ROODS APPROACH

FAST BRUSHING
 CONTENT

• INTRODUCTION
• GOALS
• PRINCIPLES
• FOUR RULES OF SENSORY INPUT
• SEQUENCE OF MOTOR DEVELOPMENT
• ONTOGENIC MOTOR PATTERNS
• FACILITATION TECHNIQUES
• INHIBITION TECHNIQUES
• OT INCORPORATE ROODS APPROACH
 INTRODUCTION

• MARGARET S. ROOD
• OT & PT
• MUSCLE ACTION CAN BE ACTIVATED, FACILITATED AND INHIBITED THROUGH
SENSORY SYSTEM
 GOALS

• NORMALIZE MUSCLE TONE- LIGHT WORK MUSCLES IN SKILLED MOVEMENT,

HEAVY WORK MUSCLES FOR POSTURAL SUPPORT
• TREATMENT BEGIN AT DEVELOPMENTAL LEVEL OF FUNCTIONING- CEPHALO
CAUSAL, PROXIMAL TO DISTAL, FLEXORS- EXTENSOR- ADDUCTORS- ABDUCTORS
• MOVEMENT DIRECTED TOWARD PURPOSEFUL GOAL- MOTIVATION, WILLED AND
MEANINGFUL EVENT
• REPETITION NECESSARY FOR TRAINING MUSCULAR RESPONSES – 1000
REPETITION FOR AN ENGRAM . INTERNEURONAL CIRCUITS TO PERFORM MOTOR
ACT
 PRINCIPLES

1. TONIC NECK AND LABYRINTHINE REFLEXES ASSIST OR RETARD EFFECTS OF

SENSORY STIMULATION

TNR INFLUENCE EXTENSOR TONE(POSTURAL REFLEXES)

TLR RECEPTORS IN SEMICIRCULAR CANAL AND IN VESTIBULE. INFLUENCED BY
POSITION OF HEAD RELATION TO GRAVITY
INVERSION ELICIT RIGHTING REACTIONS
 PRINCIPLES

2. STIMULATION OF SPECIFIC RECEPTORS PRODUCE HOMEOSTATIC RESPONSES,

REFLEXIVE PROTECTIVE, ADAPTIVE RESPONSES
HOMEOSTATIC VIA ANS
REFLEXIVE VIA SPINAL & BRAIN STEM CIRCUITS
ADAPTIVE RESPONSE THROUGH INTEGRATION OF ALL REGIONS OF NERVOUS
SYSTEM
 FOUR RULE OF SENSORY INPUT

1. FAST BRIEF STIMULUS- LARGE SYNCHRONOUS MOTOR OUTPUT (USED TO CONFIRM

REFLEXES ARC IS INTACT)
2. FAST REPETITIVE SENSORY INPUT – MAINTAINED RESPONSE (TRANSMIT IMPULSES
ALONG C FIBRES AND GAMMA FIBRES. STIMULUS INTO FUSIFORM MOTOR SYSTEM
DRVE ALPHA NEURON OF MUSCLE)
3. MAINTAINED SENSORY INPUT- MAINTAINED RESPONSE (IMPULSES REINFORCE
PRESENCE OF GRAVITY)
4. SLOW RHYTHMICAL REPETITIVE SENSORY INPIT- DEACTIVATE MIND AND
BODY( GENERALIZED CALMING EFFECT)
 PRINCIPLES

3. MUSCLE HAVE DIFFERENT DUTIES

• LIGHT WORK MUSCLES
• HEAVY WORK MUSCLES

• STABISERS
• MOBISERS
 PRINCIPLES

4. HEAVY WORK MUSCLES SHOULD BE INTEGRATED BEFORE LIGHT WORK

MUSCLES
USE OF UPPER EXTREMITIES
FINE FINGER GRIP IN STABILIZED ARM
 SEQUENCE OF MOTOR DEVELOPMENT

1. RECIPROCAL INHIBITION( INNERVATION)- EARLY MOBILITY, REFLEX, PHYSICAL

OR QUICK MOVEMENT
2. COCONTRACTION (CO – INNERVATION)- STABILITY, TONIC IN STATIC PATTERN,
HOLD, SIMULTANEOUS AGONIST ANTAGONIST CONTRACTION
3. HEAVY WORK – MOBILITY SUPERIMPOSED ON STABILITY, PROXIMAL
MOVEMENT AND DISTAL FIXED, QUADRUPED
4. SKILL- HIGHEST LEVEL OF MOTOR CONTROL, PROXIMAL FIXED, DISTAL
MOVES.ARTIST IN PAINTING
 ONTOGENIC MOTOR PATTERNS

• SEQUENCE OF MOTOR DEVELOPMENT

1. SUPINE WITHDRAWAL ( SUPINE FLEXION)

2. ROLL OVER ( TOWARD SIDE LYING)
3. PIVOT PRONE( PRONE EXTENSION)
4. NECK CO- CONTRACTION (CO- INNERVATION)
5. ON ELBOWS ( PRONE ON ELBOWS)
6. ALL FOURS ( QUADRUPED)
7. STATIC STANDING(BIPEDAL STANCE)
8. WALKING
 SUPINE WITHDRAWAL (SUPINE FLEXION)

• TOTAL FLEXIONRESPONSE AT T10 VERTEBRAL LEVEL

• PROTECTIVE POSITION – FLEXION OF NECK, CROSSING ARMS AND LEGS
PROTECT ANTERIOR SURFACE OF BODY
• INTEGRATION OF TLR
• MOBILITY POSTURE REQUIRES RECIPROCAL INNERVATION
• PATIENT- NO RECIPROCAL FLEXION, DOMINATED EXTENSOR TONE
 ROLL OVER(TOWARD SIDE LYING)

