PHYSIOLOGY OF LARGE HEMISPHERES OF THE BRAIN AND CEREBELLUM.

In preceding lecture we have been concerned with many of the subconscious motor activities integrated in the spinal cord and brain s especially those responsible for posture and librium. In the present chapter we will discus control of motor function by the cerebral o and cerebellum as well as their relationship t basal ganglia and the other lower centers. I of this control is "voluntary" in contradistinction to the subconscious control effected by the lower centers. Yet we will also see that at least motor functions of the cerebral cortex and cerebellum are not entirely "voluntary."

THE CORTEX—THE PRIMARY AND PREMOTOR AREAS

Figure illustrates a broad area of the cerebral cortex that is concerned either with sensation from the somatic areas of the body or with control of body movement. The posterior part of this area the somatic sensory cortex, we have already discussed. Lying directly anterior to the somatic sensory area in front of the central sulcus, as illustrated in the figure, and occupying approximately the posterior one half of the frontal lobes is the motor cortex. Nerve signals originating from this region cause muscle contractions in different parts of the body.

The motor cortex is divided into two separate divisions, the primary motor area and the premotor area. The primary area contains very large pyram-idal motor neurons that send their fibers all the way to the spinal cord through the corticospinal tract and therefore have almost direct communication with the anterior motor neurons of the cord for control of either individual muscles or small groups of muscles. Even very weak electrical stimuli in this primary motor area usually will elicit a muscle contraction somewhere in the body. The primary motor cortex is also frequently referred to as area IV of the cortex because this area containing the large pyramidal cells is area IV in Brod-mann's histological classification of the different cortical areas. This area is frequently called areas VI and VIII because it occupies both these areas in the Brod-mann classification of brain topology. The premotor cortex has very*few neurons that project nerve fibers directly to the spinal cord, instead, most of the nerve signals generated in this area cause more complex muscle movements, usually involving groups of muscles performing some specific task, rather than individual muscles. To achieve these results, the premotor area mainly sends its signals into the primary motor cortex to excite multiple groups of muscles. Some of these signals pass directly to the motor cortex through subcort-ical nerve fibers, but the premotor cortex also has extensive connections with the basal ganglia and cerebellum, both of which transmit signals back by way of the thalamus to the motor cortex. Thus the premotor cortex, the basal ganglia, the cere­bellum, and the primary motor cortex constitute a complex overall system for voluntary control of muscle activity.

The Motor Topographical Map in the Human Being. The topographical map of the motor cortex in the human being is quite different from that of lower animals. The reason for this is that the human being has developed two important capabilities involving the motor cortex that are not found in lower animals. These are an exceptional capability to use the hand, the fingers, and the thumb to perform highly dexterous manual tasks, and  use of the mouth, lips, tongue, and facial muscles to talk. Therefore, there are very high degrees of representation of the hand, mouth, and facial regions in the human motor cortex, the degrees of representation of the different muscle areas of the body in the motor cortex as mapped by Penfield and Rasmussen. This was done by stimulating the different areas of the motor cortex in human beings undergoing neurosurgical operations, Note that more than one half of the entire primary motor cortex is concerned with controlling the hands and the muscles of speech. Point stimulations in these areas of the motor cortex will cause contraction of a single muscle or even a portion of a single muscle. On the other hand, in those areas of the primary cortex with less intense degree of representation such as in the trunk area, electrical stimulation will usaalTy contract a group of muscles instead.

THE EXTRAPYRAMIDAL SYSTEM

The term extrapyramidal motor system is widely used in clinical circles to denote all those portions of the brain and brain stem that contribute to motor control but that are not part of the direct pyramidal system. This includes the basal ganglia, the reticular formation of the brain stem, the vestibular nuclei, and often the red nuclei as well. However, this is such an all-inclusive and diverse group of motor control areas that it is difficult to ascribe specific neurophysiological functions to the extrapyramidal system as a whole. For this reason, we have discussed the functions of the separate portions of the extrapyramidal system individually.

