ROOD’S APPROACH
INTRODUCTION
Developed by Margaret Rood in 1970s.
Also known as Sensorimotor approach or the
Rood’s system.
Based on REFLEX-HIERCHIEAL
Theory.
Margaret Rood was both OT
and PT
She mainly developed
this approach for patients
with brain damage
INTRODUCTION
She developed this technique by trial and
error method during her clinical practice.
She had shared her findings through clinical
and classroom teachings but has written very
little on her techniques.
The procedures and the rationale behind the
techniques are elaborated by two therapists
namely- Jean Ayres and Shirley Stockmeyer.
PRINCIPLES
Rood’s basic premise was:
“Motor patterns are developed from fundamental
reflex patterns present at birth which are utilized and
gradually modified through sensory stimuli until the
highest control is gained on the conscious cortical
level. It seemed 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
and by following neurophysiological principles,
establish proper motor engrams (Rood, 1954)
PRINCIPLES
1. The normalization of tone and evocation of desired muscular
responses are accomplished through use of appropriately
applied sensory stimuli. Correct sensory input is necessary for
the development of correct motor responses. Controlled
sensory input is used to evoke muscular responses reflexively,
the earliest developmental step in gaining motor control
(Rood 1954, 1962).
2. Sensorimotor control is developmentally based, and
therefore, therapy must start at the patient's current level of
development and progress sequentially to higher levels of
control (Rood, 1962; Minor, 1991).Roods identified several
developmental sequences.
PRINCIPLES
3. Movement is purposeful (Rood, 1962; Ayres 1963, 1974).
Rood used purposeful activity to demand a response from
the patient to elicit sub-cortically (unconsciously) the
desired movement pattern. The responses of agonists,
antagonists, and synergists were believed to be
reflexively (automatically) programmed according to a
purpose or plan. The cortex does not direct each muscle
individually.
4. Repetition (practice) of sensorimotor responses is
necessary for motor learning (Ayres, 1974; Rood, 1956).
Activities are used not only to elicit purposeful responses
but also to motivate repetition.
TECHNIQUES
Two Types- FACILITATION METHODS and
INHIBITION METHODS.
However, the actual response each patient
will exhibit will be an algebraic summation of
all internal and external stimuli the patient
experiences.
Hence, response of the patient is carefully
monitored and the stimuli changed as
required to elicit the desired response
FACILITATION METHODS
FAST BRUSHING
Stimulus: Fast brushing of the hair or skin, high-intensity
Area stimulated: Over the muscle, Over the dermatome
Equipment: Stirrer of a hand-held battery-operated
cocktail mixer, soft camel hair paint brush
Duration: 3-5 sec over the skin, 5 sec over each dermatome
(if no response after 30 sec, repeat 3-5 times more)
Response: Muscular Contraction that is nonspecific, has a
latency of 30 sec, and does not reach its maximum potency
until 30 to 40 min after stimulation, because of processing
by the reticular activating system. (Rood) It produces a
significant immediate facilitatory effect, the post-
application effect lasted only 30 to 45 sec (Mason, 1985)
FAST BRUSHING
Rationale: High threshold stimulus to the C size sensory
fibers are involved in the maintenance of posture and
background gamma efferent activity. High threshold
stimulation facilitates the gamma system to bias spindles to
increase response to added external or internal stretch.
AREA EFFECT
Distribution of the posterior primary rami Facilitates the tonic, deep muscles of the
adjacent to the vertebral column back
Over the rest of the body, supplied by the Facilitates a tonic response of the
anterior primary rami. (Dermatome pattern) superficial muscles
Pinna of the ear Stimulates Vagus Nerve
Dermatomes of L1-2 Voiding
Dermatomes of S2-4 Bladder retention
FAST BRUSHING
LIGHT STROKING
Stimulus: Light touch or stroking of skin, low-
intensity
Area stimulated: Over the dermatome
Response: Fast, short-lived response through
facilitation of extrafusal muscle fibers
Rationale: Activates A fibers which activate
reciprocal action of superficial phasic or
mobilizing muscles.
LIGHT STROKING
Light stroking of the dorsum of the webs of
the fingers or toes or of the palms or soles,
elicit phasic withdrawal motion of the limb.
Repetitive stimulation of this area results into
crossed-extensor reflex pattern.
ICING
Stimulus: Icing to achieve skin
temperature of 12 to 17 degree C.
Type: “A”-icing and “C”-icing
Equipment: Plastic ice popsicle
C - Icing A - Icing
Stimulus High Threshold High frequency
Effect Stimulates postural tonic Evokes reflex withdrawal
responses via C fibers via A fibers
Technique Hold the cube pressed in Quick icing
place for 3 to 5 sec then
wipe the water
ICING
Area- same as for fast brushing except distribution
posterior primary rami as this causes stimulation of
sympathetic nervous system.
A-icing of upper quadrant of abdomen i.e.
dermatomes T7-9 causes stimulation of diaphragm.
Touching lips with ice open mouth whereas touching
tongue and inside of lips closes mouth.
There is rebound effect of icing which occurs
approximately 30 sec after stimulation which causes
temporary inhibition.
