Proprioceptive Pathway: Objectives

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16th Lecture ∣ The Physiology Team

Proprioceptive pathway

Objectives:

❖ to know about proprioceptors its definition and its role in body balance.
❖ The muscle spindles and their role in stretch reflex.
❖ Organization of spinal cord
❖ Sensory receptor types
❖ Identify the major sensory pathways to the cerebral - with consciousness-
components, processes and functions & its damage(appreciate the dorsal column
system in conscious proprioception)
❖ Identify the major sensory pathways to the cerebellum - unconscious & its damage
(describe the pathway of spinocerebellar tract in unconscious proprioception from
muscles,tendons,and joints)
❖ differentiate between sensory and motor ataxia

Done by :
❖ Team leader: Fatima Balsharaf , Rahaf Alshammari, Colour index:
Abdulelah Aldossari, Ali Alammari. ● important
❖ Team members: Renad alsuelmi,Maha Alamri ,Abdullah ● Numbers
Alzaid, Esra’a alnazzawi,Haifa Alessa, Ebtesam ● Extra
Almutairi,Rawan Alharbi.

Editing file ٰ‫ﺎن إِ ﻻ َﻣﺎ َﺳ َﻌﻰ‬


ِ ‫ﻧﺴ‬
َ ‫َوأَ ن ﻟﻴْ َﺲ ﻟِ ْ ِﻺ‬
❖ Terminology

Terminology Definition

Proprioception Proprioception in Latin means proprius which means "one's own" or


"individual". Perception is the sense of the relative position of
neighbouring parts of the body and strength of effort being
employed in movement. Proprioception is defined as our body's
ability to know where it is in space.

16th Lecture ∣ The Physiology Team


Exteroception By which one perceives the outside world. Exteroception is the
sensitivity to stimuli originating outside of the body.

Interoception By which one perceives pain, hunger, etc., and the movement of
internal organs. Interoception is a lesser-known sense that helps
you understand and feel what's going on inside your body.
Receptors
Meaning of Receptors:

Certain specialized structures are present at the interface of stimulus and afferent
nerve fibers. These specialized structures convert any type of energy into
electrical energy or action potential in afferent fiber. This action is known as
transduction. Hence receptors act as biologic transducers.

Somatic receptors:
Somatic receptors are specialized structure present at the
peripheral terminations of afferent fibers..
▪Receptors are detectors and transducers which transduce different form of
energy into action potential
▪They are found in many parts of the body including the skin (cutaneous
receptors), skeletal muscles, bones and joints (proprioceptors)
▪They differ from specific receptors that mediate the special
senses of vision, hearing, smell, taste and equilibrium.

Classification of sensory receptors

A/Based on their location (Sherrington 1906)


1-Exteroceptors
2-interceptors
3-propriceptors

B/Based on their speed of adaptation


1-Slowly adapting (SA) or tonic receptors
2-Rabidly adapting (RA) or phasic receptors
3-Non adapting receptors: eg Free nerve endings for pain sensation

C/Based on their adequate stimulus


1-Mechanoreceptors
2-Thermoreceptors
3-Chemoreceptors
4-Electomangetic receptors
5-nociceptors
❖ Classification of sensory receptor
A/Based on their location

1-Exteroceptors: concerned with the external environment


• Found on the surface of the body • E.g. touch and temperature receptors
2-Interoceptors: concerned with the internal environment
e.g. chemoreceptors ,osmoreceptors.
3-Proprioceptors: concerned with position of the body in the
space.

16th Lecture ∣ The Physiology Team


• Are found in joint, tendons and muscles.

B/Sensory receptor based on their speed of Adaptation

1-Slowly adapting (SA) or tonic receptors:


Eg Muscle spindle, joint receptors, baroreceptor.
2-Rapidly adapting (RA) or phasic receptors:
Eg meissner’s corpuscles(touch), pacinian corpuscles(vibration)
3-Non adapting receptors: eg Free nerve endings for pain sensation
● When a continuous sensory
stimulus is applied, the receptor
responds at a high impulse rate at
first and then at a progressively
slower rate until finally the rate of
action potentials decreases to very
few or often to none at all.