THE CEREBELLUM AND ITS MOTOR FUNCTIONS

The cerebellum has long been called a silent area o/the brain principally because electrical excitation of this structure does not cause any sensation and rarely any motor movement. However, as we shall see, removal of the cerebellum does cause the motor movements to become highly abnormal. The cerebellum is especially vital to the control of very rapid muscular activities such as running, typing, playing the piano, and even talking. Loss of this area of the brain can cause almost total incoordination of these activities even though its loss causes paralysis of no muscles.

But how is it that the cerebellum can be so important when it has no direct capability of causing muscle contraction? The answer to this is that it both helps plan the motor activities and also monitors and makes corrective adjustments in the motor activities elicited by other parts of the brain. It receives continuously updated information on the desired program of muscle contractions from the motor control areas of the other parts of the brain. And it receives continuous information from the peripheral parts of the body to determine the instantaneous status of each part of the body—its position, its rate of movement, forces acting on it, and so forth. It is believed that the cerebellum compares the actual instantaneous status of each part of the body as depicted by the peripheral information with the status that is intended by the motor system. If the two do not compare favor-ably, then appropriate corrective signals are transmitted instantaneously back into the motor system to increase or decrease the levels of activation of the specific muscles.

Since the cerebellum must make major motor corrections extremely rapidly during the course of motor movements, a very extensive and rapidly acting cerebellar input system is required both from the peripheral parts of the body and from the cerebral motor areas. Also, an extensive output system feeding equally as rapidly into the motor system is necessary to provide the necessary corrections of the motor signals.

THE ANATOMICAL FUNCTIONAL AREAS OF THE CEREBELLUM

Anatomically, the cerebellum is divided into three separate lobes by two deep fissures:  the anterior lobe,  the posterior lobe, and flocculonodular lobe. The flocculonodular lobe is the oldest of all portions of the cerebellum; it developed along with (and functions with) the yestibular system in controlling equilibrium, as was discussed in the previous chapter. Because of its ancient heritage, it is frequently called the archicerebellum. The anterior lobe and part of the midportion of the posterior lobe are also old; this is called the paleocerebellum. On the other hand, almost 90 per cent of the posterior lobe is recent in origin and is especially highly developed in primates and human beings; this is called the neocerebellum.

The Longitudinal Functional Divisions of the Anterior and Posterior Lobes.

From a functional point of view, the anterior and posterior lobes are organized not by lobes but instead along the longitudinal axis, the human cerebellum after the lower end of the posterior cerebellum has been rolled downward from its normally hidden position. Note down the center of the cerebellum a narrow band separated from the remainder of the cerebellum by shallow grooves. This is called the vermis. In this area most cerebellar control functions for the muscle movements of the axial body, the neck, and the shoulders and hips are located.

To each side of the vermis is a large, laterally protruding cerebellar hemisphere, and each of these hemispheres is divided into an intermediate zone and a lateral zone. The intermediate zone of the hemisphere is concerned with the control of muscular contractions in the distal portions of both the upper and lower limbs, especially of the hands and fingers and feet and toes. On the other hand, the lateral zone of the hemisphere operates at a much more remote level, for this area seems to join into the overall planning of sequential motor movements. Without this lateral zone, most discrete motor activities of the body lose their appropriate timing and therefore become highly incoordinate, as we shall discuss more fully later.

Topographical Representation of the Body in the Cerebellum. In the manner that the sensory cortex, the motor cortex, the basal ganglia, the red nuclei, and the reticular formation all have topograph- ical representations of the different parts of the body, so also is this true for parts of the cerebellum. Note that the axial portions of the body lie in the vermal part of the cerebellum whereas the limbs and facial regions lie in the intermediate zones of the two hemispheres. These topographical representations receive afferent nerve fibers from all the respective parts of the body. In turn, they send motor signals into the same respective topographical areas of .the motor cortex, the basal ganglia, the red nucleus, and the reticular formation.

