An important part of physiology deals with motor functions, i.e. the ability to move, and how this is made possible by our central nervous system, which controls the skeletal muscles. Motor control is a complex performance of several regions of the brain that are hierarchically organized motor systems interacting with each other. In the following article, the basics of the interaction and functioning of these motor systems are explained.
Human motor cortex

Image: “Human motor cortex” by Iamozy. License: CC BY-SA 3.0

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How Is Movement Possible?

Any body movement relies on the motor systems of the different levels (spinal cord, brain stem, cerebellum, cerebrum), which communicate with each other via certain pathways.

Spinal Motor System

The spinal motor system regulates movement coordination at the spinal cord level, including the most basic motor response to a stimulus – the reflex. From a hierarchical point of view, reflexes represent the lowest functional level of motor control.


Image: “ Spinal cord – sections” by Polarlys. License: CC BY 2.5


A reflex is the stereotypical response to a stimulus. A reflex arc consists of the following parts:

  • Sensor
  • Afferent nerve path
  • One (monosynaptic) or several (polysynaptic) neurons
  • Efferent nerve path
  • Effector

A registered stimulus travels via the afferent nerve pathway to the motor neurons (anterior horn cells) of the spinal cord, which send the response to the stimulus via their axons (i.e., the efferent nerve pathway) to the effector organ.

Sensors of the reflex Arc

A fundamental role in motor control is played by proprioception, which describes the reception of stimuli from the internal body through mechanoreceptors. The following sensors are part of the spinal system, each of which are specialized for different stimuli:

Muscle spindles

Muscle spindles are stretch sensors of the skeletal muscles and measure muscle length and stretch rate. They consist of intrafusal fibers (specialized muscle cells), which are surrounded by a capsule consisting of connective tissue, and are arranged parallel to the skeletal muscles. They can be found more or less frequently in every muscle. Especially in small muscles, which are important for precision, the number of muscle spindles is high.

Tendon organ

Tendon organs are stretch sensors of the skeletal muscles which, in turn, measure the tension in the muscles. They are arranged in series to the skeletal muscles and are located at the transition of tendon to muscle. If the tension in the muscle increases, this stimulus is conducted via the myelinated nerve fiber of the tendon organ over the dorsal root to the spinal cord, which inhibits the motor neurons and therefore the contraction of the muscle is slowed down.

Sensors in the joints

Each joint has groups of sensors for the different movement capacities in the joint axis. These are discharged through movements of the joint, like internal or external rotation.

Cutaneous sensors

The afferent pathways of the reflex arcs also contain information from the numerous mechanoreceptors and pain receptors of the skin and of the free nerve endings of the muscles (see: multisynaptic reflex).

The efferent nerve pathways of the reflex arc: Motor neurons

The motor neurons are located in the anterior horn of the spinal cord. The following motor neurons can be distinguished:

  • γ-motor neurons, which innervate the intrafusal muscles (= muscles of the muscle spindle).
  • α-motor neurons, which innervate the extrafusal muscles (= skeletal muscles). They receive information from the sensors of skin, muscles and joints, from the corticospinal pathways as well as from the spinal cord as such. α-Motor neurons can be distinguished as follows:
phasic α-motor neurons tonic α-motor neurons
thick axons thin axons
high transmission rate low transmission rate
supply ATP-rich muscle fibers, which quickly contract and fatigue supply the muscles of the supporting apparatus
fast adaption lack of adaption

The α-motor neurons are connected with the Renshaw cells via afferent nerve pathways, which inhibits the activity of the motor neurons through a feedback inhibition.

Motor endplate

Motor nerve fibers have a different number of branches in different muscles, depending on how precise the muscle is working. Each axon of a motor anterior horn cell forms together with the muscle fibers it supplies a so-called motor unit: therefore, the muscle fibers supplied by one axon contract all at once.

The area in which the transmission of the stimulation from the nerve to the muscle takes place is called the motor endplate (or motor nerve terminal). The endings of the nerve branches do not have any myelin sheaths and the muscle fibers are a bit elevated. The motor endplate is a special synapse – excitation is transferred by the chemical messenger substance acetylcholine.

How does the transmission of the excitation at the motor endplate work?

The arriving action potential results in a presynaptic opening of calcium channels, whereby vesicles containing acetylcholine are released into the synaptic gap. The vesicles release their content through exocytosis, and the acetylcholine binds to the receptors in the postsynaptic membrane, which thereupon open their ion channels. Because of the influx of the ions, muscle cells depolarize – the result is a contraction of the muscle.