• ARM, LEG FLEX SAME SIDE

• MOBILITY PATTERN FOR EXTREMITIES, ACTIVATES LATERAL TRUNK
MUSCULATURE
• STIMULATE SEMICIRCULAR CANAL, INTURN ACTIVATE NECK & EXTRA OCULAR
MUSCLES
• PATIENTS DOMINATE THROUGH IN SUPINE
 PIVOT PRONE(PRONE EXTENSION)

• FULL ROM OF EXTENSION OF NECK, SHOULDER, LE

• MOBILITY AND STABILITY PATTERN
• DIFFICULT TO ASSUME, HOLD
• PREPARATION FOR STABILITY OF EXTENSOR MUSCLES IN UPRIGHT
• ASSOCIATED WITH LABYRINTHINE RIGHTING REACTION OF HEAD
• INDICATES INTEGRATION OF SYMMETRIC TNR , TLR
 NECK COCONTRACTION (CO INNERVATION)

• FIRST REAL STABILITY PATTERN

• COCONTRACTION OF NECK PRECEDED COCONTRACTION OF TRUNK , EXTREMITIES
• HEAD BOBS UP, DOWN( EXTENSOR, ROTATORS STRETCHED)
• NECK FLEXOR ESTABLISHED BEFORE PRONE
• RAISE HEAD AGAINST GRAVITY--- GOOD COCONTRACTION OF FLEXOR, EXTENSOR OF NECK
• ELICIT TLR WHEN FACE PERPENDICULAR TO FLOOR
• CONTRACT AGAINST GRAVITY
• PROMOTES NECK STABILITY AND EXTRA OCULAR CONTROL
 ON ELBOWS( PRONE ON ELBOWS)

• WEIGHT BEARING ON ELBOWS

• STRETCH UPPER TRUNK TO INFLUENCE STABILITY OF SCAPULAR AND GH
REGIONS
• WEIGHT SHIFT
• VISIBILITY OF ENVIRONMENT
• INHIBITORY TO STNR
 ALL FOURS (QUADRUPED)

• STABILITY OF NECK, SHOULDER

• LOWER TRUNK, LE IN COCONTRACTION PATTERN
• INITIALLY STATIC, , ABDOMEN SAG AT T10, STRETCHING OF TRUNK AND LIMB
GIRDLE
• STRETCHING DEVELOP COCONTRACTION OF TRUNK FLEX , EXTEN
• WEIGHT SHIFTING F, B, S TO S, DIAGONALLY PROVIDE MOBILITY SUPERIMPOSED
ON STABILITY (PREPARATORY TO EQUILIBRIUM RESPONSES)
 STATIC STANDING (BIPEDAL STANCE)

• UPRIGHT BIPEDAL STANCE

• SKILL OF UPPER TRUNK, UE FREE FOR PREHENSION, MANIPULATION
• WEIGHT DISTRIBUTED EQUALLY BOTH LEGS, THEN WEIGHT SHIFTING BEGINS
• HIGHER LEVEL INTEGRATION, RIGHTING , EQUILIBRIUM REACTIONS
 WALKING

• GAIT PATTERN
• UNITES SKILL, MOBILITY, STABILITY
• ABILITY TO SUPPORT BODY WEIGHT, MAINTAIN BALANCE , EXECUTE STEPPING
MOTION
• STANCE PHASE , PUSH OFF, SWING, HEEL STRIKE, STRIDE LENGTH
• COORDINATED MOVEMENT PATTERN OF BODY PARTS
 TECHNIQUES I TREATMENT PLAN

• FACILITATION TECHNIQUES (CUTANEOUS, PROPRIOCEPTION)

• INHIBITORY TECHNIQUES
• SPECIAL SENSES IN FACILITATION/ INHIBITION
• ONTOGENIC MOTOR PATTERN WITH ACTIVITIES
• NEW CONCEPTS IN SENSORY STIMULATION
 CUTANEOUS FACILITATION

• EXTRORECEPTORS OF SKIN(UNDER SKIN IN SUBCUTANEOUS TISSUE) RESPOND TO EXTERNAL

ENVIRONMENT
• SERVE PROTECTIVE WITHDRAWAL RESPONSE, PRODUCE ALERTNESS & RAPID MOVEMENTS OF LIMBS
• MODALITIES- PAIN, TEMPERATURE, TOUCH
• TRANSMITTED TO SPINAL CORD ALONG A DELTA , C FIBRES WHICH ARE THIN CONDUCTORS. TO CNS
BY SPINOTHALAMIC, SPINORETICULAR TRACTS
• CONSCIOUS EXTRIOCEPTIVE PROPRIOCEPTION- VIBRATION, STEREOGNOSIS, FINE TOUCH ALONG
DORSAL COLUMNS
• EXTRIOCEPTIVE STIMULI- ICING, FAST BRUSHING. EFFECT ON RAS, ANS
 LIGHT MOVING TOUCH

