The direct or pyramidal motor pathways regulate conscious and voluntary movements through the skeletal muscles. The tracts of motor pathways comprise upper and lower motor neurons. The upper motor neurons of direct pathways originate from the cerebral cortex and provide input to the lower motor neurons in the spinal cord or the brainstem. The lower motor neurons then innervate the skeletal muscles, which trigger muscle contraction and movement. The motor pathways are made up of the corticobulbar tract and the corticospinal tracts. The corticobulbar tract carries motor impulses to control skeletal muscles in the head and face. It controls movements of the eyes, tongue, facial expressions, and speech. The corticospinal tracts control movements of the limbs and trunk. The lateral corticospinal tract decussates in the medulla oblongata. It controls skilled movements of the distal part of the limbs, such as playing the piano. The anterior corticospinal tract decussates in the spinal cord and controls the movement of the trunk and proximal parts of the limbs.