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Roods approach
Roods approach is a neurophysiological and development
approach that was developed by margeret rood in 1950s and
1970s
At first it is used for CP patient later it's used at patient with motor
control problem mainly neurological conditions ,rheumatoid
arthritis , osteoarthritis , post fracture and soft tissue injury
Roods approach believes that motor output dependent on
sensory input and it is also based on the reflex /hierarchical model
of the CNS ,where the movement is facilitated or inhibited for
rehabilitation purpose
Motor pattern are developed from primitive reflexes which is
utilized and gradually modified through sensory stimuli until the
higher control is gain
Appropriate sensory receptors utilized in normal sequential
development will help to elicit normal motor response
Stages of motor response
1. reflex mobility
Nearly mobility pattern
Primary reflex governed by spinal and supra spinal centers
before you use hand purposefully child move his or her Extremities
reflexively
2. Stability
Simultaneous contractions of antagonists and agonists working
together to stabilize and maintain poster of the body
Good stability in trunk, neck and shoulder
3. mobility superimposed on stability
moment of proximal limb segments with the distal ends of limbs fixed
on the basis support
4. Skill
Skilled work with the emphasize on the movement of distal portion
of the body in a finely coordinated pattern that require control from
the higher cortical levels
Principles of roods approach
1. normalization of tone
Using appropriate sensory stimuli for evocating the desired muscular
response
2. Ongenic development sequence
According to roods sensory motor control is development based so
that during treatment therapist must assess current level of
development and then try to reach next higher level of control
3. Purposeful movement
Roods use purposeful activities which can help to get the desired
movement patterns from the patient
4. Repetition movement
Roods encouraged to use repetitive movement for motor learning
Basic concepts of roods approach
According to roods sensory input is required for normalization of tone and
evocation of motor response
- Supine withdrawal (Flexion): Total flexion response towards vertebral level T Requires reciprocal innervation with heavy work of proximal segments. Recommended: patients with no reciprocal flexi patients dominated by extensor tone
- 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.
- Pivot Prone: Combined Pattern Demands full range of extension or neck, snoutaers, 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.
- 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.
- 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
- 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
- Standing:
Wt. Is equally distributed on both legs after that wt.
Shifting begins.
UE are free to perform functions.
Integration: righting reaction & equilibrium reactions.
- Walking:
Sophisticated process requiring coordinated movt.
Patterns of various parts of body.
“support the body weight, maintain balance, & execute
the stepping motion “ Murray
The vital functions sequence
The vital functions sequence finally leads to well-articulated
speech. The ontogenic patterns are:
1. Inspiration
2. Expiration
3. Sucking
4. Swallowing liquids
5. Phonation
6. Chewing and swallowing solids
7. Speech
Techniques Roods approach has two main techniques Facilitatory techniques Inhibitory techniques
Facilitatory techniques
It is very important technique to improve the tone of flaccid muscles and it mainly used in patients especially those who have hypotonia or muscle weakness. This technique can help in normalizing tone and facilitating movements in the patient Light moving touch Procedure Apply with a fingertips ,camel brush, cotton swap apply 3-5 strokes and allow 30 seconds of rest between strokes to prevent over stimulation. Mediated by a delta nerve fibers sensory information that reaches the limbic system, which is a part of the brain involved in emotions and memory. Effects Increases Corticosteroid Levels in Bloodstream: This input can trigger the release of corticosteroid hormones into the blood, which are involved in stress response and regulation of metabolism. Activates Superficial Mobilizing Muscles: This input stimulates muscles that perform lighter, skilled tasks, like those used for delicate movements. Stimulates A-delta Sensory Fibers Synapsing with Fusimotor System: A-delta sensory fibers are nerve fibers responsible for transmitting sharp, quick pain signals. When they synapse with the fusimotor system (involved in muscle control), it can lead to a reflexive withdrawal response (quickly pulling away from a stimulus). This sensory input can impact hormone levels, muscle activation, and reflex responses, and it's often evaluated using specific sensory testing tools.