• LIGHT STROKE STIMULUS

• ACTIVATE SUPERFICIAL MOBILIZING MUSCLES
• INPUT TO LIMBIC– INCREASE CORTICOSTEROID ( INCREASE RESISTANCE TO DISEASE, TISSUE REPAIR,
FLUID ELECTROLYTE BALANCE)
• CAUSE RECIPROCAL INNERVATION, PHASIC WITHDRAWAL RESPONSE
• FINGER TIP, CAMEL HAIRBRUSH, COTTON SWAB
• FREQUENCY– 2 TIMES/ SEC, AT LEAST 10 TIMES THEN REPEATED 3 TO 5 TIMES
• FORMULA– 3 TO 5 STROKES, ALLOW 30 SECONDS ELAPSE BETWEEN STROKES(, REST PERIOD PREVENTS
PRESYNAPTIC INHIBITORY CALLED PRIMARY AFFERENT DEPOLARIZATION– OVERSTIMULATION)
 LIGHT MOVING TOUCH -- EFFECTS

• FACIAL REGION- AFTER FIRM PRESSURE ON UPPER LIP (GENERALIZEDINHIBITORY RESPONSE). PERIORAL
REGION
• NOSE TO CHIN , PERIORAL MIDLINE
• STIMULUS OVER SEVERAL TIMES, BEFORE RESPONSE
• INFANTS– FLEXION OF UE, LE .
• LIGHT STROKING CORNER IP TO CHEEK(PERIORAL LATERAL) – ACTIVATE SUPERFICIAL MUSCULATURE OF
NECK, HEAD TILTS LATERALLY TOWARD SIDE OF STIMULUS
• ADULTS– LIGHT MOVING TOUCH I NAVEL REGION OR DERMATOME T10 – UNILATERAL FLEXION PATTERN
• DORSAL WEB SPACES OF FINGERS, TOES– WITHDRAWAL PATTERN OF EXTREMITIES
• TIPS OF FINGERS, SOLES OF FEET– TICKLE WITHDRAWAL RESPONSE
 FAST BRUSHING

• BATTERY OPERATED BRUSH

• STIMULATE C FIBRES TO RAS– EFFECT FOR 30 MINUTES MAXIMUM
• USED BEFORE ALL STIMULUS
• NON SPECIFIC HIGH INTENSITY STIMULUS
• KEY--- APPLY DERMATOMES OF SAME SEGMENT SUPPLYING MUSCLE (MYOTOME)
• 3 TO 5 SECONDS, ELAPSE 30 SECONDS, REPEAT AGAIN
• ADJACENT TO VERTEBRAL COLUMN OVER POSTERIOR PRIMARY RAMII TO FACILITATE DEEP TONIC MUSCLES OF
BACK(INVERTED IS EFFECTIVE)
• ANTERIOR PRIMARY RAMII BRUSHED TOPICALLY FACILITATE SUPERFICIAL MUSCLE
• DERMATOMAL SEGMENT (T2 TO T12) CORRESPONDS TO SPECIFIC GROUP MUSCLES
• BRUSHING---- BEST ON ISOLATED GROUPS WHERE DERMATOME LIES OVER MUSCLE TO FACILITATE
 FAST BRUSHING --- CONTRAINDICATIONS

• OUTER RING OF TRIGEMINAL NERVE– C2 DERMATOME. RAS , EXTENSIVE NERVE ENDINGS

CAUSE GENERALIZED INHIBITORY RESPONSE
• HIGH CERVICAL SPINAL CORD OR BRAINSTEM INJURIES– AUTONOMIC DYSREFLEXIA,
POSSIBLY INDUCING COMA
• PINNA OF EAR(C2 CAN, TRIGEMINAL OF FACIAL NERVE, VAGUS), DERMATOMAL SKIN L1, L2
DETRUSOR URINE CAUSE VOIDING
• DERMATOMES SO TO S4– BLADDER RETENTION IN INCONTINENT PATIENTS, CONSTRICTION
OF SPHINCTER MUSCLES
• CAUTION ON INFANTS , CHILDRENWITH FLACCIDPARALYSIS– UNDERDEVELOPED CNS , ANS
 ICING

• EXTREME THERMAL FACILITATION

• FACILITATION OF MUSCLE ACTIVITY & ANS RESPONSES
• POWERFUL STIMULUS, RESULTS UNPREDICTABLE
• A – ICING
• C- ICING
• AUTONOMIC ICING
 A ICING

• QUICK ICING
• PATIENT WITH HYPOTONIA , STATE OF RELAXATION
• ACTIVATE MYELINATED A DELTA CAUSING REFLEX WITHDRAWAL IN
SUPERFICIAL MUSCLES
• APPLIED ON SKIN
• 3 SWIPES AND WATER BLOTTED WITH TOWEL BETWEEN SWIPE
• WITHDRAWAL– ON DORSAL WEB SPACES, PALMS, SOLES OF HANDS, FEET
• ALERT MENTAL PROCESSES IF APPLIED TO PALMAR SURFACE OF FINGERTIPS
 C ICING

• HIGH INTENSITY NOCICEPTIVE STIMULUS

• AFFECT NON SPECIFIC C FIBRES
• FACILITATION OF MAINTAINED POSTURAL RESPONSE
• ICE CUBE PRESSED ON SKIN OF DERMATOME SERVING SAME SPINAL SEGMENT
OF TARGET MUSCLES TO BE STIMULATED
• EXCESS WATER BLOTTED AWAY
• RESPONSE TAKE LONG 30 MINUTES, IT TRAVEL SPINAL CIRCUITS & ACTIVATES
RAS
 AUTONOMIC ICING

