11 feb lect. reflexes, Ashok Solanki, asso. prof physio,
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Transcript of 11 feb lect. reflexes, Ashok Solanki, asso. prof physio,
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Apr 10, 2023 Dr. Ashok Solanki 1
REFLEX CONTENTS:
DEFINITIONREFLEX ARCTYPES/CLASSIFICATION OF
REFLEXESSTRETCH REFLEXMUSCLE SPINDLEPROPERTIES OF REFLEXES
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Apr 10, 2023 Dr. Ashok Solanki 2
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Nerve pathwaysAscending Tracts
Tract Signal function
Dorsal columns Vibration, tactile sensation, conscious proprioception
Spinocerebeller Proprioception
Spinothalamic (lateral and anterior)
Pain, temperature, itch (lateral), crude touch (anterior)
Spinoreticular Pain
Spinomesencephalic Pain
Spino-cervico-thalamic Pain (touch?)
Spinohypothalamic Pain
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Structure of spinal cord
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Fetal 3rd month: ends at coccyx
Birth: ends at L3 Adult position at approx L1-2
during childhood End: conus medullaris
This tapers into filum terminale of connective tissue, tethered to coccyx
Spinal cord segments are superior to where their corresponding spinal nerves emerge through intervetebral foramina (see also fig 17.5, p 288)
Denticulate ligaments: lateral shelves of pia mater anchoring to dura (meninges: more later)
Spinal cord
http://www.apparelyzed.com/spinalcord.html
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Spinal nerves continued
Divided based on vertebral locations 8 cervical 12 thoracic 5 lumbar 5 sacral 1 coccygeal Cauda equina (“horse’s tail”): collection of nerve
roots at inferior end of vertebral canal
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Classified as
According to centre IN THE SPINAL CORD-
seg, inter, supra.
According to function-
flexor, extensor, postural R.
Clinically-
supreficial, deep, visceral
No. of synapse involved.
Mono and polysynaptic
According to origin–
spinal cord, brain stem, cortical etc.
Conditional and unconditional – since birth
Rapid, stereotyped, invountary response to a sensory stimuli consciouslly or unconsciouslly.
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CLASSIFICATIONCONDITIONED (ACQUIRED)/
UNCONDITIONED(SINCE BIRTH)CEREBELLER, CORTICAL, MIDBRAIN,
SPINALSOMATIC:FLEXOR , EXTENSOR
VISCERAL: AUTONOMICMONOSYNAPTIC , POLYSYNAPTICSUPERFICIAL, DEEP, VISCERAL,
PATHOLOGICALSEGMENTAL, INTERSEGMENTAL,
SUPRASEGMENTAL
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Dr. Ashok Solanki
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Functions or reflex action
Maintain the homeostasis- b.p regulation, heart rate, digestive , autonomic reflexes
Automatic actionsBalance and posture Reflex maintining the movements -eyes
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REFLEX ARC ANATOMICAL NERVOUS PATHWAY OF
REFLEX IS CALLED REFLEX ARC.
RECEPTOR
SENSORY / AFFERENT NERVE
CENTER
EFFERENT / MOTOR NERVE
EFFECTOR ORGAN
* BELL-MAGENDIE LAW: DORSAL ROOTS ARE SENSORY & VENTRAL ROOTS ARE MOTOR.
