reflexes
TRANSCRIPT
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PHYSIOLOGY OF REFLEXES
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Definition
Classification
Characteristics of reflexes
Monosynaptic reflexes
Polysynaptic reflexes
Others
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Definition
Coordinated involuntary motor response initiated by stimulus, applied to peripheral receptors.
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• Basic unit of integrated reflex activity is REFLEX ARC. it has 5 components :
1. Receptor - muscle spindle ( DTR)2. Afferent - 1a , II fibers3. Centre - spinal cord 4. Efferent - motor nerve 5. Effector - extrafusal fibers.
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Definition
Classification
Characteristics of reflexes
Monosynaptic reflexes
Polysynaptic reflexes
Others
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Classification of reflexes
REFLEXES
Clinical classificationSuperficial
Deep Visceral
Pathological
Anatomic classification
Segmental Intersegmental Suprasegmental
No. of synapsesAsynaptic
Monosynaptic Bisynaptic
Polysynaptic
Functional classificationFlexor
Extensor Righting Postural
Withdrawal
Conditioned Unconditione
d
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Clinical classification
• Superficial - stimulating superficial structures Examples• Deep – stimulating receptors deep in muscle. Examples• Visceral – stimulating receptors in viscera. Examples• Pathological – present only during abnormality
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Anatomic classification
• Segmental – reflex arc pass thru one anatomic segment . Ex : knee jerk
• Intersegmental – involve > one segment Ex : crossed extensor response.
• Suprasegmental – involve interaction with suprasegmental components.
Ex: postural reflexes (head-limb)
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Number of synapses
• Asynaptic axon reflex
• Monosynaptic stretch reflex
• Bisynaptic reciprocal innervation
• Polysynaptic superficial reflex
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Functional classification
• Flexor reflexes• Extensor reflexes• Righting reflexes• Postural reflexes• Withdrawal reflexes
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Others
• Unconditioned reflexes – inborn or inherent reflexes .
• Conditioned reflexes – acquired reflexes.
Secretion of saliva when food is kept in mouth is unconditioned reflex and,
secretion even with thought is ‘conditioned’.
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Definition
Classification
Characteristics of reflexes
Monosynaptic reflexes
Polysynaptic reflexes
Others
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MONOSYNAPTIC REFLEXES
• Stretch reflex
• Inverse stretch reflex
• Reciprocal innervation
• Clonus
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Stretch reflex
• When a skeletal muscle with intact nerve supply is stretched, it contracts – stretch reflex.
• Stimulus – stretch• Response – contraction • Sense organ – muscle spindle
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Muscle spindle
• Proprioceptor present in skeletal muscle.
• 6-14 muscle fibers - Intrafusal fibers (IFF) - in a spindle shaped fibrous sheath.
NBF - nuclear bag fibersNCF – nuclear chain fibers
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• Afferents : I a and II fibers
I a - from central part of all fibers (annulospiral ends)II – only from NCF ( flower spray ends )
• Efferent : gamma fibers to both NBF and NCF. alpha motor neurons supply extrafusal fibers
I a and gamma 1 – dynamic responseII and gamma 2 – static response
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Functions of muscle spindle :
• Maintains length of muscle fibers (EFF) at rest or activity – gives feed back to higher centers for comparing with intended movement.
• Monitor velocity of muscle contraction.
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Gamma efferent discharge• IFF are not strong enough or not plentiful enough
to cause shortening of muscle.
• It causes shortening thru reflex arc (indirectly) – shortening of IFF – stretch of NBF and 1a aff - reflex muscle contraction through alpha fibers .
• If muscle is stretched during the gamma stimulation, additional AP s are stimulated and rate of discharge of 1a afferents increases .
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(gamma motor neurons increases sensitivity of muscle spindle to stretch)
Normally there is increased gamma discharge in
parallel to alpha. Due to this alpha-gamma linkage, spindle also shortens along with muscle.
Due to this continues response of spindle through out muscle contraction , the physiologic oscillation is reduced and muscle contraction is smoothened.
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• Factors influencing gamma discharge –
noxious stimulus of skin
anxiety
Jendrassik’s maneuver : strong simultaneous motor act causes increased gamma discharges and thru irradiation influences other levels.
when voluntary act precedes by 0.5 sec, jerk is inhibited (negative reinforcement)
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Higher centers also influence muscle tone through influencing gamma efferents – brain stem nuclei, cerebellum and motor cortex.
Cortex inhibits gamma neurons and cerebellum facilitates them.
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Importance of stretch reflex• Production of muscle tone – “partially contracted
state of muscle”.• Maintenance of posture – in erect posture gravity
tends to flex hip/knee - this slight initial flexion stretches the extensor , causing its contraction reflexly.
due to this man remains standing.Mainly in anti-gravity musclesNon fatiguebleSimple reflex arc (short latency)
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• DTR are monosynaptic reflexes.• Electrical analogue for DTR is the HOFFMAN’s
reflex or H – reflex,
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INVERSE STRETCH REFLEX [Auto inhibition / lengthening reaction / clasp knife
reflex ]• When a limb is passively flexed, in spasticity, lot of
resistance occurs due to contraction of antagonist muscle. ( in this muscle, the spindle is activated by stretch which inturn causes contraction of the same thru 1a )
• When flexed with force it gives off (clasp knife) . This is due to activation of GTO of antagonist muscle.
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• Impulses from GTO thru 1b afferents – reach motor neurons supplying same muscle thru an inhibitory interneuron in b/w ( golgi bottle organ) . Therefore it relaxes
• GTO detects force of contraction and helps in preventing tearing of muscle
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RECIPROCAL INNERVATION
• Stimulation of afferent nerve results in contraction of agonist muscle with relaxation of antagonist muscle.