Brain Stem Motor System

Purpose: The brain stem, consisting of medulla oblongata, pons and midbrain, is a kind of coordinating unit of all motor control. Through the reflexes of the brain stem, quick adaptation to changing environmental conditions is possible.

The brain stem has a connection with higher regions of the brain, and through descending pathways, coming from its nucleus areas, the motor neurons of the spinal cord are activated or inhibited.

Important motor nuclei of the brain stem:

  • Red nucleus
  • Vestibular nuclei (lateral vestibular nucleus = Deiters nucleus; medial vestibular nucleus)
  • Parts of the reticular formation

Important afferent nerve pathways of the brain stem:

  • Motor cortex
  • Cerebellum
  • Vestibular system

Important efferent nerve pathways of the brain stem:

  • Rubrospinal tract
  • Vestibulospinal tract
  • Medial and lateral reticulospinal tract
Pathways stimulating the neurons of the flexors Pathways inhibiting the neurons of the flexors Pathways stimulating the neurons of the extensors Pathways inhibiting the neurons of the extensors
Rubrospinal tract Rubrospinal tract
Vestibulospinal tract Vestibulospinal tract
Medial reticulospinal tract Lateral reticulospinal tract
Lateral reticulospinal tract Medial reticulospinal tract

The most important reflexes of the brain stem are:

  • Static reflexes are body righting reflexes, which coordinate the body position in space.
  • Statokinetic reflexes, like physiological nystagmus and the elevation-induced labyrinthine tonic reflex, are reflexes that are triggered by movement and ensure that the balance is maintained.
  • Reflexes coordinating food intake are: the sucking reflex, salivary reflex, chewing and swallowing reflex.
  • Defensive reflexes include the corneal reflex and the cough reflex.

Cerebellum and Motor Control

Purpose: Fine motor skills – coordination of supporting and target-directed motor skills and the preparing of motor programs.

The cerebellum receives information from the labyrinth, spinal cord and the idea of the movement from the motor cortex. Its efferent nerve pathways go from the brain stem via the thalamus to the motor cortex. Its anatomical structure of cortex and marrow with nuclei resembles the structure of the cerebrum.

All pathways coming from the cerebellum go through the nuclei of the cerebellum (= fastigial, interposed and dentate nuclei). The cortex of the cerebellum contains in its three layers different neurons, which are afferently provided either by climbing fibers from the olive or by the mossy fibers from other areas.

The afferent nerve pathways of the cerebellum:

  • The archicerebellum receives information from the vestibular nuclei.
  • The paleocerebellum receives information from the spinal marrow and the pyramidal tract.
  • The neocerebellum receives the concept of movement of the associative parts of the cortex of the cerebrum.

The afferent nerve pathways of the cerebellum:

  1. Starting from the cerebellar vermis, efferent nerve pathways go through the fastigial nucleus to the brain stem and coordinate muscle tone, balance and supporting motor skills.
  2. The efferent nerve pathways of the intermediate part go via the interposed nucleus and the efferent nerve pathways of the cerebellar hemispheres via the dentate nucleus to the brain stem (red nucleus) and then via the thalamus to the motor cortex of the cerebrum. The intermediate part corrects the planned movement of the motor cortex and coordinates the targeting with the supporting motor skills. The hemispheres of the cerebellum make motor programs for fast target-directed movements, based on information from the associative cortex and the concepts of movement planned by the cerebrum. The necessary supporting motor skills are activated through the connection to the brain stem.

Basal Ganglia

Purpose: Control and modulation of complex movements (e.g. writing), which makes harmonic motion sequences possible, motor memory.
Basal ganglia classic

Image: “Connectivity diagram showing excitatory glutamatergic pathways as red, inhibitory GABAergic pathways as blue, and modulatory dopaminergic pathways as magenta. (Abbreviations: GPe: globus pallidus external; GPi: globus pallidus internal; STN: subthalamic nucleus; SNc: substantia nigra compacta; SNr: substantia nigra reticulata)” by Andrew Gillies. License: CC BY-SA 3.0

Basal ganglia are subcortical nuclei, near the thalamus. They are part of the extrapyramidal system. From a functional (not anatomical) point of view, the following structures belong to the basal ganglia:

  • Striatum = caudate nucleus and putamen
  • Pallidum
  • Substantia nigra (in the area of the midbrain)
  • Subthalamic nucleus (in the area of the diencephalon)

The basal ganglia receive information from different parts of the cerebral cortex. They generate motor programs for slow movements and adapt speed and the degree of movement to the conditions of the organism. The basal ganglia either have a stimulating or an inhibiting effect on the motor functions. Based on this fact, it becomes clear why degenerative diseases of the basal ganglia manifest with either excessive movements—like Huntington’s diseaseor to the contrary, with akinesia—like Parkinson’s disease.