• AFFECT SESSION, INFLUENCE OUTPUT OF THYROID, ADRENAL GLANDS

• RECIPROCAL PATTERN BETWEEN DIAPHRAGM, ABDOMINAL MUSCLES
• UPPER RIGHT QUADRANT OF ABDOMEN ( TO TO T9) ALONG ANGLE OF LOWER RIB
• APPLIED BRIEFLY 2/3 TIMES FROM MIDLINE TO LATERAL DIRECTION
• MELTED WATER BLOTTED INSTEAD OF STROKED
• INCREASE BREATHING PATTERNS, VOICE PRODUCTION, GENERAL VITALITY
• ICE CHIPS
- INSIDE MOUTH STIMULATE MUCOSA
- FACILITATE CLOSURE OF MOUTH
- AID SWALLOWING
- SAFELY INNER WALL CHEEKS, POSTERIOR TONGUE . ON LIPS CAUSE OPENING OF MOUTH
- ICE FOR 2/ 3 SEC TO UPPER STERNLY NOTCH INDUCE SWALLOWING IN PATIENT WITH DYSPHAGIA
 ICING- CONTRAINDICATIONS

• NECK TO TRIGEMINAL NERVE DISTRIBUTION, PINNA OF EAR

• MIDLINE AXIS OF BODY(INCREASED NERVE ENDINGS)
• SPINAL CORD INJURY CAN, C5- AUTONOMIC DYSREFLEXIA , SEIZURES,
VASCOCONSTRICTIONS
• HISTORY OF CARDIOVASCULAR PROBLEMS
• LEFT SHOULDER- ANGINA, HEART ARRHYTHMIA OCCUR
• BEHIND EAR- SUDDEN LOWERING OF BP
PROPRIOCEPTIVE FACILITATORY TECHNIQUES

• IN 1970, ROOD ABANDONED EXTEROCEPTIVE, ENDORSED PROPRIOCEPTIVE

INPUT(UNPREDICTABLE RECRUIT OTHER NEURONS IN EXTEROCEPTIVE)
• FACILITATION OF MUSCLE SPINDLE, GOLGI TENDON ORGAN, JOINT RECEPTORS,
VESTIBULAR APPARATUS
• THERAPIST MORE CONTROL OVER MOTOR RESPONSE
• PROPRIOCEPTORS ADAPT SLOWLY THAN EXTEROCEPTOR
• PRODUCE SUSTAINED POSTURAL PATTERNS
• RESPONSE LAST AS LONG AS STIMULUS APPLIED
PROPRIOCEPTIVE FACILITATORY TECHNIQUES

• HEAVY JOINT COMPRESSION

• STRETCH
• INTRINSIC STRETCH
• SECONDARY ENDING STRETCH
• STRETCH PRESSURE
• RESISTANCE
• TAPPING
• VESTIBULAR STIMULATION
• INVERSION
• THERAPEUTIC VIBRATION
• OSTEOPRESSURE
 HEAVY JOINT COMPRESSION

• JOINT COMPRESSION, FORCE GREATER THAN BODY WEIGHT

• APPLIED LONGITUDINAL AXIS OF BONE
• FACILITATE CONTRACTION AT JOINT
• COMBINED WITH DEVELOPMENTAL PATTERNS ,PRONE ON ELBOWS, QUADRUPED,
SITTING, STANDING
• COMPRESSION- THERAPIST MANUALLY, WEIGHTED CUFFS, SAND BAGS
• EFFECTIVE IN LONGITUDINAL AXIS- HUMERUS (GH JOINT),
FEMUR(ACETABULUM)
 STRETCH

• PHYSIOLOGIC STIMULUS
• ACTIVATE SELECTIVE PROPRIOCEPTORS
• QUICK STRETCH--- PRINCIPLES OF RECIPROCAL INNERVATION
• HOLDING PROXIMAL BONY PROMINENCE OF LIMB TO BE STRETCHED WHILE
MOVING DISTAL JOINT IN ONE DIRECTION (EX….ELBOW JOINT SECURED WHEN
FOREARM INTO FLEXION TO STRETCH TRICEPS)
• USED ON LIGHT WORK MUSCLES (PHYSIOLOGIC FLEXORS, ADDUCTORS)
 INTRINSIC STRETCH

• USE OF INTRINSIC MUSCLES TO PROMOTESTABILITY OF SCAPULO HUMERUS

REGION
• ON ELBOWS– SHOULDER STABILITY ENHANCED IN ENGAGING ACTIVITY
REQUIRED RESISTIVE GRASP
• RESISTANCE FORM OF STRETCHING– INCREASE FUSIFORM ACTIVITY IN MUSCLE
SPINDLE
• QUADRUPED--- PATIENT BEAR MORE WEIGHT ON ULNAR SIDE OF HIS OR HER
HAND
• USE CONES, FLAT TOWELS, HORIZONTAL BARS ANGLED DOWNWARD LATERAL
SIDE OF FORE ARM TO DISTRIBUTE WEIGHT ON ULNAR SIDE OF WRIST
 SECONDARY ENDING STRETCH

• COMBINED RESISTANCE, MAINTAINED STRETCH

• FACILITATE DEVELOPMENTAL MUSCLE PATTERN
• SUPINE WITHDRAWAL---- SUPINE ON MAT. KNEES FLEXED, FEET FLAT ON SUPPORTING SURFACE.
SMALL NOOK UNDER HEAD. FOLD TOWEL UNDER LUMBOSACRA REGION….FULLEXTENSOR STRETCH
• MUSCLE FULL STRETCH– FIRES SECONDARY ENDINGS , FACILITATORY TO FLEXOR, INHIBITORY TO
EXTENSOR . DRIVING FLEXOR THROUGH EXTENSORS
• RESISTANCE TO FLEXOR, ADDUCTORS, INTERNAL ROTATORS OF SHOULDER BY COMPRESSIVE
DEVICE SUCH AS BICYCLE PUMP
• INTEGRATING TLR IN SUPINE
 STRETCH PRESSURE