However, note that the large lateral portions of the cerebellar hemispheres do not have topographical representations of the body. These areas of the cerebellum connect mainly with the association areas of the brain, especially the premotor area 10

of the frontal cortex and the somatic sensory and sensory association areas of the parietal cortex. Presumably this connectivity with the association areas allows the lateral portions of the cerebellar hemispheres to play important roles in planning and coordinating the sequential patterns of muscular activities.

Afferent Pathways from the Brain. An extensive and important afferent pathway is the corticopontocerebellar pathway, which originates mainly in the motor cortex but to a lesser extent in the sensory cortex as well and then passes by way of the pontile nuclei and pontocerebellar tracts to the contra-lateral hemisphere of the cerebellum. In addition, important afferent tracts originate in the brain stem; they include  an extensive olivocerebellar tract, which passes from the inferior olive to all parts of the cerebellum; this tract is excited by fibers from the motor cortex, the basal ganglia, widespread areas of the reticular formation, and the spinal cord;  vestibulocerebellar fibers, some of which originate in the vestibular apparatus itself and others from the vestibular nuclei; most of these terminate in the flocculonodular lobe and fas-tigial nucleus of the cerebellum; and  reticulocerebellar fibers, which originate in different portions of the retic-ular formation and terminate mainly in the midline cerebellar areas (the vermis).

Afferent Pathways from the Periphery. The cerebellum also receives important sensory signals directly from the peripheral parts of the body through four separate tracts, two of which are located dorsally in the cord and two ventrally. The two most important of these tracts: the dorsal spi-nocerebeliar tract and the ventral spinocerebellar tract These two tracts originate in the sacral, lumbar, and thoracic segments of the cord. Similar tracts originate in the neck segments of the cord and course roughly along with the dorsal and ventral spinocerebellar tracts in their passage to the cerebellum. These are the cuneocerebellar tract that joins the dorsal spinocerebeliar tract and the rostral spinocer-ebellar tract that joins the ventral spinocerebeilar tract. The dorsal tracts enter the cerebellum through the inferior cerebellar peduncle and terminate in the cerebellum on the same side as their origin. The two ventral tracts enter the cerebellum through the superior cerebellar peduncle, but they terminate in both sides of the cerebellum.

The signals transmitted in the dorsal spinocerebellar tracts come mainly from the muscle spindles and to a lesser extent from other somatic receptors throughout the body, such as from the Golgi tendon organs, the large tactile receptors of the skin, and the joint receptors. All these signals apprise the cerebellum of the momentary status of muscle contraction, degree of tension on the muscle tendons, positions and rates of movement of the parts of the body, and forces acting on the surfaces of the body.

On the other hand, the ventral spinocerebellar tracts receive less information from the peripheral receptors. Instead, they are excited mainly by the motor signals arriving in the spinal cord from the brain through the corticospinal and rubrospinal tracts. Thus, this ventral fiber pathway tells the cerebellum that the motor signals have indeed arrived at the cord, and it also apprises the cerebellum of the intensity of the signals.

Output Signals from the Cerebellum

The Deep Cerebeflar Nuclei and the Efferent Pathways. Located deep in the cerebellar mass are three deep cerebellar nuclei—the dentate, interpositus, and fasiigial nuclei. The vestibular nuclei in the medulla also function in some respects as if they were deep cerebellar nuclei because of their direct connections with the cortex of the flocculonodular lobe. All the deep cerebellar nuclei receive signals from two different sources: the cerebellar cortex and the sensory afferent tracts to the cerebellum. Each time an input signal arrives in the cerebellum, it divides and goes in two directions:  directly to one of the deep nuclei and  to a corresponding area of the cerebellar cortex overlying the deep nucleus; then, a short time later, the cerebellar cortex relays its output signals also to the same deep nucleus. Thus, all the input signals that enter the cerebellum eventually end in the deep nuclei. We shall discuss this circuit in greater detail later. Three major efferent pathways lead out of the cerebellum:

(1)           A pathway that begins in the cortex of the lateral zone of the cerebellarhemisphere, then passes to the dentate nucleus, next to the ventrolateral andventroan-terior nuclei of the thalamus, and finally to the cerebral cortex. Thispathway plays an important role in helping coordinate "voluntary" motor activitiesinitiated by the cerebral cortex.