Fast brushing Fast brushing refers to a type of gentle, quick touch sensation applied to the skin. Same procedure as the light moving touch and mediated by c nerve fibers Which sends collaterals in the RAS Effects Mediated by C Nerve Fibers: This sensation is transmitted through C nerve fibers, which are a type of nerve fiber involved in transmitting slower, chronic pain signals. Effect on Reticular Activating System (RAS): The C nerve fibers send branches (collaterals) to the Reticular Activating System (RAS), which is a network of nerve pathways in the brainstem involved in regulating wakefulness and arousal Fast brushing, like light moving touch, involves gentle, quick sensations transmitted by specific nerve fibers. These sensations can influence the brain's arousal and wakefulness through connections with the Reticular Activating System (RAS). Quick icing or A- icing Quick icing, also known as A Icing, involves applying ice or a cold stimulus to the body. Procedure Ice is supplied to the skin in 3 quick swipes and water blotted with a towel between swipes Effect Effect on Patients with Hypotonia: Patients with hypotonia (low muscle tone) may benefit from quick icing. The cold stimulus can help stimulate and awaken muscles by triggering a reflexive response. State of Relaxation: Despite the stimulating effect on muscles, quick icing can also promote relaxation in the body. Alerts Mental Processes: The sudden cold sensation can have a stimulating effect on the nervous system, potentially increasing alertness and cognitive processes. Quick icing is a technique that uses cold to stimulate muscles and mental alertness, particularly useful for patients with low
Combined with Developmental Patterns: Approximation is often integrated with developmental movement patterns to promote natural and functional movements. Done Manually or with Weights/Sandbags: Approximation can be performed manually (by a therapist or practitioner) or with the use of weights or sandbags placed strategically on the body to create resistance and stimulate muscle engagement. Approximation is a technique used to promote muscle contraction and strengthen specific muscle groups. It involves bringing body parts closer together either manually or with added resistance (such as weights or sandbags), often in conjunction with developmental movement patterns for optimal effectiveness. This approach can aid in improving muscle tone, coordination, and overall functional movement. Stretch
- Stretch Intrinsic (Stretch Reflex) This technique activates proprioceptors (sensory receptors in muscles and tendons) by stretching selected muscles. Effects Promotes stability in the shoulder region by shifting more weight onto the ulnar (inner) side of the hands, encouraging a stronger grip.
- Secondary Ending Stretch (Clasp-Knife Reflex) Combines resistance and stretching to facilitate natural movement patterns. Effects By stretching a muscle fully, it activates secondary nerve endings that encourage flexor muscles to contract and inhibit extensor muscles.
- Pressure Stretch (Palm Reflex) Applies pressure and stretching to certain muscle groups, activating both muscle spindles (proprioceptors) and external sensory receptors. Effects
By pressing the pads of the thumb, index, and middle fingers and then stretching them apart, this technique triggers sensory responses that can enhance coordination and reflexes.These techniques aim to stimulate proprioceptors and reflexes to improve muscle function, stability, and coordination during movement. They are commonly used in therapeutic settings to support rehabilitation and enhance motor skills. Vibratory Stimulation Used for tactile stimulation to desensitize hypersensitive skin and produce changes in muscle tone. Activates muscle spindles’ sensory nerves to induce muscle contractions and suppress the stretch reflex. Procedure Vibratory stimuli are applied over muscle bellies using a high- frequency vibrator (100-300 cycles per second). This activates muscle spindles’ primary sensory nerves (la afferents), causing muscle contractions and inhibiting the stretch reflex (tonic vibration reflex). Each application should last 1-2 minutes to avoid heat and friction buildup. Prone position (lying face down) may be suitable for vibrating flexor muscle groups, while the supine position (lying face up) may enhance extensor muscles Resistance (Rood's Approach) Rood's approach uses heavy resistance to stimulate both primary and secondary endings of the muscle spindle.It is employed in an isotonic (constant muscle tension) fashion during developmental activities to influence stabilizing muscles. Procedure Resistance is applied during specific developmental movements or exercises to target stabilizing muscles.The goal is to enhance muscle proprioception (awareness of muscle position and movement) and improve motor control. Resistance is applied during specific developmental movements or exercises to target stabilizing
Involvement in Cranial Nerve Function: The vestibular system influences cranial nerves, which are important for sensory and motor functions of the head and neck. Supports Bilateral Integration: It assists in coordinating movements between both sides of the body. Contribution to Auditory and Language Development: Vestibular input is linked to auditory processing and language development. Enhances Eye Pursuits: Stimulating the vestibular system can improve eye movements and tracking abilities. Types of Stimulation Linear Acceleration/Deceleration: Movements in horizontal and vertical planes, such as walking or riding in a car. AngularAcceleration/Deceleration: Rotational movements like spinning, rolling, or swinging. Effect of Stimulation Speed Fast Stimulation: Quick movements tend to stimulate the vestibular system. Slow Rhythmic Rocking: Gentle, rhythmic rocking motions have a calming and relaxing effect. Static Vestibular System in the Inverted Position The static vestibular system refers to the part of the vestibular system that helps maintain balance and posture during still or stationary positions. Being in an inverted (upside-down) position activates this system. Effects Increased Muscular Tonicity: In the inverted position, the static vestibular system increases muscle tone (tonicity) in specific muscle groups. Muscles Activated: This includes muscles of the neck, midline trunk extensors (muscles along the spine), and selected extensors in the limbs (muscles that straighten the arms and legs).