• PADS OF THUMBS, INDEX AND MIDDLE FINGERS ON SKIN OVER SUPERFICIAL

MUSCLES
• FIRM DOWNWARD PRESSURE, STRETCHING MOTION ACHIEVED, THUMB
MOVING AWAY
• DEGREE OF PRESSURE--- DEFORMATION OF SKIN, STRETCH UNDERLYING
MUSCLE FIBRES
• STIMULUS NOT EXCEED 3 SECONDS
• DERMATOMALLY OR OVER MUSCLE BELLY
• LUBRICANT REDUCE FRICTION ON SKIN
 RESISTANCE

• HEAVY RESISTANCE- STIMULATE PRIMARY, SECONDARY NERVE ENDING

• ISOTONIC FASHION IN DEVELOPMENTAL PATTERN INFLUENCE STABILIZER MUSCLES
• RESISTANCE AT CONTRACTION AT SHORTER RANGE -- FACILITATE AFFERENTS IN DEEPER,
TONIC POSTURAL MUSCLES
• FAST BRUSHING, QUICK STRETCH BEFORE RESISTANCE FOR MAX RESPONSE
• INTERMITTENT RESISTANCE GRADED TO DESIRED MOTION BETTER THAN MANUAL
STRETCHING FOR ALLEVIATING TIGHT MUSCLES
• CONTRACT AGAINST RESISTANCE– READJUST SHORTER LENGTH, LESS SENSITIVE TO
STRETCH
 TAPPING

• OVER MUSCLE BELLY WITH FINGER TIPS

• PERTUSSIS 3 TO 5 TIMES OVER MUSCLE TO BE FACILITATED
• BEFORE OR DURING PATIENT VOLUNTARILY CONTRACTING MUSCLE
• STIMULATION INCREASES TONE OF UNDERLYING SKELETAL MUSCLE
 VESTIBULAR STIMULATION

• POWERFUL PROPRIOCEPTIVE INPUT

• STATIC LABYRINTHINE– PROMOTE EXTENSOR PAYTERN OF NECK, EXTREMITIES, TRUNK
• KINETIC LABYRINTHINE– PHYSICAL SUB CORTICAL RESPONSE, PROTECTIVE EXTENSION
• VESTIBULAR SYSTEM– ACTIVATE ANTIGRAVITY MUSCLE, THEIR ANTAGONIST BEFORE ZTRETCH REFLEX OF MUSCLE SPINDLE
• VESTIBULAR SYSTEM– DIVERGENT, AFFECT TONE, BALANCE, DIRECTIONALLY, PROTECTIVE RESPONSES, CRANIAL NERVE
FUNCTION, BILATERAL INTEGRATION, AUDITORY – LANGUAGE DEVELOPMENT, EYE PURSUITS
• STIMULATION IN LINEAR ACCELERATION, DECELERATION IN HORIZONTAL, VERTICAL PLANES. ANGULAR ACCELERATION,
DECELERATION LIKE SPINNING, ROLLING, SWINGING
• EITHER FACILITATORY OR INHIBITORY DEPENDING ON RATE OF STIMULATION
• FAST ROCKING– STIMULATE
• SLOW RHYTHMIC ROCKING--- RELAX
 INVERSION

• ALTER MUSCLE TONE IN SKELETAL MUSCLE

• STATIC VESTIBULAR SYSTEM- INCREASE TONICITY OF MUSCLES OF NECK, MIDLINE TRUNK EXTENSORS,
SKELETAL EXTENSORS OF LIMBS
• HEAD DOWN POSITION– EXTENSOR TONE INCREASED
• UPRIGHT POSITION– EXTENSOR TONE DECREASED
• BEST RESULTS– HEAD MUST NORMAL ALIGNMENT WITH NECK
• IF NECK FLEX OR EXTEND, TNR INTERFERE WITH RESPONSE
• EXTREME CARE IN CARDIOVASCULAR– BP CHANGES, DECREASED TONE, GENERALIZATION RELAXATION,
REDUCTION OF BP
• COMBINED WITH VIBRATION OR NECK COMPRESSION TO CHANGE TONE IN SKELETAL MUSCLES
 THERAPEUTIC VIBRATION

• SERIES OF RAPID TOUCH STIMULI

• TACTILE STIMULATION– DESENSITIZE HYPERSENSITIVE SKIN, TONAL CHANGES IN MUSCLE
• HIGH FREQUENCY VIBRATOR (DELIVER TO 100 TO 300 CYCLE/SEC)-----IA AFFERENT– CONTRACTION OF MUSCLE,
INHIBITION OF ITS ANTAGONIST MUSCLE, SUPPRESSION STRETCH REFLEX(TONIC VIBRATION REFLEX)
• LOW FREQUENCY VIBRATOR(DELIVER 50 TO 100 CYCLES/ SEC) – FIRE SUB CUTANEOUS ENCAPSULATED
RECEPTORS (PACINIAN CORPUSCLES)--- ROLE IN SUPPRESSION OF PAIN PERCEPTION AT CUTANEOUS LEVEL
• SHORT LATENCY PERIOD, LASTS AS LONG AS STIMULUS APPLIED
• TONIC VIBRATION REFLEX– VIBRATOR ON BELLY PARALLEL WITH MUSCLE FIBRES
• ON TENDON– STIMULATE ADJOINING MUSCLES
• MUSCLE SHOULD BE ON STRETCH OR CONTRACTING
 THERAPEUTIC VIBRATION – CONT

