SISTEM SARAF 2

Ida Ayu Eka Widiastuti

Bagian Fisiologi FK Unram
Tujuan Pembelajaran
Menjelaskan jalur sensori somatik dan jalur motorik
Mengklasifikasikan jenis refleks
Membedakan respons motorik yang dihasilkan oleh tiap refleks:
sederhana dan kompleks
Mengilustrasikan tahapan refleks
Menjelaskan modifikasi refleks
Menjelaskan fisiologi nyeri
Introduction
Millions of sensory neurons are delivering information to the CNS all
the time
Millions of motor neurons are causing the body to respond in a
variety of ways
Sensory and motor neurons travel by different tracts within the spinal
cord
Sensory and Motor Tracts
• Communication to and from the brain involves tracts
• Ascending tracts are sensory
 Deliver information to the brain
• Descending tracts are motor
 Deliver information to the periphery
Sensory and Motor Tracts
Naming the tracts
• If the tract name begins with “spino” (as in spinocerebellar), the tract
is a sensory tract delivering information from the spinal cord to the
cerebellum (in this case)
• If the tract name ends with “spinal” (as in vestibulospinal), the tract is
a motor tract that delivers information from the vestibular apparatus
(in this case) to the spinal cord
Sensory and Motor Tracts
There are three major sensory tracts
• The posterior column tract
• The spinothalamic tract
• The spinocerebellar tract
Sensory and Motor Tracts
The three major sensory tracts involve chains of neurons
• First-order neuron
 Delivers sensations to the CNS
 The cell body is in the dorsal or cranial root ganglion
• Second-order neuron
 An interneuron with the cell body in the spinal cord or brain
• Third-order neuron
 Transmits information from the thalamus to the cerebral
cortex
Sensory and Motor Tracts
Neurons in the sensory tracts are arranged according to three
anatomical principles
Sensory modality
Somatotropic
Medial-lateral rule
Sensory and Motor Tracts
• Sensory modality
 Fine touch sensations are carried in one sensory tract
• Somatotopic
 Ascending tracts are arranged according to the site of origin
• Medial-lateral rule
 Sensory neurons that enter a low level of the spinal cord are
more medial within the spinal cord
Sensory neurons that enter at a higher level of the spinal cord
are more lateral within the spinal cord
Sensory and Motor Tracts
Posterior Column tract consists of:
• Fasciculus gracilis
 Transmits information coming from areas inferior to T6
• Fasciculus cuneatus
 Transmits information coming from areas superior to T6
Sensory and Motor Tracts
• Spinothalamic tract
Transmits pain and temperature sensations to the thalamus
and then to the cerebrum
• Spinocerebellar tract
Transmits proprioception sensations to the cerebellum
Sensory and Motor Tracts
Motor tracts
• CNS transmits motor commands in response to sensory information
• Motor commands are delivered by the:
 Somatic nervous system (SNS): directs contraction of skeletal
muscles
 Autonomic nervous system (ANS): directs the activity of
glands, smooth muscles, and cardiac muscle
Sensory and Motor Tracts
Motor tracts
• These are descending tracts
• There are two major descending tracts
 Corticospinal tract: Conscious control of skeletal muscles
 Subconscious tract: Subconscious regulation of balance,
muscle tone, eye, hand, and upper limb position
Sensory and Motor Tracts
The Corticospinal Tracts
Consists of three pairs of descending tracts:
 Corticobulbar tracts: conscious control over eye, jaw, and face
muscles
 Lateral corticospinal tracts: conscious control over skeletal
muscles
 Anterior corticospinal tracts: conscious control over skeletal
muscles
Refleks…
What is a reflex?
 A reflex is an automatic, involuntary response.
A reflex can be a response to a stimulus or to internal
feedback.
Reflexes are necessary to survival.
What is the function of a reflex?
The function of a reflex is to maintain homeostasis.
Removes body from painful stimuli that could cause tissue damage.
Prevents body from suddenly falling and moving.
Maintains blood pressure, breathing rate, water intake, blood carbon dioxide
levels, etc.
Protects us from irritants: coughing, sneezing, vomiting, etc.
Reflex Arc
Components of a Reflex Arc
There are 5 basic components to a reflex arc:
Sensory receptor – a nerve or specialized tissue located at the end of a
sensory neuron that is the first structure to respond to a stimulus.
Sensory neuron – may act as the sensory receptor.
Spinal cord or brain tissue
Motor neuron
Effector organ/tissue – the tissue that responds to the message from the
motor neuron.
• Muscle
• Gland
Types of Reflexes
There are two main groups of reflexes:
1. Somatic reflexes

2. Autonomic/visceral reflexes

How reflexes are categorized depends on the effector tissue involved.