(2)           A pathway that originates in the midline structures of the cerebellum (thevermis) and then passes through the fastigial nuclei into the medullary and pantileregions of the brain stem. This circuit functions in close association with theequilibrium apparatus to help control equilibrium and also, in association with theretic-ular formation of the brain stem, helps control the postural attitudes of thebody. It was discussed in detail in the previous chapter in relation to equilibrium.

(3)    A  pathway that originates  in the  intermediate zone of the  cerebellahemisphere, between the verrnis and the lateral zone of the cerebellar hemisphere,then passes (a) through the nucleus interpositus to the ventrolateral and ventroanterior nuclei of the thalamus, and thence to the cerebral cortex, (b) to several midline structures of the thalamus and thence to the basal ganglia, and (c) to the red nucleus and reticular formation of the upper portion of the brain stem. This circuit is believed to coordinate mainly the reciprocal contractions of agonist and antagonist muscles in the peripheral portions of the limbs—especially in the hands, fingers, and thumbs.

THE NEURONAL CIRCUIT OF THE CEREBELLUM

The human cerebellar cortex is actually a large folded sheet, approximately 17 cm wide by 120 cm long, with the folds lying crosswise. Each fold is called a folium. And lying deep in the folded mass of cortex are the deep nuclei.

The Functional Unit of the Cerebellar Cortex—the Purkinje Cell. The cerebellum has approximately 30 million nearly identical functional units. This functional unit centers on the deep nuclear cell and on the Purkinje cell, of which there are also 30 million in the cerebellar cortex, the three major layers of the cerebellar cortex: the molecular layer, the Purkinje cell layer, and the granular cell layer. Then, beneath these layers, the deep nuclei are located far within the center of the cerebellar mass.

The Neuronal Circuit of the Functional Unit, the output from the functional unit is from a deep nuclear cell. However, this cell is continually under the influence of both excitatory and inhibitory influences. The excitatory influences arise from direct connections with the afferent fibers that enter the cerebellum. The inhibitory influences arise entirely from the Purkinje cells in the cortex of the cerebellum.

The afferent inputs to the cerebellum are mainly of two types, one called the climbing fiber type and the other called the mossy fiber type. There is one climbing fiber for about 10 Purkinje cells. After sending collaterals to several deep nuclear cells, the climbing fiber projects all the way to the molecular layer of the cerebellar cortex where it makes about 300 synapses with the soma and dendrites of each Purkinje cell. This climbing fiber is distinguished by the fact that a single impulse in it will always cause a single, very prolonged, and peculiar oscillatory type of action potential in each Purkinje cell with which it connects. Another distinguishing feature of the climbing fibers is that they all originate in the inferior olive of the medulla, whereas the cerebellar afferent fibers from all other sources are almost entirely of the mossy type.

The mossy fibers also send collaterals to excite deep nuclear cells. Then these fibers proceed to the granular layer of the cortex where they synapse with hundreds of granule cells. These in turn send very small axons, less than 1 micron in diameter, up to the outer surface of the cerebellar cortex to enter the molecular layer. Here the axons divide into two branches that extend 1 to 2 millimeters in each direction parallel to the folia. There are literally millions of these parallel nerve fibers in each small segment of the cerebellar cortex (there are about 1000 granule cells for every Purkinje cell). It is into this molecular layer that the dendrites of the Purkinje cells project, and 80,000 to 200,000 of these parallel fibers synapse with each Purkinje cell; as these fibers pass along their 1 to 2 mm course, each of them contacts about 50 Purkinje cells. Yet, the mossy fiber input to the Purkinje cell is quite different from the climbing fiber input because stimulation of a single mossy fiber will never elicit an action potential in the Purkinje cell; instead, large numbers of mossy fibers must be stimulated simultaneously to activate the Purkinje cell. Furthermore, this activation usually takes the form of prolonged facilitation or excitation that, when it reaches threshold for stimulation, causes repetitive Purkinje cell firing of normal, short-duration action potentials rather than the single prolonged action potential occurring in response to the climbing fiber input.