• This is the physiological basis for normal movements and Crossed extensor reflex
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CLONUS
• Regular, rhythmic contractions of muscle, subjected to sudden maintained stretch.
• Mechanism – in UMN lesions, the inhibitory effect of CST on gamma neurons is lost. So gamma eff discharges are increased. So, spindles are already hyperactive
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• When muscle is stretched passively, bursts of impulses from them discharges all the motor neurons at once .
The consequent contraction stops the spindle discharges, but due to sustained stretch the spindles are again stimulated and it continues
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Definition
Classification
Characteristics of reflexes
Monosynaptic reflexes
Polysynaptic reflexes
Others
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POLYSYNAPTIC REFLEXES
Response with fewer synapses is earlier than with more synapses (due to synaptic delay)
Some activities reverberate until they become unable to cause a propagated transsynaptic response and dies out.
These are common in brain and SC
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WITHDRAWL REFLEX • Mechanism is ‘reciprocal innervation’ . Severe pain leads to crossed extensor
response.
Sherrington pointed out the survival value of it.
flexion of stimulated limb- is to get away extn. Of other limb – to support the body.
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SUPERFICIAL REFLEXES
• Stimulating areas of skin or mucosa causes contraction of corresponding muscles due to their surface origin.
• Corneal / conjunctival reflex• Abdominal reflex• Gluteal reflex• Anal reflex• Bulbocavernous reflex• Cremastric reflex• Plantar reflex
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• Reflex arc for these reflexes is not definitely known. It seems to be long and complex – including many interneurons.
Afferent- carried thru posterior columns and STTEnd up - in mid brain, thalamus or fore brainEfferent – carried down thru CST, or extra
pyramidal tracts – to anterior horn cell.
• In UMN lesions , superficial reflexes lost ( path may be damaged) and DTR are exaggerated (release phenomenon)
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Definition
Classification
Characteristics of reflexes
Monosynaptic reflexes
Polysynaptic reflexes
Others
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MASS REFLEX
• When central excitatory state is marked, the excitatory impulses irradiate not only to many somatic areas of SC , but also to autonomic areas.
• Ex : In chronic paraplegias, mild noxious stimulus cause – in addition to withdrawal response in all 4 limbs- urination, defecation, sweating and BP fluctuations
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• Mechanism – when central inhibitions are lost, it leads to increased activity through reverberating circuits (irradiation)
Also due to prolonged effects of sympathetic mediators.
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SPINAL SHOCK
• WHEN spinal cord transection is complete , there is a period immediately after the accident when all spinal reflexes below the level of transection are reduced or suppressed.
• Over wks-months , the reflexes gradually return and are exaggerated.
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• Mechanism –
(of shock)- sudden withdrawal ,of tonic facilitatory influences from the brain.
(of recovery) – denervation super-sensitivity and increased post synaptic receptors.
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Definition
Classification
Characteristics of reflexes
Monosynaptic reflexes
Polysynaptic reflexes
Others
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Characteristics of reflexes
• Irradiation • Delay • Summation • Occlusion • Subliminal fringe • Facilitation • Recruitment
• After discharge• Fatigue • Fractionation • Reciprocal
innervation• Rebound
phenomenon
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Irradiation
• Strong stimulus• Spread to neighboring neurons producing a
wider response.• Mechanism – collaterals
Withdrawal responseCrossed extensor responseMass reflex Reinforcement
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Delay
• Total reflex delay / reaction time• Central delay
• Mechanism – due to synapse
Ex : KNEE JERK - reaction time – 19-24 msec central delay – 0.6-0.9 msec
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Summation
• Subliminal stimuli – insufficient response
• Spatial summation – applied simultaneously• Temporal summation – in series
• Mechanism – persistence of excitability in the path of reflex arc, which summates with the next.
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Occlusion
T : tension produced by simultaneous stimulation of 2 afferents.
t1 : by afferent 1 t2 : by afferent 2
T < t1 + t2
Mechanism : due to common motor nerves shared by both afferents.
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Tt 1 + t 2
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Subliminal fringe
Reverse of occlusion
T > t 1 + t 2
Mech – separate stimuli – inadequate for some motor neurons ( subliminal )
- simultaneous stimuli – these subliminal ones get summated.
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Facilitation
If reflex is elicted repeatedly at proper intervals, the response becomes progressively higher .
Mechanism : passage of 1st impulse facilitates the transmission of next one – by decreasing synaptic resistance , the next subliminal stimulus becomes liminal. (facilitation)
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Recruitment
Direct motor nerve stimulation – tension quickly rises to maximum.
Sensory afferent stimulation – gradual rise
Mechanism – inteneuron ( ?? )
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After discharge
After a reflex contraction , if stimulus discontinued – relaxes gradually ( not at once )
Mechanism – interneuron go on discharging . And also impulse takes longer time to reach muscle thru interneuron.
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Fatigue
If a reflex is elicited repeatedly, it becomes feebler and disappear.
Mechanism – seat of fatigue is CNS (mainly synapse)
Synapse > motor end plate > muscle.
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Fractionation
Direct motor N stimulation – higher amount of contraction , than reflexly thru afferent N
Mechanism – strength of impulse lost while crossing synapse, so only part of ( fraction of ) motor pool is stimulated
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Reciprocal innervation
In a reflex , when protagonists contracts, antagonists relax to same degree.
Mechanism – bisynaptic – inhibitory interneuron present.
i afferent – at single joint. ii, iii, iv - at several joints
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Rebound phenomenon
(just as muscle is excited , it can also be inhibited reflexly – reflex inhibition- tone decreased and muscle elongated)
Following it, if stimulus is stopped – tone is increased much more , instead of going to normal resting tone .
Mechanism - ??
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