Autonomic Reflexes
The effector tissues of autonomic reflexes are smooth muscle,
cardiac muscle and glandular tissue.
Both the brain and spinal cord can act as integrating centers for
autonomic reflexes.
Autonomic reflexes result in gastric juice secretion, mouth watering
upon seeing/smelling/thinking about food, regulating blood
pressure, adjusting heart rate to level of exercise, etc.
Somatic Reflexes
The effector tissue of somatic reflexes is skeletal muscle.
• You have conscious control over all of your skeletal muscles.
• Some skeletal muscle movements do not require your conscious thought.
These movements occur without you consciously having to initiate the
muscular movement.
• Breathing, swallowing, blinking, ability to pull away from a hot object before you
even sense the heat, etc.
Examples of Somatic Reflexes
• There are three common somatic reflexes discussed in most
anatomy and physiology courses.
Stretch (knee-jerk, patellar) reflex.
Withdrawal (flexor) reflex.
Crossed-extensor reflex.
Anatomy of a Stretch Reflex
• Simplest reflex arc.
• Involves two neurons.
1. Doctor taps your patellar tendon with Reflex Hammer.
2. Tapping of the tendon causes muscle to stretch.
3. Stretching of muscle stimulates specialized sensory receptors located in
thigh muscles called muscle spindles to be stretched.
4. Sensory dendrites in muscle spindles become stimulated.
5. Sensory dendrites conduct message of stimulation towards spinal cord
through a nerve.
Anatomy of a Stretch Reflex
6. Sensory dendrite meets up with its cell body in the dorsal root.
7. From the cell body, the axon conducts the information into the spinal cord.
8. In the spinal cord, the sensory axon synapses with a motor neuron.
9. The motor axon carries the message out of the spinal cord through the
anterior root.
10. The motor axon will synapse with the muscles of the thigh which results in
contraction of the quadriceps muscle – response: knee extension.
Anatomy of a Stretch Reflex
Anatomy of a Withdrawal Reflex
• Involves three neurons.
• Function remove a limb or body part form a painful stimulus.
1. Step on a stone with your left foot.
2. A sensory neuron acts as a sensory receptor and is stimulated by the stone.
3. Sensory dendrites conduct message of stimulation towards spinal cord
through a nerve.
4. Sensory dendrite meets up with its cell body in the dorsal root.
Anatomy of a Withdrawal Reflex
5. From the cell body, the axon conducts the information into the spinal cord.
6. In the spinal cord, the sensory axon synapses with an interneuron.
7. The interneuron synapses with a motor neuron in the spinal cord.
8. The motor axon carries the message out of the spinal cord through the
anterior root.
9. The motor axon will synapse with the muscles of the thigh which results in
contraction of the hamstring muscles – response: knee flexion.
Anatomy of a Withdrawal Reflex
Anatomy of a Crossed-Extensor Reflex
Associated with a withdrawal reflex of the lower limbs.
Prevents falls by shifting weight of body to unaffected limb.
1. This reflex begins in the spinal cord.
2. The same sensory neuron that picked up the pain stimulation will synapse
with a second interneuron in the spinal cord.
3. The second interneuron will carry information to opposite side of the spinal
cord, where the interneuron will synapse with a motor neuron.
Anatomy of a Crossed-Extensor Reflex
4. The motor axon carries the message out of the spinal cord through the
anterior root.
5. The motor axon will synapse with the muscles of the thigh which results in:
knee extension.
Nyeri…
DEFINISI
• “Pengalaman sensori dan emotional yang tidak
menyenangkan yang berhubungan dengan kerusakan
jaringan yang nyata atau berpotensi” (IASP, International
Association for the Study of Pain, 1979)
• Nyeri merupakan mekanisme protektif.
 SISTEM SARAF DAN NYERI
Somatosensory
System