• VIBRATOR APPLIED IN LIGHT PRESSURE– (DEEP PRESSURE IS INHIBITORY, INTERFERE IN RESULTS)

• DURATION– NOT EXCEED 1 TO 2 MIN PER APPLICATION (AS HEAT FRICTION WILL RESULT)
• POSITION: BEST PRONE- FLEXOR GROUP. SUPINE– EXTENSOR GROUP
• TEMPERATURE: ICE- PAINFUL JOINTS, TONIC VIBRATION REFLEX. COOL – INCREASE TONE, SNOW, TONIC VIBRATION
REFLEX. WARM ENVIRONMENT- CUTANEOUS STIMULATION, SKIN RECEPTORS FIRING
• EMOTIONAL STATE: DEPRESSION/ANGRY– TONIC VIBRATION REFLEX LESS EFFECTIVE THAN CALM. MEDICATIONS–
MUSCLE RELAXANTS, BARBITURATES BLOCK SYNAPTIC TRANSMISSION, DECREASED TONIC VIBRATION REFLEX
• NOT CHILDREN LESS THAN 3 YEARS, NOT APPLIED NEAR JOINTS IN CHILDREN( NOT WELL DEVELOPED CNS)
• NOT IN ELDERLY PERSONS MORE THAN 65 , SKIN THINNER, INCREASES TREMOR, IMPAIR SYNERGIES
• ELECTRICAL VIBRATOR: USEFUL TOOL IF PROPERLY USED. TRAINING FOR THERAPISTS NEEDED.
 OSTEOPRESSURE

• PRESSURE ON BONY PROMINENCE. FACILITATE / INHIBITORY TO VOLUNTARY MUSCLES

• PRODUCE SLOWER REACTION PRECEDED BY LIGHT MOVING TOUCH STIMULUS
• EX. LIGHT MOVING TOUCH TO C7 OF ARM, PRESSURE OVER LATERAL EPICONDYLE OF ELBOW ARM
EXTENDS
• PRESSURE ON MEDIAL MALLEOLUS– FACILITATE LATERAL DORSIFLEXORS
• PRESSURE ON LATERAL MALLEOLUS– FACILITATE MEDIAL DORSIFLEXORS, INHIBIT CALF MUSCLES
• LIGHT MOVING TOUCH TO DERMATOMES L3, L4. PRESSURE NEARBY PROMINENCE AFFECT ACUPRESSURE
POINTS
• TWO POINTS BELOW MEDIAL, LATERAL MALLEOLUS SIMILAR TRADITIONAL CHINESE MEDICINE.
POINTS PROMOTE DEEP SLEEP , CORRECT INSOMNIA
 SPECIFIC INHIBITION TECHNIQUES

• NEUTRAL WARMTH
• GENTLE SHAKING OR ROCKING
• SLOW STROKING
• SLOW ROLLING
• LIGHT JOINT COMPRESSION ( APPROXIMATION)
• TENDINOUS PRESSURE
• MAINTAINED STRETCH
• ROCKING IN DEVELOPMENTAL PATTERNS
 NEUTRAL WARMTH

• AFFECT TEMPERATURE RECEPTORS OF HYPOTHALAMUS, STIMULATE PNS

• HYPERTONIA, SPASTICITY, RIGIDITY
• CHILDREN WITH ADD
• RECUMBENT POSITION, ENTIRE BODY WRAPPED IN COTTON BLANKET OR
COMFORTER APPROX 5 TO 10 MINUTES
• PROVIDE HEAT COMPATIBLE WITH RECEPTORS OF HYPOTHALAMUS
• RELAXED AND TONE DECREASED
 GENTLE SHAKING OR ROCKING

• GENERALIZED INHIBITORY TECHNIQUE

• LIGHT JOINT COMPRESSION, TRACTION OF CERVICAL VERTEBRAE, SLOW RHYTHMIC CIRCUMDUCTION
OF HEAD
• HEAD:
- SUPINE , THERAPIST PALM OF RIGHT HAND UNDER OCCIPUT. LEFT HAND ON TOP OF HEAD OF PATIENT
- NECK IN SLIGHT FLEXION, HEAD MOVED SLOWLY IN CIRCUMFERENTIAL PATTERN.
- SLOW , RHYTHMICALLY, LIGHT JOINT COMPRESSION THROUGH CERVICAL VERTEBRA WITH LEFT HAND
- SLOW CIRCUMDUCTION CONTINUE , RIGHT HAND APPLY GENTLE TRACTION (PLACING FINGER TIPS
UNDER RIDGE OF OCCIPITAL BONE, APPLYING SLIGHT PULLING ACTION ,AFTER EACH LIGHT
COMPRESSION OF CERVICAL VERTEBRA)
 GENTLE SHAKING OR ROCKING–
SIGNIFICANCE
• EMPHASIS- SLOW CONTINOUS MOTION ELICIT RELAXATION RESPONSE
• MOTION– AFFECT PROPRIOCEPTORS OF NECK, VESTIBULAR APPARATUS. HENCE
JOINT RECEPTORS BETWEEN CERVICAL VERTEBRA AND MUSCLE SPINDLE IN
NECK MUSCLE STIMULATED
• SLOW CIRCUMDUCTION– HAIR CELLS IN SEMICIRCULAR CANAL & IN VESTIBULE
TO ALTER RATE OF DISCHARGE
• SIMILAR TECHNIQUES FOR SHOULDER & PELVIC GIRDLE PROMOTE SEGMENTAL
RELAXATION OF UPPER EXTREMITIES
 GENTLE SHAKING OR ROCKING-- UE