Function: Inhibition of motor functions

The striatum receives stimulating afferent nerve pathways (mediated by glutamate) from the cortex and more inhibiting ones (mediated by dopamine) from the substantia nigra. The efferent nerve pathways of the striatum have an inhibiting effect on pallidum and substantia nigra, transmitted by GABA.


Function: Enhances motor skills, “antagonist” of the striatum.

Its afferent nerve pathways come from the striatum, the subthalamic nucleus and the thalamus. Efferent nerve pathways go to the thalamus as well as to the cerebral cortex.

Subthalamic nucleus

Function: Inhibiting effect on motor skills

The subthalamic nucleus is connected to the pallidum through afferent nerve pathways (inhibiting) and through efferent nerve pathways (stimulating). It also receives afferent nerve pathways from the cerebrum and the thalamus.

The basal ganglia are in contact with the cerebral cortex via functional loops. This means: Information from specific areas of the cortex are interconnected in the corresponding parts of the basal ganglia and have an backwards effect on them through outgoing efferent nerve pathways.

There is, for example, a functional loop which specifically acts on the muscles of the mouth and the face, another one which controls the motor skills of the eyes, and more complex loops that are related to cognitive performance, motivation and inner drive. This is why disorders of the basal ganglia exhibit not only motor-related symptoms but also mental-motivational and demential changes.

Cerebral Cortex and Motor Control

Purpose: After a motivation for movement has arisen and a concept for the movement has been developed (both in the cerebral cortex), the concept is sent to the cerebellum and the basal ganglia. The programs for fast movements are developed in the basal ganglia and the slow ones in the cerebellum. Through the “gateway to consciousness” (the thalamus), the motor programs arrive at the motor cortex, which initiates the movement.

The motor cortex

Purpose: Executing of complex movements

According to Brodmann, the cerebral cortex consists of different areas, with area 4 (primary motor cortex) and 6 (secondary motor cortex) forming the motor cortex. In each of these two areas, the muscle groups are represented somatotopically.

The motor cortex is the highest functional level in the hierarchy of motor control. It receives information from subordinated regions of the brain, processes them, and acts as a kind of “general” who gives the ultimate command to execute the movement. The following precedes the execution of movement:

  1. The motivation for movement originates in the limbic system and the frontal lobe.
  2. Associative areas of the cerebral cortex form a concept for movement.
  3. The cerebellum and the basal ganglia create the corresponding motor program.
  4. The motor program travels through the thalamus to the motor cortex.

The motor cortex arranges the execution of movement via the pyramidal tract (= corticospinal tract). It is connected with all the important centers of the brain; for example, with the brain stem for the coordination of the supporting motor skills through these important tracts: corticorubral tract and corticoreticular tract. From the brain stem, the rubrospinal tract and the reticulospinal tract lead to the spinal cord.

The pyramidal tract has over a million efferent fibres, which branch on their way: one portion branches towards thalamus, red nucleus, and others; one portion branches towards the motor nuclei of the brain via the corticobulbar tract. The major part, however, goes directly to the motor neurons of the spinal cord. 80 % of these fibres cross in the lower area of the brain stem and the minor part in the spinal cord to the opposite side.

Distinction: Pyramidal tract and extrapyramidal tracts

While the pyramidal tract with its neurons in the cerebral cortex controls our conscious movements, the extrapyramidal system has its areas of nuclei below the cerebral cortex and modifies the involuntary movements. It autonomously controls  our involuntary movements of the muscles and the basic tone of the muscles. Its connections to the visual system, the organ of equilibrium, the cerebrum, and the cerebellum enable us to smoothly execute complex movements.

corticospinal tract

Image: “Corticospinal Tract” by philschatz. License: CC BY 4.0

Pathophysiology of the Motor Systems

Diseases of the spinal cord


A complete section of the spinal cord leads to a loss caudal of the lesion of all motor, sensory, and vegetative functions. Furthermore, an initial so-called spinal shock is common; it manifests as total areflexia, which however regresses in the further process.

Diseases of the brain stem

Decerebration syndrome

Heavy trauma to the brain can damage the tracts between the cerebral cortex and the brain stem. The cerebral cortex is consequently excluded from the control of the organism (= syndrome of decerebration), whereas the functioning of the brain stem is preserved.