Brain Spinal Cord PNS

Somatosensory Dorsal Horn Afferent Neuron

Cortex Ventral Root Efferent Neuron

A-delta Fibers
Thalamus
C-Fibers
TIPE NYERI
1. Nyeri cepat (≤ 1 detik)
= nyeri tajam, nyeri tertusuk,nyeri akut, dan nyeri elektrik.
2. Nyeri lambat (> 1 detik)
= nyeri terbakar, nyeri berdenyut, nauseous pain, dan nyeri kronik
(umumnya berhubungan dengan kerusakan jaringan)
RESEPTORS
Mekanoreseptor – tekanan dan
rabaan; regangan

Termoreseptor – suhu (panas, dingin)

Proprioseptor – otot (perubahan

panjang otot), persendian

NOSISEPTOR –NYERI (akhiran serabut

saraf bebas)
Nosiseptor

Akhiran serabut
saraf bebas yang
berespon terhadap
stimulus yang
membahayakan
 Nosiseptor
• Nosiseptor merupakan reseptor khusus yang berespon
hanya pada noxious stimuli dan membangkitkan impuls
saraf yang otak menginterpretasikannya sebagai “nyeri”
Stimulus Nyeri
1. Mekanik
2. Suhu
3. Kimia (yang dilepaskan dari jaringan yang rusak)
 Bradikinin, serotonin, histamine, K+, asam, asetilkolin,
dan enzm proteolitik dapat mengeksitasi nyeri kimia
 Prostaglandins dan substansi P meningkatkan
sensitivitas nyeri tapi tidak mengeksitasinya secara
langsung.
Lokasi Nyeri
 Nyeri somatik superfisial timbul dari area kulit
 Nyeri somatik dalam, dari: otot, persendian,
tendon dan fascia
 Nyeri viseral, berasal dari reseptor di organ visera
 TRANSMISI SINYAL NYERI
I. Afferent –Neuron Sensorik
1. Serabut A-delta
Berukuran lebih besar, transmisinya cepat,
bermyelin, menghantarkan nyeri tajam
Termasuk reseptor mekanik, tercetus
akibat tekanan mekanik yang kuat dan
temperatur ekstrem
Kecepatan hantaran 6-30 m/dt.
Berakhir di lamina I (lamina marginalis)
kornu dorsalis MS
Neurotransmitter: glutamat
 2. Serabut C
Berukuran kecil, transmisinya lambat, tidak
bermyelin, menghantarkan nyeri tumpul.
Mekanoreseptor and thermoresptor
Kemoreseptor, terutama dicetuskan oleh
bahan-bahan kimia yang dilepaskan selama
proses inflamasi.
Kecepatan hantaran 0.5 - 2 m/dt
Berakhir di lamina II dan III kornu dorsalis MS
(substantia gelatinosa)
Neurotransmitter: substansi P
II. Efferent – Motor neurons
 JALUR NYERI DI MEDULA SPINALIS DAN BATANG
OTAK
Terdapat 2 jalur penghantaran sinyal nyeri,
menuju otak, yaitu:
1. Traktus Neospinotalamikus
a. Serabut nyeri cepat tipe A delta
b. Terminasi pada area retikuler batang otak dan
talamus (ventrobasal complex dan posterior
nuclear group)
c. Ditransimisikan menuju korteks somatosensori
d. dapat terlolakisasi lebih tepat pada berbagai
bagian tubuh
2. Traktus Paleospinotalamikus
a. Serabut nyeri lambat tipe C.
b. Berakhir di batang otak dan talamus, yaitu:
(1) reticular nuclei medulla, pons, dan
mesensefalon
(2) tectal area mesencephalon
(3) regio periaqueductal abu-abu
c. Lokalisasi nyeri yang ditransmisikan melalui jalur
ini tidak jelas (multisinaptik, konektivitas difus)
KATEGORI NYERI
• Berdasarkan Lokasi
a. Nyeri kutaneus
b. Nyeri somatik
c. Nyeri viseral
d. Nyeri alih
• Berdasarkan Durasi
a. Nyeri akut
b. Nyeri kronik
Selamat
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