NEUROPHYSIOLOGICAL AND
DEVELOPMENTAL TREATMENT
APPROACHES
By: Dr Mihirdev Jhala (PT)
MPT (Neuro)
ROODS APPROACH
• Margaret Rood was both occupational therapist and
a physical therapist.
• Her major contributions to the treatment of
persons with brain damage included emphasis on
1. Controlled sensory stimulation
2. Use of ontogenetic sequence
3. The need to demand a purposeful response
through the use of activity.
• Her treatment was orignally designed for cerebral
palsy, but she believed it was applicable to any
patient with motor control problems.
• Roods basic premise was:
• Motor patterns are developed from fundamental
reflex patterns present at birth which are utilized and
gradually modified through sensory stimuli untill the
highest control is gained on the conscious cortical
level.
• If it were possible to apply the proper sensory stimuli
to the appropriate sensory receptor as it is utilized in
normal sequential development ,it might be possible
to elicit motor responses reflexly so as to establish
proper motor engrams.
• There are 4 major components of Roods theory,
which are included in each treatment:
1. The normalization of tone and evocation of
desired muscular responses is accomplished
through the use of appropriate sensory stimuli
correct sensory input is necessary for the
development of correct motor responses.
Controlled sensory input is used to evoke
muscular responses reflexivel, which rood
believed is the earliest developmental step in
gaining motor control.
2. Sensorimotor control is developmentally based and
therefore therapy must start at the patients level of
development and progress him sequentially to
higher and higher levels of sensorimotor control
according to sequences rood has identified.
Muscular responses reflexicely obtained are used
in developmental patterns in an effort to develop
supraspinal control of those responses.
• 3. Movement is purposeful. Rood used activity to
demand a purposeful response from the patient in
order to subcortically elicit the desired movement
pattern. The responses of agonist, antagonists, and
synergists are reflexively programmed according to
a purpose or plan. Sensation that occurs during
during movement is basic to motor learning.
• 4. Repetition of sensorimotor responses is
necessary for learning .
CONTROLLED SENSORY INPUT
• Facilitation methods:
1. Tactile stimulation: fast brushing and light stroking.
2. Thermal facilitation ot icing
3. Heavy joint compression
4. Quick light stretch of a muscle.
5. Tapping of the tendon or muscle belly.
6. Pressure on the muscle belly.
7. Secondary stretch
8. Stretch to the intrinsic muscles of the hand or foot.
9. Resistance in the form of stretch.
10. Shortened hand held resisted contraction(SHRC)
INHIBITION METHODS
1. Light joint compression
2. Slow stroking
3. Slow rhythmical movement
4. Neutral warmth
5. Pressure on the tendenious insertion of the
muscle.
6. Maintained stretch.
SEQUENCES OF MOTOR CONTROL
• A muscular response is first evoked reflexively
using sensory stimulation, then responses so
obtained are used in developmental patterns, and
finally the patient uses the response purposefully to
gain control over it.
• Ontogenetic motor patterns:
1. Supine withdrawal
2. Roll over
3. Pivot prone
4. Neck cocontraction
5. On elbows.
6. All four pattern
7. Standing
8. walking
VITAL FUNCTION DEVELOPMENTAL SEQUENCE
1. Inspiration
2. Expiration
3. Sucking
4. Swallowing
5. Phonation
6. Chewing
7. Swallowing solids
8. Speech,defined as production of recognizable
words.
BOBATH NEURODEVELOPMENTAL APPROACH
• Dr. and mrs. Bobath, english neurologist and
physiotherapist, have devised methods of
evaluation and treatment for persons with CP and
hemiplegia.
• They believe the methods would be effective for
any patient having central nervous system deficit
resulting in abnormal patterns of movement.
BASICS OF THIS APPROACH
• Sensations of movement are learned, not
movements.
• Basic postural and movement patterns are learned
that are later elaborated on to become functional
skills.
• Every skilled activity takes place against a
background of basic patterns of postural control,
righting , equilibrium, and other protective
reactions,reach, grasp and release.
• When the brain is damaged, abnormal patterns of
posture and movement develop that are
incompatible with the performance of normal
everyday activities.
• The abnormal patterns develop because sensation
is shunted into these abnormal patterns.
• The law of shunting refers to a phenomenon the
bobath describe as afferent inflow being short
circuited either temporarily or more permanently
into patterns of abnormal coordination released
from higher inhibitory control.
GRADING FOR CP ASSESMENT CHART
• 0- cannot be placed in test postures
• 1- can be placed in test posture, but the position
cannot be held.
• 2-can hold test posture momentarily after being
placed.
• 3-can assume an approximate test posture
unaided, in any manner.
• 4-can assume and sustain test posture in near
normal manner.
• 5-normal.
REFLEX INHIBITING PATTERNS
• RIPs are used to inhibit patterns of abnormal
muscle tone, such as those caused by influence of
predominating primitive tonic reflexes.
• Inhibition of abnormal tone is always used
concurrently with facilitation of the righting and
equlibrium reactions.
• Key point of control.
HANDLING
• The bobath term their manner of control of the
patient through RIPs and their movement of him to
elicit righting and equilibrium responses, as
handling.
• Handling is used to control postural control
• To regulate the coordination of agonist, antagonist
and synegists.
• To inhibit abnormal patterns and to facilitate normal
automatic responses.
RIGHTING AND EQUILIBRIUM REACTIONS
• RIPs are inhibition imposed from the outside, but
true inhibition of primitive patterns can be gained
only through elicitation of the righting and
equlibrium reactions.
SENSORY STIMULATION
1. Weight bearing with pressure and resistance is
used to elicit increased postural tone and to
decrease involuntary movements.
2. Placing and holding
3. Tapping