• SUPINE POSITION
• THERAPIST SLIDE LEFT HAND BWN PATIENTS’ LEFT ARM& CHEST(AXILLA) SO HAND IS FACING UPWARD, SUPPORTING
JUST BENEATH SCAPULA. RIGHT HAND ON PATIENTS LEFT SHOULDER
• LEFT HAND BELOW SCAPULA, RIGHT HAND ON TOP OF LEFT SHOULDER, THERAPIST GENTLY ROTATE UPPER REGION
OF SHOULDER BACKWARD (POSTERIORLY)
• SHOULDER ROTATED BACKWARD ABOUT 4 TIMES , DEPENDING ON PATIENTS SHOULDER MOBILITY AND PAIN
• IMMEDIATE RESPONSE– LEFT SHOULDER APPEAR LOWER ,RESTING FULLY ON SUPPORTING SURFACE
• USED ON RIGHT TOO TO PROMOTE SYMMETRY
• WELL WITH SPASTIC SCAPULA
• SLOWLY RELAXES, MOBILIZES SSCAPULA SO GLIDE ALONG WITH US
• PROCEDURES CONTINUED RELAXATION PALPATED IN MUSCLE OR OBSERVED IN PATIENTS POSTURE
 GENTLE SHAKING OR ROCKING – PELVIC
GIRDLE
• SUPINE POSITION
• THERAPIST STAND OR STRADDLE THE PATIENT, THERAPIST HAND AROUND
LATERAL ASPECT OF PELVIC GIRDLE
• THUMBS PLACED ON PELVIC CREST & FINGERTIPS UNDER GLUTEAL MUSCLES
• THERAPIST CAN LIFT & GENTLY ROTATE PELVIS FROM SIDE TO SIDE
 GENTLE SHAKING OR ROCKING

• SUPINE POSITION
• THERAPIST MOVE TO BOTTOM OF FEET
• THERAPIST PLACE PALM OF HAND UNDER PATIENT HEEL, SLOWLY LIFTS THE LEGS ABOUT
12 INCHES OFF THE MAT. THERAPIST LEANS BACKWARD WHILE DOING TO PUT SLIGHT
TRACTION OF LEGS
• THERAPIST LOWER LEGS ON MAT, JIGGLED LATERALLY IN SCISSORS FASHION ( THERAPIST
HAND UNDER HEEL (TA),CAREFULLY JIGGLE ENTIRE BODY TOWARD HEAD & FEET)
• SLOW JIGGLING– RELAXING ALLOWING PATIENT BODY TO EVENLY DISTRIBUTED ON
SURFACE BELOW
 SLOW STROKING

• INHIBITORY TECHNIQUE
• PRONE POSITION
• THERAPIST PROVIDES RHYTHMIC, MOVING, DEEP PRESSURE OVER DORSAL DISTRIBUTION OF
PRIMARY POSTERIOR RAMII OF SPINE
• APPLY FINGER TIP PRESSURE ON BOTH SIDES OF SPINOUS PROCESS TO AFFECT NERVE
ENDINGS, SYMPATHETIC OUTFLOW OF ANS
• STROKING SLOWLY, CONTINUOUSLY FROM OCCIPUT TO COCCYX
• HANDS ALTERNATED, ONE REACH BOTTOM OF SPINE , OTHER STARTINGA DOWNWARD FROM
TOP
 SLOW STROKING- VARIATIONS

• LUBRICANT (HAND CREAM) PREVENT FRICTION ON SKIN

• SOME USE ENDS OF FLEXED (PIP) JOINTS OF INDEX, LONG FINGER PROVIDE FIRM,
CONTINUOUS DOWNWARD PRESSURE TO BOTH SIDE OF SPINOUS PROCESS
• SOME ON ULNAR SIDE OF HANDS IN CASCADING MOTION WITH ALTERNATING PRESSURE
FROM NECK REGION TO LUMBAR AREA
• CLINICALLY BENEFICIAL IF APPLIED BY SOFT MUSIC
• MUSIC USED CLOSURE TECHNIQUES FOLLOWING SI TO CALM CHILDREN AFTER VESTIBULA,
PROPRIOCEPTIVE FACILITATION
• PROCEDURE NOT EXCEED 3 MINUTES( REBOUND PHENOMENON- EXCITATION OF SNS)
 SLOW ROLLING

• SIDE LYING POSITION ( HEMIPLEGIC FIRST IN UNINVOLVED SIDE DOWN)

• THERAPIST KNEELS BEHIND PATIENT , LACES ONE HAND ON RIB CAGE, OTHER HAND LATERAL
PELVIS
• PATIENT ROLLED SLOWLY FROM SIDELYING TO PRONE POSITION, BACK AGAIN RHYTHMIC FASHION
• ROLLING ENTIRE BODY LYING SIDE TO PRONE, THERAPIST INCORPORATE SOME ROTATIONAL
MOVEMENTS BETWEEN HIP& TRUNK
• TECHNIQUES ON BOTH SIDE OF BODY
• IN SOME , PILLOW BWN KNEES OR UNDER HEAD TO PREVENT FRICTION AND MALALIGNMENT OF
BODY
 LIGHT JOINT COMPRESSION