Precautions: same as Fast brushing.
PROPRIOCEPTIVE STIMULI
Stimuli has effects only as long as applied.
1. Quick stretch: light, low thresholds stimulus, activates
phasic response of same muscle through afferent ending
of the spindles and the alpha motor neuron, immediate
effect, facilitates same muscle and inhibits antagonist.
2. Tapping: tendon or the belly of muscle, same as quick
stretch, percussion over tendon using finger-tips.
3. Pressure: over muscle belly, elicits stretch response by
placing a stretch on spindles, manually or by equipment.
4. Secondary stretch: maintained stretch at end on range to
facilitate type-2 fibers of the spindle, facilitates antagonist
at the time when they are at shortened range.
PROPRIOCEPTIVE STIMULI
5. Co-contraction: stretch to intrinsic muscles of
the hand or foot, causes co-contraction of
proximal stabilizing muscle, can be combined
with weight bearing for further facilitation. E.g.:
Prone on elbow => child shoots water pistols,
grasping handle of pools, grasping Cone.
6. Resistance: many spindles stimulated, causes
the spindle to fire impulses in order to get
extrafusal muscle unit firings, overflow occurs.
PROPRIOCEPTIVE STIMULI
STIMULI EFFECT
Resistance to phasic Prevents immediate inhibition of the contracting
contraction muscles due to the effect of GTO
Resistance to contraction of Used to bias the spindles of deeper, tonic muscles
muscle in shortened range which cannot be stimulated by C fibers
Resistance to Eccentric Provides both internal and external stimuli which
contraction activates primary afferents
PROPRIOCEPTIVE STIMULI
Heavy Joint Compression: facilitates co-contraction of
one joint-slow oxidative muscles around joint, resistance
greater than that of body weight, activates high
threshold receptors. E.g.: Prone on elbows, prone on
hand, quadruped, standing and ask patient to lift one
extremity, add weight (hat or crown with weight,
weighted bags, lead X-ray aprons etc).
Pressure on bony prominences: both facilitating and
inhibiting effect. E.g.: Pressure on lateral aspect of
calcaneous => facilitates medial dorsiflexors and inhibits
calf muscle. Pressure over medial aspect => facilitates
lateral dorsiflexors and inhibits calf muscle.
SPECIAL SENSES
Auditory : Facilitating-rhythmic music, noisy clinic, fast
and high pitched voice of therapist; Inhibitory-lullaby, soft
voice
Visual: Facilitating- colorful environment, lighted or multi-
stimulated clinic; Inhibitory – dull, colorless and
uninteresting environment.
Olfactory and Gustatory stimuli can be both facilitating
and inhibiting through their influence on Autonomic
nervous system.
Labyrinthine system- static positions and movement of
head used to influence postural tone and modify tonic
labyrinthine reflexes.
INHIBITORY METHODS
LIGHT JOINT COMPRESSION
Inhibits spastic multi-joint fast glycolitic
muscles
E.g. : Hemiplegic patients, shoulder
spasticity, hold the elbow, abduct 35-45
degree and gently push the head into glenoid
fossa.
Compression in long axis of the body
segments in correct weight-bearing
alignment.
SLOW STROKING
Slow stroking over area of posterior primary
rami with firm but light pressure inhibits
muscle tone in general.
E.g.: Stroking along the vertebral column
using alternate hands for 3 minutes or until
the patient relaxes.
Reduces choreo-athetosis.
SLOW ROCKING AND ROLLING
Chair rocking, hollow barrel, etc
Avoid self-rocking
Slow rolling from supine to side-lying.
NEUTRAL WARMTH
Maintenance of the body heat by wrapping
the area in cotton blanket or under pillow or
comforter for 10-20 minutes.
Rebound effect appears if heat greater than
body temperature is used.
PRESSURE ON THE TENDINOUS
INSERTION
Inhibits stimulated muscle Through Pacinian
corpuscles.
E.g.: Extrinsic flexors of hand- constant
pressure over long tendons as Grasp of
enlarged, firm or hard adapted handles.
This has inhibitory effect on flexors and
reciprocal facilitatory effect to extensors.
MAINTAINED STRETCH
Stretch or lengthened position re-biases
spindle to longer position.
The balance of tone between agonist and
antagonist will be disturbed.
However, sometimes prolonged positioning
is desired E.g.: Spastic flexors held in cast or
splints.
Weak muscle can also be maintained in a
shortened position.
CONCLUSION
Positioning is a primary concern, especially
when little voluntary control exists.
Extensive use of mats, bolsters, balls, and
other specialized equipment is common in
the Rood approach.
Movement patterns can be incorporated into
games, such as tug of war, to provide an
occupational focus to regaining motor
control.
REFERENCES
Occupational Therapy for Physical
Dysfunction by Catherine Trombly and Anna
Scott
Cash’s Textbook of Neurology for
Physiotherapist by Downie
Neuro-rehabilitation: A Multisensory
Approach by Shereen Farber
Applied Theories in Occipational Therapy by
Cole M.
ANY QUESTIONS?
THANKS…..