Mechanisms by which Receptors Adapt


● First, the pacinian corpuscle is a viscoelastic structure so that after
stimulation within few hundredths of a second, the fluid within the
corpuscle redistributes, so that the receptor potential is no longer elicited.
● The second mechanism of adaptation of the pacinian corpuscle, but a much
slower one, results from accommodation, which occurs in the nerve fiber
itself. This probably results from progressive “inactivation” of the sodium
channels in the nerve fiber membrane
❖ Classification of sensory receptor

C/Sensory Receptors Types Based on their adequate stimulus


● MECHANORECEPTORS: which detect mechanical compression or stretching
of the receptor or of tissues adjacent to the receptor eg proprioceptors
● THERMORECEPTORS: which detect changes in temperature, some
receptors detecting cold and others warmth.
● NOCICEPTORS (pain receptors): which detect damage occurring in the
tissues, whether physical damage or chemical damage eg free nerve
endings

16th Lecture ∣ The Physiology Team


● ELECTROMAGNETIC RECEPTORS: which detect light on the retina of the eye
eg rods and cones
● CHEMORECEPTORS: which detect taste in the mouth, smell in the nose,
oxygen level in the arterial blood, osmolality of the body fluids, carbon
dioxide concentration, and perhaps other factors that make up the
chemistry of the body. Eg chemo R in carotid bodies
Activation of Sensory Receptors: Generation of Receptor Potential (RP)

Generation of Action Potential:


• Stimuli (mechanical, thermal, chemical) cause deformation in the sensory receptors
• This causes influx of positive ions and generation of RP
• RP induces a local circuit of current flow that spreads along nerve fiber and
generates APs when threshold is reached

Relation Between Stimulus Strength & Receptor Potential Amplitude:

Dr’s note:
-Increase stimulus lead to increase
amplitude of action potential generation.
-Increase stimulus lead to increase rate of
frequency of generated action potential

Examples of RA and SA Receptors


Classification of Nerve fibers
A/ General Classification
1-Myelinated (A- fiber)
▪ Αα (thickly myelinated)
▪ Aβ (intermediate m.)
▪ Aδ (thinly myelinated)
2-Unmyelinated (C-fiber)

16th Lecture ∣ The Physiology Team


B/ Numerical Classification
What Are the Stimulus Features That Are Mediated by Sensory Receptors?

Sensory receptors mediate 4 features of a stimulus:

1-Modality: is what we perceive after a stimulus.


-Examples of sensory modalities: vision, hearing, smell, taste, touch
and temperature
-Each modality has many sub-modalities (e.g. taste can be sweet,
bitter, sour, salty), Temperature sub-modalities: cold and heat

2-Intensity: depends on the stimulus strength and is encoded by


action potential frequency.

3-Location: the site on the body or space where the stimulus


originated.

4-Duration: time from onset to offset of a stimulus.


-If persists for long time, the perceived intensity diminishes
(adaptation)
❖ To know about proprioceptors its definition and its role in body balance.

PROPRIOCEPTION
● Perception about the relative positions of different body parts and
strength of effort being employed in movements.
It can be divided into:
1. Static position sense: which means conscious perception of the
orientation of the different parts of the body with respect to one another
‫ﻫﺬا ﻳﻌﻨﻲ اذا ﻃﻠﺒﺖ ﻣﻦ اﻟﻤﺮﻳﺾ ﻳﻐﻠﻖ ﻋﻴﻮﻧﻪ ورﻓﻌﺖ اﺻﺒﻌﻪ‬
‫ﻷﻋﻠﻰ او ﻷﺳﻔﻞ وﺗﺴﺄﻟﻪ وﻳﻦ ﺗﺤﺲ اﺻﺒﻌﻚ ﻓﻴﻪ ﻓﻮق وﻻ ﺗﺤﺖ‬

16th Lecture ∣ The Physiology Team


2. Dynamic proprioception: rate of movement sense: also called kinesthesia
or dynamic proprioception ‫وﻫﺬا ﻳﻌﻨﻲ اﻧﻚ ﺗﻤﺴﻚ اﺻﺒﻊ ﻣﻦ اﻟﻴﺪ ﻣﺜﻼً وﺗﺤﺮﻛﻪ ﻷﻋﻠﻰ‬
‫واﺳﻔﻞ ﺑﺴﺮﻋﺔ ﻣﻌﻴﻨﻪ وﺗﺴﻮي ﻣﺮه ﺛﺎﻧﻴﺔ ﺑﺴﺮﻋﺔ ﻣﺨﺘﻠﻔﺔ‬
‫وﺗﺴﺄل اﻟﻤﺮﻳﺾ ﻫﻞ ﻓﺮق ﻓﻲ اﻟﺴﺮﻋﺔ او ﻧﻔﺲ ﺑﻌﺾ‬

