Refleks

V. Sutarmo Setiadji

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Definition of reflex
A long distance pathway process initiate by a stimulus or a change in the environment as an information which is received by sense organ, integrates the information, and uses the nervous system, endocrine system, or both, to react appropriately.
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Physiological Reflex:
- Somatic reflex the effector is skeletel muscles - Autonomic reflex the effectors are the heart, smooth muscles, or glands

Pathological Reflex:
- Reflex which is arise in a pathological conditions
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Other classification of reflex:

Spinal Reflexes Central reflexes Unconditioned reflex Conditioned reflex Segmental Intersegmental Walking reflex - Ipsilateral - Contralateral - Monosinaps - Multisinaps - Stretch reflex - Withdrawal reflex

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Sel Saraf = Neuron

Dendrit
Takik Ranvier Axon hillock Akson

Lempeng sinaps

Soma
Sel Schwann

Ujung akson

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The reflex arc

- It may contains only two neurons, the sensory (afferent) and motor (efferent) neurons and has single synapse (monosynaptic) and has no interneuron

- Or contains more than two neurons and synapses (polysynaptic)

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Reflex arc, the simplest neural circuit

Afferent fiber Skin

Sensory receptor Efferent fiber

Central nervous system

Spinal cord Muscle as an effector)

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Upper motor neuron/ neuron dari pusat yang lebih tinggi Saraf aferen Kulit

Reseptor indra Saraf eferen

Sistem saraf pusat

Otot (sebagai efektor)

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Medula spinalis (sumsum tulang belakang)

The sensory receptors it may a special receptor cells (rods and cones in eyes, hair cells in cochlea and vestibular apparatus, receptor cells in taste buds) or the end of sensory nerve fiber in other senses with or without special structures.
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There are four kinds of effector : skeletal muscle,

: smooth muscle : the heart

: glands
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Percobaan Pavlov:
- Pada anjing yang lambungnya dilubangi untuk dipasangi kateter. - Setiap kali mulutnya disuapi makanan, keluar liur lambung melalui kateter. Begitu setiap kali. - Setiap kali bel dibunyikan, meski berkali-kali, tidak keluar liur lambung. - Tetapi bila bel dibunyikan setiap kali sebelum mulutnya disuapi makanan pada selang waktu yang pendek, lama-lama bunyi bel sendiri dpt menimbulkan sekresi liur lambung.
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Percobaan Pavlov membuktikan bahwa:

- Antara reseptor dan kelenjar liur lambung terdapat lengkung refleks yang telah berfungsi sebelum percobaan dimulai. - Antara reseptor pendengaran di telinga dan kelenjar liur lambung secara anatomi telah dihubungkan oleh lengkung refleks, tetapi mula-mula lengkung refleks belum berfungsi. - Setelah menjalani latihan beberapa kali, lengkung refleks yang belum berfungsi dapat menjadi berfungsi.
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Percobaan Pavlov diakui sebagai dasar- dasar proses belajar Refleks terkondisi (terbentuk karena latihan)

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Neural Stimulus and response segment Deep tendon Achilles S1 Plantar flexion upon striking the tendon (normal) Biceps C5, C6 Elbow flexion upon striking the tendon (normal) Brachioradialis C5, C6 Radial deviation upon striking the tendon (normal) Jaw Cranial V, Mouth closes upon striking anterior chin (normal)Exaggerated (UMNL) different with Chvosteks sign Medial hamstring L5, S1 Knee flexion upon striking the semimembranosis tendon (normal) Lateral hamstring S1, S2 Knee flexion upon striking the biceps femoris tendon (normal) Patellar L2,L3,L4 Knee extension upon striking the infrapatellar tendon (normal) Tibialis posterior L4, L5 Plantar flexion and inversion upon striking the tibialis posterior just behind the medial malleolus (normal) Triceps C7 Elbow extension upon striking the triceps tendon (normal)
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Reflex

Superficial
Abdominal
Upper

Lower

T7-T10 T10-L1

Movement of the umbilicus toward the area being stroked (normal); if unilateral, pinpointing the involved quadrant indicates the approximate level of lesion
Anal sphincter contracts with touching or stroking the perianal skin (normal) Scrotum contracts and testicle retracts with stroking the skin on the anterior, inner thigh (normal); unilateral absence indicates LMNL injury at L1, L2; bilateral absence indicates UMNL Gluteal muscles contract with stroking the overlying skin (normal). Back extensor muscles contract with stroking the skin overlying the erector spinae muscles (normal)

Anal

S2-S4

Cremasteric

T12, L1, L2

Gluteal Lumbar

L4, L5S1-S3 T12-L5

Plantar S1, S2 Toes flex with lightly stroking the plantar surface of the foot (normal)
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Clonus

