Roods approach @Dr.Muskan Rastogi (PT) BPT,MPT(OBG)

intro and application of roods approach
@Dr.Muskan Rastogi (PT)
BPT,MPT(OBG)

1. Muskan Rastogi ROODS APPROACH

2. INDEX Introduction Principles Basic concepts of roods approach Techniques 9/3/20XX Presentation Title 2

3. Introduction Rood approach is a neurophysiological approach developed by Margaret Rood in 1940 based on reflex or hierarchical model of the central nervous system. Rood's basic concept was that motor patterns are developed from primitive reflexes through proper sensory stimuli to the appropriate sensory receptors in normal sequential developmental pattern to improve motor performance. 3

4. 4 PRINCIPLES Basic principles of Rood Approach are: 1. Normalization of tone: Using appropriate sensory stimuli for evocating the desired muscular response is the basic principle of Rood approach. 2. Onto genic developmental sequence: Rood recommended the use of onto genic developmental sequence. According to Rood, sensory motor control is developmentally based, so that during treatment therapist must assess current level of development and then try to reach next higher levels of control. 3. Purposeful movement: Rood used purposeful activities which can help to get the desired movement pattern from the patient. 4. Repetition of movement: Rood encouraged to use repetitive movements for motor learning.

5. BASIC CONCEPTS OF ROODS APPROACH According to Rood, sensory input is required for normalization of tone and evocation of desired muscular responses. Sensory stimulus and their relationship to motor functions play a major role in the analysis of dysfunction and in the application of the treatment. 5 Rood's four basic concepts are Mobility and stability muscles(Tonic and phasic) The Onto genic Sequence Appropriate sensory stimulation Manipulation of the autonomic nervous system

6. 6 1.Mobility and stability muscles(tonic and phasic) According to Rood approach, muscle groups are categorized according to the type of work they do and their responses to specific stimuli. Phasic muscles (also known as light work muscles or mobility muscle) are the muscle groups responsible for skilled movement patterns with reciprocal inhibition of antagonist muscles e.g. the flexors and adductors. Tonic muscles (also known as heavy work muscles or stability muscle) are the muscle groups responsible for joint stability with co-contraction of muscles which are antagonists in normal movement. Though some muscles perform both light and heavy work functions, Rood mentioned specific properties of phasic and tonic muscles. Phasic muscles are fast glycolytic fiber type, superficial and usually one joint muscle. They have high metabolic cost and rapidly fatigue. Tonic muscles are different from phasic. The muscles are slow oxidative fiber type, deep and usually single joint type. These are Pennate, the large area of attachment muscle, has low metabolic cost and slow fatigue.

7. 7 2.The Ontogenic Sequence Rood introduced two categories of onto genic sequences : a. The Motor development sequence The motor development sequence finally leads to skilled and finely coordinated movements. The ontogenic motor patterns are: i. Supine withdrawal ii. Roll over iii. Pivot prone iv. Neck co-contraction. v. Prone on elbow vi. Quadruped vii. Standing viii. Walking

8. Rood also categorized these patterns under the following four phases, using the concepts of light and heavy work: i. Mobility or reciprocal innervations: It is a nearly mobility pattern, primarily reflex governed by spinal and supraspinal centers. It includes supine withdrawal, roll over, and pivot prone. ii. Stability or co-contraction: It is defined as simultaneous contractions of antagonists and agonists, working together to stabilize and maintain the posture of the body. It includes pivot prone, neck co-contraction, prone on elbow, quadruped and standing. iii. Mobility superimposed on stability: It is defined as a movement of proximal limb segments with the distal ends of limbs fixed on the base of support. It includes weight shifting in prone on elbows, quadruped, and to and fro rocking that later on can be promoted to crawling in different directions. iv. Skill or Distal mobility with proximal stability: It is defined as skilled work with the emphasis on the movement of distal portions of the body in a finely coordinated pattern that require control from the highest cortical level. 8

9. 9 b. The vital functions sequence The vital functions sequence finally leads to well-articulated speech. The ontogenic patterns are: i. Inspiration ii. Expiration iii. Sucking iv. Swallowing liquids v. Phonation vi. Chewing and swallowing solids vii. Speech

10. 3. Appropriate sensory stimulation The relearning of muscular activity is based on the phenomena of summation which activates or deactivates the sensory receptors, utilizing afferent input to affect the anterior horn cell of the spinal cord. Rood utilized the anterior horn cell excitability by using sensory stimulus. According to Rood, there are four types of receptors which can be stimulated and in order to get desired muscular response: i. Proprioceptive receptors ii. Exteroceptive receptors iii. Vestibular receptors iv. Special sense organs 10

11. 4. Manipulation of the autonomic nervous system 9/3/20XX Presentation Title 11 Rood introduced two groups of autonomic nervous system stimuli: i. Sympathetic Nervous System Stimuli: It includes icing, unpleasant smells or tastes, sharp and short vocal commands, bright flashing lights, fast tempo and arrhythmical music. ii. Parasympathetic Nervous System Stimuli: It includes slow, rhythmical, repetitive rocking, rolling, shaking, stroking the skin over the paravertebral muscles, soft and low voice, neutral warmth, contact on palms of hands, soles of feet, upper lip or abdomen, decreased light, soft music and pleasant odors.