Thus, the Purkinje cells are stimulated by two types of input circuits—one that causes a highly specific output in response to the incoming signal and the other that causes a less specific but tonic type of response. It should be noted that by far the greater proportion of the afferent input to the cerebellum is of the mossy fiber type, because this represents the afferent input from almost all the cerebellar afferent tracts besides those from the inferior olive.

Balance Between Excitation and Inhibition in the Deep Cerebellar Nuclei.

The output signals from the Purkinje cells to the deep nuclei are entirely inhibitory. Therefore, referring again to the circuit of Figure 53-14, one should note that direct stimulation of the deep nuclear cells by both the climbing and the mossy fibers excites them, whereas the signals arriving from the Purkinje cells inhibit them. Normally, there is a continual balance between these two effects so that the degree of output from the deep nuclear cell remains relatively constant at a moderate level of continuous stimulation. On the other hand, in the execution of rapid motor movements, the timing of the two effects on the deep nuclei is such that the excitation appears before the inhibition. Then a few milliseconds later inhibition occurs. In this way, there is first a very rapid excitatory signal fed back into the motor pathway to modify the motor movement, but this is followed within a few milliseconds by an inhibitory signal. This inhibitory signal resembles a "delay-line" negative feedback signal of the type that is very effective in providing damping. That is, when the motor system is excited, a negative feedback signal presumably occurs after a short delay to stop the muscle movement from overshooting its mark, which is the usual cause of oscillation.

FUNCTION Of THE CEREBELLUM IN CONTROLLING MOVEMENTS

The cerebellum functions in motor control only in association with motor activities initiated elsewhere in the nervous system. These activities may originate in the spinal cord, in the reticular formation, in the basal ganglia, or in areas of the cerebral cortex. We will discuss, first, the operation of the cerebellum in association with the spinal cord and lower brain stem for control of postural movements and equilibrium and then discuss its function in association with the motor cortex for control of voluntary movements.

The cerebellum originated phylogeneticaily at about the same time that the vestibular apparatus developed. Furthermore, as was discussed in the previous chapter, loss of the flocculonodular lobes of the cerebellum causes extreme disturbance of equilibrium. Yet, we still must ask the question, what role does the cerebellum play in equilibrium that cannot be provided by the other neuronal machinery of the brain stem? A clue is the fact that in persons with cerebellar dysfunction equilibrium is far more disturbed during performance of rapid motions than during stasis. This suggests that the cerebellum is especially important in controlling the balance between agonist and antagonist muscle contractions during rapid changes in body positions as dictated by the vestibular apparatuses. One of the major problems in controlling this balance is the time required to transmit position signals and kinesthetic signals from the different parts of the body to the brain. Even when utilizing the most rapidly conducting sensory pathways at 100 meters per second, as used by the spinocerebellar system, the delay for transmission from the feet to the brain is still 15 to 20 milliseconds. The feet of a person running rapidly can move as much as 10 inches during this time. Therefore, it is impossible for the brain to know at any given instant during rapid motion the exact position of the different parts of the body.

Therefore, during the control of equilibrium, it is presumed that the extremely rapidly conducted vestibular apparatus information is used in a typical feedback control circuit to provide almost instantaneous correction of postural motor signals as necessary for maintaining equilibrium even during extremely rapid motion, including rapidly changing directions of motion. The feedback signals from the peripheral areas of the body help in this process, but their help is presumably contin­gent upon some function of the cerebellum to compute positions of the respective parts of the body at any given time, despite the long delay time from the periphery to the cerebellum.

