1.sistem motorik
TRANSCRIPT
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SIST M MOTORIK
Penyusun : Willy Wijaya, dr
Pembimbing: Henny. A.S, dr, SpS(K)
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Effectors MOTOR SYSTEM
Skeletal Muscle → SOMATIC MOTOR SYSTEM
Smooth Muscle → AUTONOMIC MOTOR SYSTEM
Glands (sympathetic and Parasympathetic)
Elements of Motor System
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KORTEX PUSAT MOTORIK
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Lower Motor Neuron
cell body: anterior horn
axon: anterior root,
spinal nerve
axon terminal:
neuromuscular
junctionEffector:
skeletal muscle
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Somatic Motor System
Upper Motor Neuron
Lower Motor Neuron
Skeletal Muscle
Auxiliary
Motor Pathways
motor nerve
pyramidaltract
reflexarc
descendingpathways from
brain stem
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Corticospinal Tract
Origin: Cerebral Cortex
Brodmann Area 4 (Primary Motor Area, M I)
Brodmann Area 6 (Premotor Area, PM )
Brodmann Area 3,1,2 (Primary Somesthetic Area, S I)
Brodmann Area 5 (Anterior Portion of Sup. Parietal Lobule)
Corona Radiata
lnternal Capsule, Posterior Limb
Crus Cerebri, Middle PortionLongitudinal Pontine Fiber
Pyramid - pyramidal decussation
Corticospinal Tract - Lateral and Anterior
Termination: Spinal Gray (Rexed IV-IX)
Upper Motor Neuron Pyramidal Tract
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T
R
A
K
T
US
P
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M
ID
A
LI
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Upper Motor Neuron Pyramidal Tract
1. corona radiata
2. internal capsule,
posterior limb
3. crus cerebri
4. longitudinal
pontine fiber
5. pyramid
6. pyramid decussation
7. lateral corticospinaltract
8. anterior corticospinal
tract
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Upper Motor Neuron
Pyramidal Tract
1. corona radiata
2. internal capsule
3. crus cerebri
4. pontine longitudinal fiber
5. pyramid
6. pyramid decussation
7. lateral corticospinal tract
8. anterior corticospinal tract
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T
R
A
K
T
U
S
E
X
T
R
A
P
I
RA
M
I
DA
L
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CorticospinalTract
• completion of
myelination in2nd year of life
• time of
standing and
walking
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Upper Motor Neuron Pyramidal Tract
Corticobulbar Tract
- Corticofugal fibers projecting to, and terminating in
the portions of lower brainstem
- Termination:
1) motor nuclei (upper motor neuron pathway)
hypoglossal, ambiguus, facial motor,
trigeminal motor, abducens, trochlear
and oculomotor nucleus2) sensory relay nuclei
nuclei gracilis and cuneatus, trigeminal
sensory nucleus, solitary tract nucleus
3) reticular formation (corticoreticular fiber)
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Corticobulbar Tract (UMN Pathway)
- Corticofugal fibers projecting to, cranial motor nuclei
GSE - hypoglossal (XII), abducens (VI),
trochlear (IV) and oculomotor (III) nucleus
SVE - ambiguus (IX, X, XI), facial motor (VII),
trigeminal motor (V) nucleus
- largely bilateral
laryngeal, pharyngeal, palatal and upper facial
muscles of mastication and extraocular muscles
- unilateral
lower facial musculature (facial palsy)
SCM and trapezius (uncrossed) --- spinal accessory
- Pseudobulbar Palsy --- syndrome of bilateral UMN lesion
Upper Motor Neuron Pyramidal Tract
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Upper Motor Neuron vs Lower Motor Neuron Syndrome
LMN syndrome UMN Syndrome
Type of Paralysis Flaccid Paralysis Spastic Paresis
Atrophy Severe Atrophy No (Disuse) Atrophy
Deep Tendon Reflex Absent DTR Increase
Pathological Reflex Absent Positive Babinski Sign
Superficial Reflex Present Absent
Fasciculation and Could be Absent
Fibrillation Present
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Upper Motor Neuron Syndrome
Spasticity
- Increased resistance to passive movement in
antigravity muscle (flexor in arm, extensor in leg)
Clasp Knife Phenomenon
- Sign of Upper Motor Neuron Syndrome,
especially internal capsule lesion
cf. Rigidity
- increased muscle tone, no increased DTR
Cogwheel Phenomenon
- symptom of basal ganglia or cerebellar lesion
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LESI SESUAI TINGKATAN
a. Lesi kortikal : parese kontralateral, jarang plegi.
b. Lesi kapsula interna : hemiplegi spastik kontralateral.
Terlibat kortikonuklearis→ paralisis fasialis
kontralateral.
c. Lesi pedunkel : hemiplegi spastik kontralateral +
paralisis n.okulomotoris isilateral.
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d. Lesi pons : hemiplegi kontralateral, mungkin
bilateral. Nervus kranial mungkin tidakterkena.
e. Lesi piramidalis : hemiparesis flasid
kontralateral, jaras ekstrapiramidalis utuh.
f. Lesi servikal : traktus piramidalis lateral
terlibat→ hemiplegi spastik ipsilateral.
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g. Lesi torakalis : monoplegi spastik
ipsilateral tungkai, bila bilateral →
paraplegi.
h. Lesi radix anterior : kelumpuhan flasid
ipsilateral.
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SINDROMA CORNU ANTERIOR
• Paling sering terkena pada poliomielitis akut
dan atrofi muskular spinalis progresif kronik.
• Mengakibatkan paralisis flasid disertai atrofi
otot.
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