The cortical control of movement: a clinical perspective

The hierarchy of motor control refers to the different levels of organization and processing involved in controlling movement in the body. These levels range from higher cortical areas involved in planning and decision-making to lower spinal cord reflexes that respond automatically to external stimuli.

The cerebral cortex, the brain's outermost layer, is pivotal in processing complex cognitive tasks, emotions, and various sensory inputs and executing voluntary motor activities. This intricate structure is divided into three primary functional areas: the motor areas, sensory areas, and association areas.
Motor Areas
The motor areas located in the frontal lobe are central to controlling voluntary movements. This region is further subdivided into the primary motor cortex and the premotor cortex.

The direct motor pathways, also known as the pyramidal tracts, are a group of neural pathways that originate in the brain and descend through the spinal cord. They control the voluntary movement of the body. There are two major direct motor pathways: the corticospinal and the corticobulbar tracts.
The corticospinal tract is responsible for the voluntary movement of the limbs and trunk. It originates in the cerebral cortex of the brain and descends through the cerebrum's internal capsule and the...

Sensory impulses related to touch, pressure, vibration, and proprioception from various body parts, such as the limbs, trunk, neck, and posterior head, travel to the cerebral cortex through the posterior column-medial lemniscus pathway. The pathway’s name derives from the two white-matter tracts that convey the impulses: the spinal cord's posterior column and the brainstem's medial lemniscus. First-order sensory neurons extend their axons into the spinal cord, forming the posterior columns...

The somatosensory cortex in the parietal lobes is crucial for interpreting sensory data such as touch, temperature, and proprioception. The somatosensory cortex, situated in the parietal lobes, plays a vital role in interpreting sensory information like touch, temperature, and proprioception—awareness of body position. This specialized brain region features an organized structure wherein neurons at the top primarily process sensations originating from the lower body. In contrast, those at the...

The indirect motor or extrapyramidal pathways originate in the brainstem, the lower portion of the brain that connects it to the spinal cord. They consist of several distinct tracts, each with specialized functions. The four main tracts of the indirect motor pathways are the vestibulospinal tract, the reticulospinal tract, the tectospinal tract, and the rubrospinal tract.
The vestibulospinal tract originates in the vestibular nuclei of the brainstem. The vestibular system detects changes in...