• JOINT COMPRESSION OF BODY WEIGHT OR LESS THAN BODY WEIGHT INHIBIT SPASTIC MUSCLES AROUND JOINT
• HEMIPLEGIC PATIENT TO ALLEVIATE PAIN , AFFECT MUSCLE IMBALANCE AROUND SHOULDER JOINT

SITTING OR SUPINE LYING

• THERAPIST ONE HAND OVER SHOULDER, OTHER HAND UNDER FLEXED ELBOW JOINT
• ARM ABDUCTED 35 TO 45* , COMPRESSION FORCE OF BODY WEIGHT OR LESS APPLIED THROUGH LONGITUDINAL AXIS OF
HUMERUS
• COMPRESSION OF GH JOINT, ARTICULATION OF HUMERUS, ULNA.DRAMATIC EFFECT
• AFTER MUSCLE RELAX, CIRCUMDUCTION IN SMALL FOR PAIN, STIFFNESS IN SHOULDER
• ELBOW- COMPRESSION TO ELBOW, SHOULDER. WRIST AND ELBOW BENEFITS IF IN LOLONGITUDINAAXIS.THERAPIST ONE
HAND BEHIND ELBOW, FOREARM IN MID, WRIST EXTENDED, COMPRESSION APPLIED THROUGH HEEL OF PATIENT HAND
• GREATEST EFFECT DURING THE STIMULUS APPLIED
 TENDINOUS PRESSURE

• MANUAL PRESSURE TO TENDON INSERTION, ACROSS LONG TENDONS

• EFFECT ON SPASTIC, TIGHT MUSCLE WHERE TENDON ACCESSIBLE FORCES OF PRESSURE
• PRESSURE BY HARD SURFACE PREFERRED TO SOFT
• THERAPIST USES CONE I HAND WITH TAPERED END TOWARD THUMB SIDE TO INHIBIT FLEXORS
• HARD SURFACE OVER ANTERIOR ASPECT OF FOREARM INHIBITORY TO EXTRINSIC FLEXOR OF
HAND (PRINCIPLE I ORTHOSIS, I MANAGE MUSCLE IMBALANCE, CONTRACTURE PROVIDE BY
SPASTICITY)
• PACINIAN CORPUSCLE RESPONSIBLE FOR INHIBITION OF MUSCLE. GOLGI TENDON LOCATED I
MUSCULOTENDINOUS INSERTION, MONITOR TENDON TENSION
 MAINTAINED STRETCH

• POSITION HYPERSONIC EXTREMITIES IN ELONGATED POSITION FOR VARIOUS PERIODS CAUSE

LENGTHENING OF MUSCLE SPINDLE
• LONGER POSITION LESS SENSITIVE BY MUSCLE TO STRETCHING
• LENGTHENED POSITION FOR STRONGER AGONIST TO INCREASE THRESHOLD OF MUSCLE
SPINDLES( NOT PASSIVE)
• ANTAGONIST FACILITATION– CUTANEOUS TO OFFSET IMBALANCE. AUTO-GENERATED INHIBITION
VIA GOLGI TENDON TO RECIPROCAL FACILITATE ANTAGONIST MUSCLE
• SPASTICITY REDUCED, IF PRACTICE VERY SMALL RANGE CONTRACTIONS OF ISOLATED MUSCLES
AND THEIR ANTAGONIST . REPEATEDLY DONE WITH NO RESISTANCE IN GRAVITY ELIMINATED,
SPASTICITY REDUCED MAINLY IN EXTENSOR & ABDUCTORS.
 ROCKING IN DEVELOPMENTAL PATTERNS

• ENCOURAGE MOVEMENT AS GAINED MASTERY OF STATIC POSITION

• DEVELOPMENTALLY ASSUME, ACHIEVE STATIC POSITION, THEN INTEGRATE COORDINATE MOVEMENT WHILE MAINTAINING
POSTURE (SKILL)
• EX…. QUADRUPED – SHIFT WEIGHT TO 3 POINT STANCE , ONE HAND FORWARD REACH, GRASP, EXPLORE . BEGIN MOVEMENT SHIFT
FORWARD, BACKWARD. PROGRESS SIDE TO SIDE, DIAGONAL IF COMFORT ON RHYTHMIC MOVEMENT
• HEMIPLEGIC ASSISTED QUADRUPED , STABILITY OF INVOLVED ELBOW , THERAPIST APPLY PRESSURE, STRETCH TO TRICEPS,
ANCONEUS
• THERAPIST APPLY COMPRESSION GREATER THAN BODY WEIGHT TO FACILITATE COCONTRACTION, PRESSURE EXERTED ON
EXTENDED WRIST , HEEL OF HAND INHIBITS WRIST FFLEXOR
• LIGHT MOVING TOUCH ON DORSAL OF HAND PROMOTE FINGER EXTENSION
• ROCKING IN QUADRUPED NECK STRAIGHT , FOR PROPRIOCEPTORS OF NECK NOT INFLUENCE TONE ON LIMBS
• PATIENT MOVE IN A- P PLANE, SHOULDER, PELVIC GIRDLE MOBILIZED. THEN INCORPORATE FLEXION, EXTENSION, ROTATION OF
NECK AD REFLEX INHIBITION MEASURE