Structures concerned with proprioception:


1. Proprioceptors (spatial orientation, four inputs).
2. Brain Stem (Cortico, Rubro, Vestibulo, Reticulo, Olivo, Tectospinal).
3. vestibular system (apparatus, nuclei).
4. Ascending Tracts.
5. Visual system.
6. Cerebellum (flocculonodular lobe → dynamic equilibrium, Uvula →
Static equilibrium).
7. Cerebral cortex (primary cortical center for equilibrium located in
the parietal lobe deep in the sylvian fissure).

Types of Proprioception:
1. Conscious proprioception: reach the level of cerebral cortex sensory area via
dorsal column tract.
2. Subconscious proprioception: reach the level of cerebellum via spinocerebellar
tracts (Ventral & Dorsal) ,these are main ascending sensory pathways for
proprioception

Role of Proprioception
Proprioception informs us about:
▪The location of a body part in relation to other parts
▪The rate of movement of a body part when it is moving
▪The degree to which our muscle are being contracted or stretched
▪The amount of tension created in our tendons
▪The head orientation in relation to the ground and in response to movement
Proprioceptive information is carried from periphery to the CNS by proprioceptors
and other somatic receptors
❖ To know about proprioceptors its definition and its role in body balance.
Three Types of Proprioceptors:
Proprioceptors include the muscle spindles, Golgi tendon organs, and joint
receptors. These provide a sense of body position and allow fine control of skeletal
movements
● 1)Muscle spindles:
○ measure the changing length of a muscle
○ Imbedded in the perimysium between muscle fascicles
● 2)Golgi tendon organs:
○ located near the muscle-tendon junction

16th Lecture ∣ The Physiology Team


○ Monitor tension within tendons (locomotory organs )
● 3)Joint kinesthetic receptors:
○ Sensory nerve endings within the joint capsules

2
❖ Identify the major sensory pathways to the cerebral - with consciousness-

SENSORY TRACTS
•DORSAL COLUMN SYSTEM
•ANTEROLATERAL SYSTEM

Each system carries different types of sensations which are known as MODALITIES
like pain,temperature,finetouch,crude touch, vibration, proprioception etc

1. Dorsal column pathway

16th Lecture ∣ The Physiology Team


carries signal of fine touch(two point discrimination), pressure, vibration,
stereognosis and proprioception,
2. Spinothalamic pathway
carries signals of pain, temperature, deep pressure, and crude touch.
3,4-Posterior and anterior spinocerebellar pathways
carry subconscious proprioception.Dorsal gray horn-to lateral column-to medulla
oblongata-to pons–to cerebellum.

DORSAL COLUMN MEDIAL LEMNISCAL


SYSTEM “Advanced types of sensations”
1.Touch sensations requiring a high
degree of localization of the stimulus
2.Touch sensations requiring
transmission of fine gradations of
intensity
3.Phasic sensations like vibratory
sensations
4.Sensations that signal movement -Fine Touch
against skin -Fine Pressure
5.Joints Position sensations -Vibration
-Position
(Proprioception)
6.Pressure sensations requiring fine
degrees of judgment of intensity
7.Strereognosis
ANTEROLATERAL SYSTEM (Ventral & lateral
spinothalamic tracts)
1.Pain
2.Thermal sensations, (warmth & cold)
3.Crude touch and pressure sensations
capable only of crude localizing ability on
the surface of the body
4.Tickle and itch sensations
5.Sexual sensations If you want Dr.Najeeb explanations for tracts click here
Mid term part
Two point discrimination in the dorsal column

