Refleks

A reflex is a rapid, predictable motor response to a stimulus 

Reflexes may:  (a) be inborn (intrinsic) or learned (acquired) (b) involve only peripheral nerves and the spinal cord  (aka: spinal reflexes) (c) Involve higher brain centers as well

Reflex Arc - There are five components of a reflex arc (i) Receptor – site of stimulus (ii) Sensory neuron – transmits the afferent impulse to the CNS (iii) Integration center – either monosynaptic or polysynaptic region within the CNS (iv) Motor neuron – conducts efferent impulses from the integration center to an effector (v) Effector – muscle fiber or gland that responds to the efferent impulse

Innate Reflexes

Innate reflexes: Reflexes you are born with.

The are genetically or developmentally programmed

Examples:

Withdrawing from pain

Suckling

Chewing

Tracking objects with the eyes     

                              

Acquired Reflexes

Acquired reflexes are learned motor patterns

Generally more complex than innate reflexes

Examples:

Slamming on the break when driving

Professional skier making quick adjustments in body position

Reflexes

Visceral (Autonomic) reflexes regulate body functions

Digestion, blood pressure, sweating ect…

Somatic reflexes involve skeletal muscles

Function to maintain posture, balance and locomotion

Spinal reflexes:  The important interconnections and processing events occur in the spinal cord.

Cranial reflexes: The integration center is in the brain

Types of Reflexes

Monosynaptic reflexes:  The sensory neuron synapse directly on a motor neuron.

The delay between stimulus and the response is minimized.

The synapse is considered the integration center                                          

Polysynaptic reflexes:  There is at least one interneuron between the sensory and motor neuron

More complex responses

Upper Motor Neurons:

Upper motor neurons: Starts in the motor cortex of the brain and terminates within the medulla (another part of the brain) or within the spinal cord.

Damage to upper motor neurons can result in spasticity and exaggerated reflexes (because of the loss of inhibition) “Spastic Paralysis”

Lower Motor Neurons

Lower motor neurons go from the spinal cord to a muscle.

The cell body of a lower motor neuron is in the spinal cord and its termination is in a skeletal muscle.

The loss of lower motor neurons leads to weakness, twitching of muscle (fasciculation), and loss of muscle mass (muscle atrophy). “Flaccid Paralysis”.

Reflexes

Intact reflexes require

Intact sensory afferent nerves (coming to the spinal cord)

Intact synapse within the spinal cord

Intact efferent motor nerves coming from the spinal column

Adequately functioning muscle.

Reflexes can also be modified by conditions higher in the cord than the relevant

Synapse including the brain it self.

The purpose of testing reflexes is to check the integrity of the system as a whole.

An absent reflex indicates a problem somewhere in the reflex arc but it does not tell you where.

Stretch Reflexes

Stretching of the muscle activates a muscle spindle.

A muscle spindle is a bundle of specialized skeletal muscle fibers that act as sensory receptors.

An impulse is transmitted by afferent fibers to the spinal cord

Motor neurons in the spinal cord cause the stretched muscle to contract

The integration area in the spinal cord causes the antagonist muscle to relax (reciprocal inhibition)

Stretch Reflex Example

Patellar Reflex (L2, L3, L4)

Tap the patellar tendon

muscle spindle signals stretch of muscle

motor neuron activated & muscle contracts

Quadriceps muscle contracts

Hamstring muscle is inhibited (relaxes)

Reciprocal innervation (polysynaptic- interneuron)

antagonistic muscles relax as part of reflex

Lower leg kicks forward

sensory and motor connections between muscle and spinal cord are intact.

Stretch Reflex Example : Ankle Jerk (S1, S2)

Stretch the Achilles tendon by pushing up with your left hand on the ball of the foot (extend the ankle): Swing the patellar, hammer onto the tendon, striking it sharply.

Measure the response by: feeling the push against, your left hand and observing, the contraction of the calf muscles.

Stretch Reflex Example: Biceps jerk (C5, C6)

Bend the patient’s arm at the elbow so it is lying relaxed across the lower part of the chest.

Find the long head of biceps tendon in the antecubital fossa and stretch it by pushing down on it with your thumb.

Swing the patellar hammer down and strike your thumb sharply.

Grading Reflexes

Grading of reflexes:

0+ = absent

1+ = hyporeflexic (reduced reflex)

2+ = normal

3+ = hyperreflexia (exaggerated reflex)

4+= clonus

Say “one plus”

Conditions such as hypothyroidism and spinal shock diminish reflexes.

Stimulant drugs, anxiety, and hyperthyroidism increase reflexes. 

Tendon Reflexes

Controls muscle tension by causing muscle relaxation that prevents tendon damage.

Golgi tendon organs in tendon.

Activated by stretching of tendon.

Inhibitory neuron is stimulated (polysynaptic).

Motor neuron is hyperpolarized and muscle relaxes.

Both tendon & muscle are protected

Flexor Reflex

Withdrawal reflex.

When pain receptors are activated it causes automatic withdrawal of the threatened body part.

Reciprocal inhibition:  Interneurons in the spinal cord prevent a stretch reflex in the antagonistic muscles.

Crossed Extensor Reflex

Complex reflex that consists of an ipsilateral withdrawal reflex and a contralateral extensor reflex.

This keeps you from falling over, for example if you step on something painful.

When you pull your foot back, the other leg responds to hold you up.

Cutaneous Reflexes

Elicited by gentle cutaneous stimulation

Important because they depend on upper motor pathways (Brain) and spinal cord reflex arcs.

Cutaneous Reflexes Plantar Reflex

Tests spinal cord from L4 to S2

Indirectly determines if the corticospinal tracts of the brain are working

Draw a blunt object downward along the lateral aspect of the plantar surface (sole of foot)

Normal: Downward flexion (curling) of toes

Abnormal Plantar Reflex Babinski’s Sign

Great toe dorsiflexes (points up) and the smaller toes fan laterally.

Happens if the primary motor cortex or corticospinal tract is damaged.

Normal in infants up to one year old because their nervous system is not completely myelinated.