Relationship of Cerebellar Function to the Spinal Cord Stretch Reflex

One major component of cerebeilar control of posture and equilibrium is an extreme amount of information transmitted from the muscle spindles to the cerebellum through the dorsal spinocerebel-lar tracts. In turn, signals are transmitted into the brain stem through the cerebellar fastigial nuclei to stimulate the gamma efferent fibers that innervate the muscle spindles themselves. Therefore, a cerebellar stretch reflex occurs that is similar to but more complex than the spinal cord stretch reflex. It utilizes signals that pass all the way to the cerebellum and back again to the muscles. In general, this reflex adds additional support to the cord stretch reflex, but its feedback time is considerably longer, thus prolonging the effect. Through this feedback pathway many of the postural ad­justments of the body are believed to occur.

FUNCTION OF THE CEREBELLUM IN VOLUNTARY MUSCLE CONTROL

In addition to the feedback circuitry between the body periphery and the cerebellum, an almost entirely independent feedback circuitry exists between the motor cortex and the cerebellum. This is illustrated in its simplest form in Figure 53-15 and in a much more complex form, involving the basal ganglia also in the control circuit, in Figure 53-16. Most of the signals of this circuit pass from the motor cortex and adjacent cortical areas to the cerebeilar hemispheres and then back to the cortex again, successively, through the dentate and inter-positus cerebeilar nuclei and the ventrolateral and ventroanterior nuclei of the thalamus. These circuits are not involved in the control of the axial and girdle muscles of the body. Instead, they serve two other motor control functions involving respectively (a) the intermediate zone of the cerebeilar hemisphere, and (b) the large lateral zone of this hemisphere. Let us discuss each of these separately.

CEREBELLAR FEEDBACK CONTROL OF THE DISTAL LIMBS THROUGH THE INTERMEDIATE CEREBELLAR ZONE AND INTERPOSITUS NUCLEUS

The intermediate zone of each cerebeilar hemisphere receives information from two sources: (1) direct information from the motor cortex, and (2) feedback information from the peripheral parts of the body, especially from the distal portions of the limbs. After the cerebellum has integrated this information, output signals are then transmitted mainly to the cerebral cortex through relays in the interpositus nucleus and the thalamus. In addition, signals pass directly from the interpositus nucleus to the magnocellular portion (the lower portion) of the red nucleus that gives rise to the rubrospinal tract. The rubrospinal tract in turn innervates especially those portions of the spinal cord gray matter that control the distal parts of the limbs, particularly the hands and fingers.

Ordinarily, during rapid movements, the motor cortex transmits far more impulses than are needed to perform each intended movement, and the cerebellum therefore must act to inhibit the motor cortex at the appropriate time after the muscle has begun to move. The cerebellum is believed to assess the rate of movement and calculate the length of time that will be required to reach the point of intention. Then appropriate inhibitory impulses are transmitted to the motor cortex to inhibit the agonist muscle and to excite the antagonist muscle. In this way, appropriate "brakes" are applied to stop the movement at the precise point of intention.

Thus, when a rapid movement is made toward a point of intention, the agonist muscle contracts strongly throughout the early course of movement. Then, suddenly, shortly before the point of intention is reached, the agonist muscle becomes completely inhibited while the antagonist muscle becomes strongly excited. Furthermore, the point at which this reversal of excitation occurs depends on the rate of movement and on the previously learned knowledge of the inertia of the system. The faster the movement and the greater the inertia, the earlier the reversal point appears in the course of movement.