16th Lecture ∣ The Physiology Team


1- ‫ﻣﻌﻨﺎﻫﺎ ﻗﺪرة اﻟﺠﺴﻢ ﻋﻠﻰ اﻻﺣﺴﺎس ﺑﺎن ﻫﻨﺎك ﺟﺴﻤﻴﻦ ﻳﻼﻣﺴﺎﻧﻪ وﻟﻴﺲ‬
‫ﺟﺴﻢ واﺣﺪ‬
‫ ﻣﻞ ﻣﺘﺮ اﻻﺣﺴﺎس ﻋﻨﺪﻧﺎ ﺑﻴﺼﻴﺮ‬٣ ‫ﻓﻲ اﻟﻜﺘﻒ ﻟﻮ ﻛﺎن اﻟﻤﺴﺎﻓﺔ ﺑﻴﻦ اﻟﺠﺴﻤﻴﻦ‬
‫ﻛﺄن ﺟﺴﻢ واﺣﺪ ﻳﻼﻣﺴﻨﺎ‬
‫ﻣﻞ ﻣﺘﺮ راح ﻳﺠﻴﻨﺎ اﺣﺴﺎس اﻧﻬﺎ ﺟﺴﻤﻴﻦ‬٣ ‫ﻟﻜﻦ ﻓﻲ اﻟﻴﺪ ﻟﻮ ﻛﺎن ﺑﻴﻦ اﻟﺠﺴﻤﻴﻦ‬
‫ﺑﻌﻜﺲ اﻟﻜﺘﻒ ﻟﻴﻪ ؟‬
Number of receptors
Area of representation

‫اﻟﺪﻛﺘﻮرة رﻛﺰت ﻋﻠﻴﻬﺎ‬

Sensory Homunculus (Little Man)


▪Body is represented upside-down, with large representation of hands & lips
▪The extent of representation is proportional to the density of sensory receptors
❖ Identify the major sensory pathways to the cerebellum - unconscious & its damage
The Dorsal & Ventral Spinocerebellar Tracts
1-The Dorsal Spinocerebellar tract (dSCT)
▪ Carry signals directly to cerebellum at a speed of up to 120 m/s mainly from
muscle spindles, but also from GTO, skin receptors & joint receptors
▪ Enter cerebellum through inferior cerebellar peduncle
▪ Terminate in vermis & intermediate zone
▪ Functions of dSCT are to informs the cerebellum about:
▪ Muscle length and contraction

16th Lecture ∣ The Physiology Team


▪ Degree of tension on tendons
▪ Position and rate movement of parts of body.
▪ Forces acting on the body surfaces

2-The Ventral Spinocerebellar tract (vSCT):


▪ Carry some signals from periphery (mainly from Golgi tendon organs) directly to
cerebellum, but excited mainly by descending motor signals from brain
(corticospinal & rubrospinal tracts) and from the spinal cord itself
▪ Enter cerebellum through superior cerebellar peduncle and terminate on both
sides of cerebellum
▪ Functions of vSCT:
▪ informs the cerebellum about:
▪ Which motor signals have arrived to the spinal cord.
❖ Damage of major sensory pathways to the cerebral - with consciousness-

16th Lecture ∣ The Physiology Team


Dorsal column lesion Spinothalamic lesion

Dorsal column damage

•Sensory ataxia
•Patient staggers; cannot perceive position or
movement of legs
•Visual clues help movement

Positive Romberg test (Ask the patient to close the eyes while
standing: observe whether the patient becomes unstable )
The test depends on the integrity of proprioception from
the joints of the legs.

If the damage above the decussation the abnormality


will occur contralateral

Positive Romberg test


❖ differentiate between sensory and motor ataxia

Ataxia and Gait Disturbances

Ataxia: inability to coordinate voluntary muscular movements that is


due to nerve damage (CNS or PNS) and not due to muscle
weakness (called also incoordination)

● Pathophysiology
– Result from any condition that affects the central and peripheral nervous systems

16th Lecture ∣ The Physiology Team


– Ataxia Types :
•Motor ataxia
•Sensory ataxia

•Motor Ataxia
–Caused by cerebellar disorders
• Intact sensory receptors and afferent pathways
•Integration of proprioception is faulty
•Midline cerebellar lesions cause truncal ataxia
•Lateral cerebellar lesions cause limb ataxia
•Thalamic infarcts may cause contralateral ataxia with sensory loss

Features of Cerebellar ataxia


- Clumsy movements. –Incoordination of the limbs (intention tremor)
– Wide-based, reeling gait (ataxia) –Alcoholic intoxication produces similar effects!

