Roods approach

Controlled use of sensory stimulus.
Specific Motor response
Normalization of muscle tone
Use of Developmental sequences.
Sensorimotor development = from lower to higher level.
Use of activity to demand a purposeful response.
Practice of sensory motor response is necessary for motor learning.

1. Roods Approach Dr . Maheshwari Harishchandre Assistant Professor M.P.Th (Neurosciences ) DVVPF College of Physiotherapy, Ahmednagar

2. Contents Introduction Principles Rules of sensory input Sequence of Motor Development Ontogenic Motor Pattern Facilitation Technique Inhibition Technique

3. Introduction Margared Rood (1976) PT & OT CP & patients with motor control problems.

4. Principles Controlled use of sensory stimulus. Specific Motor response Normalization of muscle tone Use of Developmental sequences. Sensorimotor development = from lower to higher level. Use of activity to demand a purposeful response. Practice of sensory motor response is necessary for motor learning.

5. Rules of Sensory Input A fast brief stimulus produces a large synchronous motor output . Use : stimulus confirms the reflex are functioning. A fast repetitive sensory input produces a mantained response . A mantained sensory input produces a mantained response . e.g. Gravity, positions Slow, rhythmical , repetitive sensory input deactivates body & mind . e.g. Slow rocking or soft music.

6. Sequence of Motor Development Reciprocal Inhibition/ Innervation : Early mobility pattern protective in nature. Phasic & reciprocal type of movement. Contraction of agonist & relaxation of antagonist. Co- contraction : Tonic (static ) pattern Simultaneous agonist & antagonist contraction.

7. Heavy Work : Controlled mobility pattern Stock meyer “mobility superimposed on stability” Proximal ms. contract & move & the distal segment is fixed. E.g. Creeping Skill : Highest level of motor control Combined Pattern Proximal segments are stabilized , distal segments moves freely. E.g. Typing.

8. Levels of Motor Control

9. Ontogenic Motor Patterns Supine withdrawl (Flexion) : Total flexion response towards vertebral level T10 Requires reciprocal innervation with heavy work of proximal segments. Recommended : patients with no reciprocal flexion patients dominated by extensor tone

10. Roll Over towards side lying : Mobility pattern for extremities & lateral trunk muscles Recommended : Patients dominated by tonic reflex patterns in supine Stimulates semicircular canals which activates the neck & extraocular muscles.

11. Pivot Prone : Combined Pattern Demands full range of extension of neck, shoulders, trunk & lower extremities. Position difficult to assume & mantain Important role in preparation for stability of extensor muscles in upright position Associated with labyrinthine righting reaction of the head Integration : STNR & TLRs.

12. Neck Contraction : Real stability pattern Activates both flexors & deep tonic extensors Elicits the tonic labyrinthine righting reaction reaction when the face is perpendicular to the floor . Recommended: Patients needs neck stability & extraocular control.

13. Prone on Elbows : Stretches the upper trunk musculature Influence stability scapular & glenohumeral regions Gives better visibility of the environment Allows weight shifting from side to side. Recommended : Patients needs to inhibit STNR

14. Quadruped Position : Lower trunk & LE are in cocontraction . Can do weight shifts in forward/backward, side to side & diagonal directions. Mobility superimposed on the stability Prepares equilibrium responses.

15. Standing : Wt. Is equally distributed on both legs after that wt. Shifting begins. UE are free to perform functions. Integration : righting reaction & equilibrium reactions.

16. Walking : Sophisticated process requiring coordinated movt . Patterns of various parts of body. “support the body weight, mantain balance, & execute the stepping motion “ – Murray

17. Facilitation Techniques

18. 1. Tactile Stimulation

19. a. Light moving touch Touch is imp. for normal growth & development ( Montague A, 1978) Mechanism Mediated by A delta sensory fibers Stimulates A delta sensory fibers synapses with fusimotor system reciprocal innervation ( phasic withdrawl response)

20. Effects : Activates low threshold hair end organ & free nerve endings. Activates sup. mobilizing muscles, Increases corticosteroid levels in the blood stream. Increases resistance against disease. Improves fluid & electrolyte balance.

21. Application Frequency Area Response Finger tips, camel hair brush or cotton swab. 3-5 strokes, 30 sec. Rest period between stroke From the nose to chin Flexion of UE & perhaps LE Light stroking from corner of lip to the cheek Activates neck ms. & head tilts laterally towards the side of the stimulus. Light moving touch to the navel or dermatome T10 in midline to lateral dir n Activates unilateral flexion pattern To the dorsal web spaces of the fingers & toes Activates a withdrawl pattrn of the extremities To the tips of the fingers or soles of the feet Facilitates a tickle withdrawl response of great magnitude

22. b. Fast Brushing Stimulus Mediated by Procedure effect Fast brushing C fibers By battery operated brush is applied over the dermatomes of the same segment that supplies the ms. ( myotome ) to be facilitated. Eg . Is applied for 3 to 5 seconds & repeated after 30 sec. Lasts for 30 minutes, stimulates C fibers which sends many collaterals in the RAS.

23. 1. Icing Extreme thermal facilitation Facilitation of ms activity & ANS responses. Uses : Quick icing – hypotonia (3 swipes, blott water after each swipe) Pressing ice cubes to the skin of dermatome corresponding to myotome to be stimulated. Ice to stimulate SNS & glandular output of thyroid & adrenal glands. Note : cardiac problems.

24. Proprioceptive Stimulation

25. Jt. gives control over the motor response. Proprioceptors adapt more slowly than exteroceptors & can produce sustained postural patterns.

26. Heavy Joint Compression Def n : Jt. Compression > body wt. applied through the longitudinal axis of the bone.(Ager J, 1974) Causes : cocontraction around jt under compression Combined with ontogenetic patterns s/a prone on elbows, quadruped, sitting & standing position. Can be applied manually or by weighted cuffs or sand bags.

27. Stretch

28. Resistance

29. Tapping It acts on muscle spindle (afferent) & increases the tone of underlying skeletal muscles. Tapping over the belly of muscles with fingertips 3-5 times over the muscle to be facilitated.

30. Vestibular stimulation Powerful propriocetive input (De Quiros JB) Therapeutic Uses : To promote extensor patterns of the neck, trunk & extremities (Static labyrinthine system) To elicit subcortical responses, s/a protective extension

31. 3.To activate antigravity muscles & their antagonist 4.Fast stimulation s/a rocking stimulates while rhythmic slow rocking causes relaxation 5.Vestibular stimulation affects tone, balance, protective responses, bilateral integration & auditory language development.

32. Vibration Frequency : High Frequency : 100 to 300 cycles/second Low frequency : 50 to 60 cycles/second Uses : HF is used to elicit tonic vibration reflex which stimulates contraction of muscle if applied directly over the belly. Inhibits contraction of antagonist ms. & suppress stretch reflex. LF vibration suppress pain perception, desensitize hypersensitive skin.

33. Osteopressure Def n : presure on bony prominence to facilitate or inhibit voluntary muscles. E.g.

34. Inhibition Techniques Gentle shaking or rocking Slow rolling Light jt. compression Tendinous pressure Mantained stretch Rocking in developmental pattern

35. Gentle Shaking & Rocking

36. Slow Rolling

37. References Concise Exercise Therapy : A comprehensive TB for physical & occupational thearapist by Roshan Mecna Therapeutic Approaches in Neurorehabilitation by Gajanan Bhalerao Manual Therapy Approaches in neurophysiotherapy by S. S. Ganvir International Occupational therapy (Sixth edition)m by Pedretti S.