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SUPERFICIAL REFLEXESCORNEAL AND CONJUNCTIVAL
REFLEXPHARYNGEAL REFLEXPALATAL REFLEXABDOMINAL RELEXPLANTAR REFLEX: Scratch over the
outer edge of sole cause plantar flexion and adduction of all toes and dorsiflexion and inversion of foot.( L5,S1)
ANAL REFLEX
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DEEP REFLEXESJAW JERK: 5TH CRANIAL NV NUCLEI BICEPS JERK: C5,6TRICEPS JERK: C6,7SUPINATOR JERK: C5,6KNEE JERK: L2,3,4ANKLE JERK: S1,2
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Apr 10, 2023
Reflex ArcSpecific nerve impulse pathway5 components of reflex arc
receptor sensory neuronintegrating centermotor neuroneffector
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PROPERTIES ONE WAY CONDUCTION SUMMATION: SPATIAL, TEMPORAL OCCLUSION SUBLIMINAL FRINGE RECRUITMENT AFTERDISCHARGE REBOUND PHENOMENON FATIGUE
RECIPROCAL INNERVATION AND RECIPROCAL INHIBITION
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Flexor (withdrawal) Reflex Step on tack (pain fibers send
signal to spinal cord Interneurons branch to different
spinal cord segments Motor fibers in several
segments are activated More than one muscle group
activated to lift foot off of tack
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Crossed Extensor Reflex Lifting left foot requires
extension of right leg to maintain one’s balance
Pain signals cross to opposite spinal cord
Contralateral extensor muscles are stimulated by interneurons to hold up the body weight
Reciprocal innervation - when extensors contract flexors relax, etc
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Apr 10, 2023
Clinical ConsiderationsChecking a patient’s reflexes may help
to detect disorders/injuryPlantar flexion reflex -- stroke the lateral
margin of the solenormal response is curling under the toesabnormal response or response of children
under 18 months is called Babinski sign (upward fanning of toes due to incomplete myelination in child)
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Apr 10, 2023 Dr. Ashok Solanki 21
Inverse stretch reflexGolgi tendon organ- 2 to 15 in each
muscle.Responds to tension and not the lengthThe Golgi tendon reflex is a protective
reflexrise in tension is sensed by the Golgi
tendon a which stimulates the I-b stimulates the I-b afferents
stimulate the inhibitory interneurons inhibit the α-motoneuron discharge to
the muscleThis reflex relaxation of the extrafusal
muscle fibers
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INVERSE STRETCH REFLEX/ AUTOGENIC INHIBITION
WHEN A MUSCLE IS STRETCHED, IT CONTRACTS BUT IF THE STRETCH IS MAINTAINED (CONTINUED), THE MUSCLE RELAXES.
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UMN lesions
•weakness, paralysis
•spasticity
• tendon reflexes
•+ Babinski sign
•little,if any,muscle
atrophy
•no fasiculation
LMN lesions
•weakness, paralysis
•flaccidity, hypotonia
•Hypo- /no tendon
reflex
• - Babinski sign
•muscle atrophy
•fasiculation of
involved muscle
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Apr 10, 2023 Dr. Ashok Solanki 24
VISCERAL REFLEXES PUPILLARY REFLEXES:
DIRECT LIGHT REFLEXINDIRECT OR CONSENSUAL LIGHT REFLEX
ACCOMODATION REFLEX: CONSTRICTION OF PUPIL, CONVERGENCE OF EYE BALLS, INCREASE IN ANTERIOR CURVATURE OF LENS
CILIOSPINAL REFLEX: STIMULATION OF SKIN IN NECK –DILATATION OF PUPILS
OCULOCARDIAC REFLEX: PRESSURE OVER EYEBALLS - BRADYCARDIA
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PATHOLOGICAL REFLEXES
BABINSKI’S SIGN +
Dorsiflexion of great toe and fanning of other toes.
CLONUSPENDULAR MOVEMENTS
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Flexor reflex (Withdrawal, "hot stove")
1. receptors sense pain
2. sensory impulse to spinal cord
3. synapse to association neuron, synapse to motor neurons
polysynaptic
4. motor neurons to flexor muscles to
5. withdraw offended body part from stimulus
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Spinal reflexes
Static stretch reflex- maintain the tone
Maintain constant degree of muscle contraction (Tone)
Continuous static receptor signal → transmitted via both primary and secondary neurons → S.C → continuous command by static gamma motor neurons → Tone.
Normal tone is due to continuous dischrge of gamma m. n.
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Stretch reflex 2 types
-Response that is transmitted:
Dynemic:
-when there is change in the length of the spindle receptor (stretching of the sensory receptor area of the muscle spindle by stretching of the muscle spindle or the whole muscle). Detect Change in length.
-transmitted by the primary fiber Aα type
Static
continuous information about the length of the muscle (not the change in length).
transmitted by both the primary Aα and secondary (Aβ and Aγ)
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APPLIED:Decreased (hypoactive) stretch reflex:
Destruction of sensory or motor nerve to the muscle
Stimulation of inhibitory areas in brain
Inhibition of facilitatory areas in the brain
Hypothyroidism
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Importance or use of stretch reflex:
1. Tone maintenance2. Maintenance of posture3. Control of voluntary movements
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What are the components of reflex action?
Components of reflex
forms
reflex arc involving
1. receptor- sensory organ
2. afferent neuron-
3. centre
4. efferent neuron
5. effector organ
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Reflex arc
Diagram showing complete reflex arc
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2. 5 Essential Components of the Reflex Arc
Dr. Ashok Solanki
Stimulus at distalend of neuron
Skin Spinal cord(in cross section)
Interneuron
Receptor
Effector
Sensory neuron
Motor neuron
Integrationcenter
(a)
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