12. TECHNIQUES

13. Facilitatory & Inhibitory Techniques To initiate a movement response, we should try to increase the neuronal activity -it refers as facilitation To decrease the capacity to initiate a movement response we should try to decrease the neuronal activity -it refers as inhibition . The sensory stimulation technique can be used separately or grouped according to the receptors activated, the nature of stimulation (intensity, duration and frequency) need to be adjusted and readjusted to meet the individual needs of the patient. TECHNIQUES USED ARE- Proprioceptive stimulation techniques. Extroceptive stimulation techniques. Vestibular stimulation techniques. Special senses (vision, hearing, smell ) stimulation techniques. Autonomic nervous system stimulation techniques 13

14. Proprioceptive Stimulation Techniques 14 Stretch: Quick and Prolonged Stretch . Application of this technique may include tapping which is commonly used in three forms; on tendon, on muscle belly and with the use of gravity. The quick stretch produce a relatively short-lived contraction of the agonist muscle and short-lived inhibition of the antagonist muscle. Prolonged and firm stretch produces inhibition of muscle responses which may help in reducing hypertonicity, e.g., Bobath's neuro-developmental technique, inhibitory splinting and casting technique. Vibration: The high frequency vibration is driven from vibrator that optimally operates at a frequency of 100–200 Hz and at amplitude of 1–2 mA. This type of vibration produce facilitation of muscle contraction through what is known as tonic vibration reflex. This facilitatory effect sustained for a brief time after application. Therefore, it can be used for stimulating muscles whose primary function is one of tonic holding. The low frequency stimulation 5-50 Hz has an inhibitory effect on muscle through its activation of spindle secondary endings and Golgi tendon organs. Approximation or compression of the joint surfaces: Facilitates posture extensors which are needed to stabilize the body. Approximation can be applied slowly to inhibit muscle control or in jerky manner to facilitate muscle control. The application may be manually and/or by using weight bearing postures. Joint awareness may be improved by approximation which will lead to enhancing motor control.

15. Extroceptive Stimulation Techniques Touch: It is one of the simple ways of facilitation of muscle activity by eliciting the phasic, protective withdrawal reflexes. The location of the stimulus and its intensity play the important role in the magnitude of reaction. Application of the touch can be manually using brief, light stroke, brief swipe ice cube, noxious stimulus and/or light pinching. Brushing : It facilitates the movement responses; Application can be manually or by using battery-operated brush. Skin overlying muscle can facilitate it and enhances static holding postural extensors and will have immediate and long latency responses. 9/3/20XX Presentation Title 15

16. 9/3/20XX Presentation Title 16 Icing for a long period : Icing given for more than 20 minutes can inhibit muscle activity and postural tone (locally). Application of the prolonged ice can be used clinically by four types; ice chips, ice wraps, ice pack and immersion in cold water. Neutral warmth : It is one of the most common way to inhibit postural tone and muscle activity. It acts through stimulating the thermo receptors and activating of parasympathetic responses. Usually, 10-20 minutes are sufficient period to produce effect. The application may be by wrapping body part with towels, hot packs, tepid baths and air splints. Maintained Touch : It can be used to produce a general calming effect and generalized inhibition. Firm manual contacts (pressure to midline abdomen, back are the commonly used techniques). Slow stroking: It is another technique used to produce a generalized calming effect by the activation of Autonomic Nervous System. It may be applied by using a flat hand over the paravertebral muscles from cervical to sacral regions. The generally calming effect can decrease muscle tone. 3-5 minutes of stroking is sufficient to produce the effect.

17. Vestibular Stimulation Techniques Total body inhibition can be achieved by slow rocking, slow anterior-posterior movement, slow horizontal movement, slow vertical movement and slow linear movement. Total body facilitation can be achieved by rolling patterns, a rocking pattern on elbows and extended elbows and crawling. Also spinning induces tonal responses and causes a strong facilitation of movement through the overflow of impulses to higher centers. A facilitation of postural extensors is another effect of vestibular stimulation if it is used by a rapid way anterior-posterior or angular acceleration of the head and body while the child in prone position. The inverted position is commonly used now to achieve a total body inhibition, while it may be used to increase to in certain extensors. 9/3/20XX Presentation Title 17

18. Special Senses Stimulation Techniques 18 Visual system: May be used to produce a decrease or an increase in firing of sensory afferent fibers and have an overall effect on CNS excitation. Cool colors, a darkened room and monotone color schemes all tend to have an inhibitory effect on muscle tone, a calming mood and generalized inhibitory response. On the other hand a facilitatory effect can be gained by intermittent visual stimuli, bright colors, bright light and a random color scheme. If the sensory component of the tactile, proprioceptive or vestibular system has been lost or severely damaged the visual stimulus may consider an effective alternative. Auditory System : As a treatment technique, it depends on the quality, quantity and effect of voice. The therapist's voice can be considered a very important therapeutic tool to produce a facilitatory or inhibitory response on muscle tone and activity. The same effect may also be gained by music. Auditory biofeedback is a very important and famous therapeutic modality which depends on intact auditory system. Olfactory System: May be used as a treatment modality especially during feeding procedures. Some odors such as vanilla and banana may be used to facilitate sucking movement. Withdrawal patterns can be facilitated with ammonia and vinegar. Therapist should use olfactory system as a treatment technique under restricted precautions because its arousal and emotional effect.

19. ANS Stimulation Techniques There are four treatment procedures can be used to affect on movement and muscle tone throughout ANS reaction which normally produce a parasympathetic response: Slow stroking over the paravertebral areas will cause inhibition. Inverted tonic labyrinthine therapy. Slow, smooth, passive movement within pain free range. Maintained deep pressure on the abdomen, palms, soles of the feet, and perineal area may cause a reduction of tone or hyperactivity. 19