Interruption of the tracts caudal of the red nucleus leads to decerebrate rigidity (= tone increase) of the extensor muscles because the inhibiting function of the red nucleus on the extensors is no longer in effect, and therefore the stimulating function of the lateral vestibular nucleus predominate. Lesions below the lateral vestibular nucleus, however, do not lead to decerebrate rigidity because in this case, the activation of the extensors through the lateral vestibular nucleus has been eliminated as well.

Diseases of the Cerebellum

Damages to the cerebellum (e.g., as a result of chronic alcohol abuse) lead to disruptions in the fine adjustment and coordination of movements.

The following symptoms are characteristic:

Hypotonus of the muscles: in case of damage in the area of the hemispheres

Hypertonus of the muscles: in case of isolated damage of the cerebellar vermis

Nystagmus (= disruption of the eye coordination) in case of damage of the medial parts of the cerebellum

Scanned language: stagnating flow of speech

Intention tremor (= strong tremor of the extremities during voluntary movements) in case of damage of the hemispheres


  • Disruption of target-directed motor skills (finger-nose test) = dysmetria: in case of damage of the hemispheres
  • Insecure straddle gait = ataxia: in case of damage of medial parts of the cerebellum
  • Inability to perform fast antagonistic movements = dysdiadochokinesia: in case of damage of the hemispheres

Diseases of the basal ganglia = Extrapyramidal movement disorders

Lesions in the area of the basal ganglia lead to disruptions of harmonic movements. Plus and minus symptoms are distinguished:

Plus symptoms Minus symptoms
Rigidity Akinesia/hypokinesia

Diseases with hypokinetic-hypertonic symptoms:

Parkinson’s disease

Parkinson’s is a degenerative disease of the substantia nigra that involves the loss of dopamine-producing cells. Because of the loss of dopamine and the resulting excess of choline, disruptions of the modulation of movements can occur – characterized by the symptom triad: “cogwheel” rigidity, tremor, and akinesia.

Diseases with hyperkinetic-hypotonic symptoms:

Huntington’s disease

The loss of GABA and choline-producing cells in the striatum leads to a predominance of impulses triggered by dopamine. The symptoms can be tics in form of muscle twitching, changing of the psyche, and even dementia. The movements of patients suffering from Huntington’s disease are fast and not rhythmical and they increase in case of excitement or intending movement.


Athetosis is characterized by slow, stereotypical, vermicular movements of the extremities, which can result in abnormal joint positions.


This movement disorder manifests in case of malfunctioning of the subthalamic nucleus as fast, skidding movements with sudden onset..

Diseases of the motor cortex

Apoplexy = Stroke

Lesions of the corticospinal tract (= pyramidal tract) in the area of the internal capsule due to, e.g., bleedings lead to paralyses. During the acute stage, loose paralyses of the contralateral side of the body are common, which turn into spastic paralyses in the further process and are characterized by pathological reflexes.

The pyramidal fibers in the internal capsule are arranged topographically, and therefore, depending on the position of damage, different muscle groups can be affected by the paralysis (hemiplegia of the arms or legs). As the motor neurons remain intact, there is no atrophy of the muscles. Fine motor skills are impaired and muscle strength is reduced because the internal capsule conducts also fibers to the brain stem and the cerebellum.

Popular Exam Questions on Motor Control

1. Which symptom does not occur in case of a functional disruption of the basal ganglia?

  1. Resting tremors
  2. Ballism
  3. Athetosis
  4. Chorea
  5. Spasticity

2. Which answer is incorrect? Important areas of the nuclei of the brain stem are:

  1. Caudate nucleus
  2. Red nucleus
  3. Lateral vestibular nucleus
  4. Vestibular nuclei
  5. Parts of the reticular formation

3. Which statement about the cerebellum is incorrect?

  1. Chronic alcohol abuse can lead to damage of the cerebellum.
  2. Rigidity, tremor, and akinesia are not typical signs of the cerebellum.
  3. Resting tremors, nystagmus, and ataxia are typical signs of the cerebellum.
  4. Dysdiadochokinesia and scanned language are signs of a disorder of the cerebellum.
  5. The hemispheres of the cerebellum create motor programs especially for fast, target-directed motor skills.
Lecturio Medical Courses


W. Kahle: Taschenatlas der Anatomie, 8. Auflage – Thieme Verlag

Hick: Intensivkurs Physiologie, 5. Auflage – Urban&Fischer Verlag

Duale Reihe – Anatomie, 1. Auflage – Thieme Verlag

E. Bierbach: Naturheilpraxis heute, 2. Auflage – Urban&Fischer Verlag

Correct answers: 1E, 2A, 3C

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