Since all these events transpire much too rapidly for the motor cortex to reverse the excitation "voluntarily," it is evident that the excitation of the antagonist muscle toward the end of a movement is an entirely automatic and subconscious function and is not a "willed" contraction of the same nature as the original contraction of the agonist muscle. We shall see later that in patients with serious cerebellar damage, excitation of the antagonist muscles does not occur at the appropriate time but instead always too late. Therefore, it is almost certain that one of the major functions of the cerebellum is automatic excitation of antagonist muscles at the end of a movement while at the same time inhibiting agonist muscles that have started the movement.

The "Damping" Function of the Cerebellum. One of the byproducts of the cerebellar feedback mechanism is its ability to "damp" muscular movements. To explain the meaning of "damping" we must first point out that essentially all movements of the body are "pendular." For instance, when an arm is moved, momentum develops, and the momentum must be overcome before the movement can be stopped. And, because of the momentum, all pendular movements have a tendency to overshoot. If overshooting does occur in a person whose cerebellum has been destroyed, the conscious centers of the cerebrum eventually recognize this and initiate a movement in the opposite direction to bring the arm to its intended position. But again the arm, by virtue of its momentum, overshoots, and appropriate corrective signals must again be instituted. Thus, the arm oscillates back and forth past its intended point for several cycles before it finally fixes on its mark, This effect is called an action tremor, or intention tremor.

However, if the cerebellum is intact, appropriate subconscious signals stop the movement precisely at the intended point, thereby preventing the overshoot and also the tremor. This is the basic characteristic of a damping system. All servocon-trol systems regulating pendular elements that have inertia must have damping circuits built into the servomechanisms. In the motor control system of our central nervous system, the cerebellum seems to provide much of this damping function.

Cerebellar Control of Ballistic Movements. Many rapid movements of the body, such as the movements of the fingers in typing, occur so rapidly that it is not possible to receive feedback information either from the periphery to the cerebellum or from the cerebellum back to the motor cortex before the movements are over. These movements are called ballistic movements, meaning that the entire movement is preplanned and is set into motion to go a specific distance and then to stop. Another important example is the saccadic movements of the eyes, in which the eyes jump from one position to the next when reading or when looking at successive points along a road when a person is moving in a car. Much can be understood about the function of the cerebellum by studying the changes that occur in the ballistic movements when the cerebellum is removed. Three major changes occur: (1) the movements are slow to begin, (2) the force development is weak, and (3) the movements are slow to turn off. Therefore, it becomes very difficult to perform the very rapid ballistic movements. Furthermore, it is almost impossible to control how far the movement will go because of the difficulty of turn- ing the movement off once it is begun. Thus, in the absence of the cerebellar circuit the motor cortex has to think very hard to turn ballistic movements on and again has to think hard and take extra time to turn the movement off. Thus, the automatism of ballistic movements is lost.

But how does the cerebellum function in the control of ballistic movements? We do not know the answer to this. The supposition is: When the motor cortex first initiates the movement, it immediately sends signals to the cerebellum at the same time. The first effect of the signals is to excite the deep cerebellar nuclei, and these immediately send an excitatory signal back to the motor cortex, red nucleus, or other motor nuclei to reinforce strongly the onset of the ballistic movement. A few milliseconds later, the signal entering the cerebellum will have had time to go through the delay circuits of the cerebellar cortex and to return by way of the Purkinje cells to the deep cerebellar nuclei, but this time inhibiting these rather than exciting them. Therefore, after this given delay time, this automatic delayed inhibitory signal presumably stops the ballistic movement by turning off the agonist muscle and, because of reciprocal innervation, turning on the antagonist at the same time.

If the student will consider once again the circuitry of the cerebellum as described earlier in the chapter, she or he will see that it is beautifully organized to perform this biphasic, first excitatory and then delayed inhibitory, function that is required for ballistic movements. The student will also see that the time delay circuits of the cerebellar cortex almost undoubtedly are fundamental to this particular ability of the cerebellum.