SENSORY ATAXIA
•Peripheral sensory lesions (e.g. polyneuropathy) cause ataxia because there is loss
of the sense of joint position proprioception.
Broad-based, high-stepping, stamping gait develops.
•This ataxia is made worse by removal of additional sensory input (e.g. vision) and is
worse in the dark.
First described in sensory ataxia of tabes dorsalis, this is the basis of Romberg's test>>
Ask the patient to close the eyes while standing: observe whether the patient becomes
unstable (and prevent falling).
❖ Quick review
★ Proprioception: Perception (sense) about the relative positions of different
body parts and strength of effort being employed in movements.
Can divide into: Static position sense & Rate of movement (sense kinesthesia
or dynamic proprioception)
★ Types:
1- Conscious proprioception: reach the level of cerebral cortex sensory area
via dorsal column tract
2- Subconscious proprioception: reach the level of cerebellum via
spinocerebellar tracts
★ Proprioceptors: provide a sense of body position and allow fine control of

16 Lecture ∣ The Physiology Team


skeletal movements. Types:
1-Muscle spindles: Imbedded in the perimysium between muscle fascicles
measure the changing length of a muscle
2- Golgi tendon organs: located near the muscle-tendon junction
Monitor tension within tendons
3- Joint kinesthetic receptors: Sensory nerve endings within the joint capsules
★ Adaptation of receptor (Types)
1- Rapid adapting or phasic receptors: eg meissner’s corpuscles(touch),
pacinian corpuscles (vibration)
2- Slowly adapting or tonic receptors: eg ruffini’s (pressure ,skin stretch)
★ 3- Non adapting receptors: eg Free nerve endings for pain sensation
★ Activation of Sensory Receptors:
Stimuli (mechanical, thermal, chemical) → cause deformation in the sensory
receptors → causes influx of +ve ions & generation of receptor potential →
induces a local circuit of current flow → spreads along nerve fiber & generates
action potentials when threshold is reached
★ Receptor potential is directly related to stimulus strength

Dorsal column damage Spinocerebellar tract damage


Cerebellar ataxia
Sensory ataxia Clumsy movements
Patient staggers; cannot perceive position or Incoordination of the limbs (intention
movement of legs tremor)
Visual clues help movement Wide-based, reeling gait (ataxia)
Positive Romberg test *Alcoholic intoxication produces similar
effects!
Ataxia: result from any condition that affects CNS & PNS
Sensory Ataxia Motor ataxia
Peripheral sensory lesions Caused by cerebellar disorders
(e.g. polyneuropathy) Intact sensory receptors & afferent pathways
lesion in thalamus & sensory Integration of proprioception is faulty
Made worse in the dark or Midline cerebellar lesions cause truncal ataxia
no vision Lateral cerebellar lesions cause limb ataxia
Romberg's test
❖ Questions
1) Which of these resembles encapsulated receptors?
A- Hair follicles receptors
B- Merkel disc
C- pacinian corpuscles
D- A&B

2) Tickle and itch sensation is carried by:


A- Dorsal column
B- Lateral spinothalamic tract
C- ventral spinothalamic tract
D- B&C

3) What type of receptors are located in carotid bodies?

16th Lecture ∣ The Physiology Team


A- Thermoreceptors
B- Mechanoreceptors
C- Chemoreceptors
D- Nociceptors

4) Thalamic infarcts may cause:


A- Contralateral ataxia
B- Contralateral ataxia with sensory loss
C- Ipsilateral ataxia with sensory loss
D- Ipsilateral ataxia

5) Which one is Rapid adapting receptor:


A- Merkel’s disc
B- krause’s end bulbs
C- Meissner’s corpuscles(touch),
D- Non

SAQ
6) what are the three types of proprioceptors?

*Muscle spindles
*Golgi tendon organs
*Joint kinesthetic receptors

7) What are the structures that are concerned with proprioception ?

Proprioceptors
* Brain stem *Visual system
* Vestibular system *Cerebellum
* Ascending tracts *Cerebral cortex

8) Mention the two types of proprioception

1-Conscious proprioception: reach the level of cerebral cortex sensory area via dorsal column tract.
2- Subconscious proprioception: reach the level of cerebellum via spinocerebellar tracts

9) Pacinian corpuscles’ Ruffini’s corpuscles are examples of ?

Joint kinesthetic receptors C 5.


B 4.
10) two point discrimination depend on
C 3.
*Number of receptors D 2.
*Area of representation
C 1.

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