Normal Head Alignment: It’s important to maintain normal alignment of the head with the neck to optimize the effects of the static vestibular system
Inhibitory technique
Gentle shaking or rocking Rhythmical circumduction of the head and slight approximation is given can also be used in the UE and LE Rhythmical Circumduction: This involves making rhythmic circular movements. For the head, this could mean gently rotating the head in a circular motion. Similarly, for the upper extremities (UE) and lower extremities (LE), it would involve circular movements of the arms or legs. Slight Approximation: This refers to bringing joints closer together, usually by applying gentle pressure or compression. In the context of the technique:
- For the head: Lightly pressing the chin towards the chest or bringing the head slightly forward.
- For UE: Bringing the shoulders or elbows slightly closer to the body.
- For LE: Bringing the knees or ankles slightly closer together. Purpose Inhibition of Muscle Tone: The rhythmic, repetitive movements and gentle compression are believed to have an inhibitory effect on excessive muscle tone, helping to relax hypertonic (overly tense) muscles. Promotion of Relaxation: By engaging in these controlled movements and positions, the technique aims to induce a state of relaxation in the muscles and joints. Slow rolling “Slow Rolling,” is a therapeutic method within Rood’s Approach used to facilitate movement patterns and sensory input. The patient starts lying on one side (side-lying position, SL). The therapist gently rolls the patient from the side-lying position to a prone (on the stomach) position and back again, in a slow and rhythmic manner. The rolling
Slow stroking “Slow Stroking,” is a specific method used in Rood’s Approach to provide sensory stimulation and influence muscle tone. The patient lies face down (prone) on a surface. The therapist applies a rhythmic, deep pressure with slow stroking movements along the length of the spine, from the base of the skull (occiput) to the tailbone (coccyx). The pressure is targeted over the dorsal distribution (back) of the posterior rami (nerve branches) of the spine.The stroking should be done in a slow and deliberate manner, and each session should not exceed 3 minutes. Purpose Sensory Stimulation: Slow stroking aims to provide specific sensory input to the nervous system, affecting muscle tone and sensory perception. Muscle Tone Modulation: The rhythmic deep pressure can help to influence and regulate muscle tone. Rhythmical Movements: The therapist maintains a consistent and rhythmic pace during the stroking, which is essential for its therapeutic effect. Targeted Area: By focusing on the dorsal distribution of the posterior rami, the technique directly affects the sensory nerves and associated muscles in the back. Caution with Duration: Limiting each session to 3 minutes helps to avoid potential negative effects such as the rebound phenomenon. Rebound Phenomenon: Prolonged or excessive stroking can lead to a rebound effect where muscle tone increases after the stimulus is removed. Keeping the duration within limits helps to prevent this. Therapeutic Use: Slow stroking is used as a sensory technique to prepare the nervous system for other therapeutic interventions or to promote relaxation. Patient Response: Monitoring the patient’s response and comfort during the procedure is important to ensure its effectiveness. Tendinous pressure The therapist applies manual pressure directly to the tendon insertion point of a muscle. The therapist locates the tendon insertion point,
which is typically where the tendon attaches to bone. Manual pressure is then applied to this specific area using the therapist’s fingers or hand. Tendinous pressure is particularly useful for muscles that are spastic (excessively contracted) or tight due to neurological conditions or muscle imbalances. By targeting the tendon insertion, the technique can help interrupt abnormal muscle contraction patterns and promote relaxation. Purpose Tendinous pressure aims to provide sensory input and influence the muscle’s neural activity, leading to a reduction in muscle tone or tightness. Localized Pressure: The pressure is applied directly at the tendon insertion site, focusing on a specific area to influence neural signaling. Sensory Input: The pressure provides proprioceptive and tactile sensory input, which can help modulate muscle tone and promote neuromuscular relaxation. Therapist Technique: The therapist adjusts the pressure level based on the patient’s response, ensuring effectiveness without causing discomfort.
Approximation
Approximation involves applying gentle joint compression using a force that
is less than or equal to the body weight (BW) to inhibit spastic muscles
around the joint.
Purpose
The goal of approximation is to provide deep sensory input to the
joint receptors, which can help modulate neural activity and reduce
hypertonicity (excessive muscle tone).
Joint compression through approximation helps to stimulate
proprioceptors (sensory receptors) within the joint, providing
feedback to the nervous system.
This sensory input can lead to a temporary reduction in spasticity and
promote relaxation of the surrounding muscles.
Rocking is an inhibitory method used in Rood’s Approach to promote
relaxation and reduce muscle tone. Rocking involves shifting the body’s
weight rhythmically in various directions—initially forward and backward,
then progressing to side-to-side and diagonal patterns.
Purpose
The goal of rocking is to provide rhythmic sensory input to the body,
which can have a calming effect on the nervous system and help
decrease muscle tone.
Rhythmic Movement Rocking is characterized by rhythmic and
repetitive weight shifts, which contribute to its inhibitory effects on
muscle tone.
Whole Body Involvement Rocking engages multiple muscle groups
and joints, promoting overall relaxation and coordination.