COMPLEX MOVEMENTS ELICITED BY STIMULATING THE AREA Electrical stimulation of the premotor area will often elicit complex contractions of groups of muscles. Occasionally, vocalization occurs, or rhythmic movements such as alternate thrusting of a leg forward and backward, coordinate moving of the eyes, chewing, swallowing, or contortions of parts of the body into different postural positions.

Some neurophysiologists have called this area the motor association area and have ascribed special capabilities to it to control coordinated movements involving many muscles simultaneously. In fact, it is peculiarly organized to perform such a function for the following reasons: (1) it has long subcortical neuronal connections with the sensory association areas of the parietal lobe; (2) it has direct subcortical connections with the primary motor cortex; (3) it connects with areas in the thalamus contiguous with the thalamic areas that connect with the primary motor cortex; and (4) most important of all, it has abundant direct connections with the basal ganglia and the cerebellum, both of which feed back to the primary motor area through the thalamus.

The Pyramidal Tract (Corticospinaf Tract). The most important output pathway from the motor cortex is the pyramidal tract, also called the corticospinal tract, which is illustrated in Figure 53-5. The pyramidal tract originates about 60 per cent from the primary motor cortex, 20 per cent from the premotor cortex, and 20 per cent from the somatic sensory areas posterior to the central sulcus. After leaving the cortex it passes through the posterior limb of the internal capsule (between the caudate nucleus and the putamen of the basal ganglia) and then downward through the brain stem, forming the pyramids of the medulla. By far the majority of the pyramidal fibers then cross to the opposite side and descend in the lateral corticospinal tracts of the cord, finally terminating principally on the interneurons in the intermediate regions of the cord gray matter. However, some of the fibers in human beings (but not in most lower animals) terminate directly on the anterior motor neurons.

A few of the fibers do not cross to the opposite side in the medulla but pass ipsilaterally down the cord in the ventral corticospinal tracts, but these fibers also cross mainly to the opposite side of the cord either in the neck or the upper thoracic region.

The most impressive fibers in the pyramidal tract are a population of large myelinated fibers with mean diameter of about 16 microns. These originate from the giant pyramidal cells, also called Bete cells, that are found only in the primary motor cortex. These cells are about 60 microns in diameter, and their fibers transmit nerve impulses to the spinal cord at a velocity of about 70 meters per second, the most rapid rate of transmission of any signals from the brain to the cord. There are approximately 34,000 of these large fibers from the Betz cells in each corticospinal tract, However, the total number of fibers in each corticospinal tract is more than a million, so these large fibers represent only 3 per cent of all of them. The other 97 per cent are mainly fibers smaller than 4 microns in diameter.

FUNCTION OF THE LARGE LATERAL ZONE OF THE CEREBELLAR HEMISPHERE—THE "PLANNING" AND "TIMING" FUNCTIONS

In human beings, the lateral zones of the two cerebellar hemispheres have become very highly developed and greatly enlarged, along with the human capability to perform intricate movements with the hands and fingers and along with the ability to speak. Yet, strangely enough, these large lateral portions of the cerebellar hemispheres have no direct input of information from the peripheral parts of the body. Also, almost all the communication between these lateral eerebellar areas and the cortex is not with the primary motor cortex itself but instead with the premotor area and primary and association somatic sensory areas. Even so, destruction of the lateral portions of the cerebellar hemispheres along with their deep nuclei, the dentate nuclei, can lead to extreme in-coordination of the purposeful movements of the hands, fingers, feet, and speech apparatus. This has been hard to understand because of lack of direct communication between this part of the cerebellum and the primary motor cortex. However, recent experimental studies suggest that these portions of the cerebellum are concerned with two important aspects of motor control: (1) the "planning" of sequential movements, and (2) the "timing" of the sequential movements.

LITERATURE

1.                 Review of Medical Physiology by W.F.Ganong, 11th ed., 1983. – P. 33-77.

2.      Textbook of Medical Physiology by Guyton, 10 ed., 2003. – P. 663-675, 678-687.