic of a lower motor neuron lesion
▪ DIFERRENCES IN TONE AND REFLEXES
 How is MASS affected in motor neuron lesion
Damage to the upper motor neuron

→ disrupt the connection from the cortex and spinal cord

→ inhibit voluntary decision & control over skeletal muscle movement → leading to the development of
disuse mass atrophy

▪ Disuse mass atrophy → accounts 15-20% loss of muscle mass compared to 75-80% in the lower motor
neuron lesion
▪ Damage to lower motor neuron lead to a  in the release of acetylcholine (Ach)

▪ Ach binds to

→ nicotinic receptors → leading to muscle contraction

→ muscle receptors that lead to cell signalling pathway → stimulate transcription factor → leading to
synthesis of muscle proteins
▪ Damage disturb the balance between protein synthesis and protein degradation → eventually leading to
proteolysis → causing denervation atrophy → 80% muscle mass loss
 Fasciculation
Can be defined as involuntary pathological muscle contraction especially of the tongue → innovated
by the hypoglossal nerve
Only affects lower motor neuron
▪ Damage of this nerve lead to a significant  in the release of acetylcholine (Ach)

▪ Ach deficiency lead to a  in Ach receptor activity → up regulation of Ach receptors →  Ach receptors

▪  Ach receptors become mechanically sensitive → as such tapping of the muscle may activate the Na+
channels to open → allowing Na+ ions to rush in → leading to  muscle contraction called fasciculation

Fibrillation is the fasciculation that are expressed on a electromyogram (EMG) → representation of

fasciculation on electromyogram
 Tone, deep tendon reflexes and strength
▪ Cortical fibres of the corticospinal pathway branches and act on the
medullary reticulospinal nuclei (MRN)
▪ These fibres to the MRN are stimulatory

▪ Axon of the MRN going to anterior column are inhibitory → primarily

inhibiting the lower motor neurons
▪ The lower motor neuron has two fibres, which innervate

→  motor neuron → innervate extrafusal fibres

→  motor neuron → innervate intrafusal fibres of the muscle spindle

Damage to the upper motor neuron → loss of the stimulation of MRN → 

stimulation of the MRN fibres to the spinal cord → leading to 
stimulation of the lower motor neurons and  reflex pathway
UMN lesion
 motor neuron →  muscle tone → hypertonia
 motor neuron activity →  sensitivity of muscle spindles →  stretch
reflex pathway → hyper reflexia ( Deep tendon reflex) → causing
spastic paralysis
 → During a physical exam, a patient demonstrates
exaggerated deep tendon reflexes. What might this
suggest about the state of their central nervous
system, and which pathways could be involved?
Answer:
Case study → Exaggerated deep tendon reflexes may suggest

1
upper motor neuron involvement or damage.
→ This could indicate a loss of inhibitory control from
higher brain centers or descending pathways,
leading to heightened reflex responses due to
increased central nervous system excitability.
 Spasticity v/s rigidity & lower motor neuron
lesion
o Spastic paralysis→ most commonly associated with an upper motor neuron lesion

o Spasticity is velocity dependent →  resistance with speed of the movement in one direction

→ no tremors but there is weakness

→ Clasp-knife phenomenon muscle gives out resistance and starts to relax at some stage.
o Rigidity is velocity independent → resistance is in both directions

→ associated with PD tremors → there is no weakness

→ Lead pipe rigidity → the arm entire flexion & extension become rigid .
→ Cogwheel rigidity → sense of rigidity or hypertonia with tremors along the way
LMN lesion
Damage to  motor neuron
  motor neuron activity →  muscle tone → hypotonia → super floppy muscle → flaccid
Damage to  motor neuron activity
  motor neuron activity →  sensitivity of muscle spindles →  stretch reflex activity → hyporeflexia →  deep tendon
reflexia → Flaccid paralysis
 Special test in UMN lesions
o Scraping the bottom the bottom of the foot from bottom up

→ activate sensory receptors

→ send information to the spinal cord

→ act on the motor neurons which control the plantar flexors muscle
around the foot
→ causing the toes to curl (point down)

o Corticospinal tract normally inhibit motor neurons going to the dorsi-

flexors more than the plantar flexors → which point the toes towards the
sky
o In UMN lesion → cortical spinal tract is damaged → losing the inhibition of the motor neurons to the dorsi-flexors →
causing plantar extensors muscle to over fire & overcome the activity of the plantar flexors → big toe dorsi-flexes (point
up towards) & other toes fan out → this is called a positive Babinski reflex (extensor plantar response)
o Positive Babinski in children  one year old → developing corticospinal tract are not fully myelinated (misfires)
→ resulting in hyper stimulation of the motor neuron to the dorsi-flexors
→ non-pathological position Babinski reflex
o A positive Babinski sign indicates upper motor neuron damage affecting the corticospinal tract in the affected
hemisphere
 Comparison between the upper versus the
lower motor neuron lesion.
Upper motor neuron lesion Lower motor neuron lesion

MASS • Minimal decrease in muscle • Significant reduction in

mass (15-20 ) muscle mass (80% )

Type of atrophy • Disuse atrophy • Denervation atrophy

Type of paralysis • Spastic • Flaccid

Tone • Hypertonia ( tone) • Hypotonia
Deep tendon reflex (DTR’s) • Hyper reflexia ( DTR/) • Hypo reflexia

Fasciculation • Absent • Present

Fibrillation • Absent • Present
Positive Babinski sign • Present • Absent
Pronator’s drift • Present • Absent
Hofman’s sign • Present • Absent
The end