Babinski

Chaddock

UMNL Antagonist and agonist muscle groups rapidly alternate involuntary contraction and relaxation with a sudden, forced stretch of a muscle (pathological); usually performed at the wrist (extension), ankle (dorsiflexion), or knee (downward force on the patella to stretch the quadriceps) UMNL(Pyramidal Tract) Great toes extend and other toes splay (extend and abduct) with stroking the lateral plantar surface and across the sole foot (pathological) Great toes extend and other toes splay with stroking the side of the foot distal to the lateral malleolus (pathological)
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Gordon

Great toes extend and other toes splay with compressing or squeezing the calf muscle (pathological) Oppenheim Great toes extend and other toes splay with stroking downward on the anteriomedial tibial surface (pathological)

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Gamma Motor Neuron Motor neurons which activate the contractile regions of intrafusal muscle fibers, thus adjusting the sensitivity of the muscle spindles to stretch. Gamma motor neurons may be "static" or "dynamic" according to which aspect of responsiveness (or which fiber types) they regulate. The alpha and gamma motor neurons are often activated together (alpha gamma coactivation) which allows the spindles to contribute to the control of movement trajectories despite changes in muscle length.

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Gamma motoneurons (-motoneurons), also called gamma motor neurons, are a component of the fusimotor system, the system by which the central nervous system controls muscle spindle sensitivity. The fusimotor system refers to the combination of muscle spindles and motoneurons. The function of the muscle spindle is to provide proprioceptive feedback for the movement, position and extension of muscles. -Motoneurons are located in the brainstem and spinal cord and are smaller than their -motoneuron counterparts, which are responsible for controlling skeletal muscle.

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Function -Motoneurons regulate the gain of the stretch reflex by adjusting the level of tension in the intrafusal muscle fibers of the muscle spindle. This mechanism sets the baseline level of activity in -motoneurons and helps to regulate muscle length and tone. For example, stimulation of a -Motoneuron from higher centers contracts the ends of the intrafusal fibres and consequently stretches the middle part of the muscle (where 1a sensory neurons are located). These afferent neurons are therefore innervated and go on to synapse with alpha-motoneurons.
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Jendrassik's maneuver Ern Jendrassik, Hungarian physician, 1858 1921] A method used to facilitate elicitation of the deep tendon reflexes of the lower extremities. The patient hooks together the fingers of the hands and attempts to pull them apart. While this pressure is maintained, the patellar or Achilles tendon reflex is tested.
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Sistem Saraf Motorik Somatik

Fungsinya dipengaruhi oleh kemauan

Sistem Saraf Motorik Autonom

Ganglion Paravertebral / Intramural Trunkus Simpatikus Fungsinya automatis/tidak dapat dikendalikan kemauan
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Neurotransmiter
Sistem Saraf Motorik Somatik
Asetlkolin Otot Rangka

Sistem Saraf Motorik Autonom Simpatik

Alat Dalam

Asetilkolin

Noradrenalin

Sistem Saraf Motorik Autonom Parasimpatik

Asetilkolin
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Asetilkolin

Pupillary ) Pupillary fibers fibers follow follow the the optic optic tract tract (posterior (posterior third third of of the the optic optic tract) tract) and and separate separate from from the the optic optic tract tract just just anterior anterior to to the the lateral lateral geniculate geniculate body. body. They They then then enter enter the the midbra midb

Pupillary fibers follow the optic tract (posterior third of the optic tract) and separate from the optic tract just anterior to the lateral geniculate body. They then enter the midbrain, where they synapse to pretectal nucleus. The pupillary fibers leave the pretectal nucleus and distributes approximately equally to both EdingerWestphal nuclei. This tract is called the tectotegmental tract.
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Thus, the optic tract carries pupillary fibers from both eyes, and the tectotegmental tract carries pupillary fibers from both pretectal nuclei. From these pupillary fiber arrangements, both pupils constrict in the consensual light reflex.

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Refleks pupil
Miosis: menyempitnya pupil bila intensitas cahaya meningkat. Retina N.II Tract. Opt CGL midbrain pretectal area Interneuron Nucl.EW (badan sel saraf praganglion) ganglionnya terdapat di organ yang dipersarafi mata m. sfingter pupil (circular pupillary muscle) kontraksi.

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Midriasis: melebarnya pupil bila intensitas cahaya menurun Retina N.II Tract. Opt CGL pretectal area Interneuron posterolateral portion of the hypothalamus trunkus simpatikus (ggl.servikalis II) m.pupilaris radialis kontraksi.

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Nerve Injury and Regeneration

V. Sutarmo Setiadji
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Causes of Nerve Injury

- Physical injury (Trauma) - Ischemia/hypoxia (vasoconstriction/ hemorrhagic) - Infection/autoimmune

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