ROOD’S APPROACH

PRESENTER NAME: Dr. ASHRIN T

MPT (NEURO)
INTRODUCTION
Margaret Rood who was both an occupational and a physical therapist
designed a treatment originally for cerebral palsy which was also applicable to
any patient with motor control problems (Rood, 1976).
Principles
1. Controlled use of sensory stimulation
• Appropriate sensory stimulus leads to specific motor response.
• Appropriate sensory stimulus leads to normalization of muscle tone.
2. Use of developmental sequences
• Sensorimotor development takes place in sequence from lower to higher level.
3. Use of activity to demand a purposeful response.
4. Practice of sensory-motor responses is necessary for motor learning
Levels of Motor Control
1. Supine withdrawal
2. Rollover
3. Pivot prone
4. Neck co-contraction
5. Prone on elbows
6. Quadruped
7. Standing
8. Walking
Sensory Inputs
To facilitate/inhibit motor responses:
1. Tactile (cutaneous)
2. Thermal
3. Olfactory
4. Gustatory
5. Auditory
6. Visual
7. Proprioceptive (Stretch, resistance).
Method of Treatment
• Sensory inputs are applied to facilitate or inhibit motor responses.
• Patients are made to go to the developmental level sequentially
starting from the level the patient already has sensory inputs can be
applied along with the developmental level.
• Finally, the use of the purpose of the activity should be incorporated
followed by practice several times.
Rules of Sensory Input
Margaret Rood (1970), described four rules of sensory input:
1. A fast brief stimulus produces a large synchronous motor output.
This type of stimulus confirms the reflex is functioning.
2. A fast repetitive sensory input produces a maintained response.
3. A maintained sensory input produces a maintained response. E.g.
Gravity-which has a constant effect on the sensory system. In all
positions(standing, sitting, or lying) the exteroceptors of the skin are
in contact with a surface, thus discharging impulses into the nervous
system.
4. Slow, rhythmical, repetitive sensory input deactivates body and
mind. For example Slow rocking or soft music activates the
parasympathetic system leads to generalized relaxation.
SEQUENCE OF MOTOR DEVELOPMENT
Margaret Rood proposed four sequential phases of motor control:
1. Reciprocal innervation/inhibition- A phasic (quick) type of
movement that requires contraction of the agonist muscles as the
antagonist muscle relaxes. It is an early mobility pattern protective
in nature.
2. Co-contraction- It is defined as the simultaneous contraction of the
agonist and antagonist muscles with the antagonist supreme It is a
tonic (static) pattern that provides the ability to hold a position or an
object for a longer duration.
3. Heavy work- It is described by stock Meyer (1967) as "mobility
super imposed on stability." In heavy work, the proximal muscles
contract and move and the distal segment is fixed. For eg., Creeping, in
quadruped position the distal segments—wrist and ankles are in a fixed
position. The neck and thorax (proximal joints) are stable whereas the
shoulder and hip girdles are free to move.
4. Skill—It is the highest level of motor control and combines the effect
of mobility and stability. In a skilled pattern, the proximal segment is
stabilized while the distal segment moves freely. For e.g.-Typing
requires stability in proximal joints (shoulder, elbow) while skilled
mobility in distal finger joints.
Outogenic Motor Patterns
1. Supine withdrawal (flexion)- Is a total flexion response towards
the vertebral level of T 10. The flexion of the neck and the crossing
of the arms and legs protect the anterior surface of the body. It is
useful in integration of the tonic labyrinthine reflex and for patients
who do not have reciprocal flexion pattern and dominated by
extensor tone.
2. Roll over- Rolling toward the side causes:
• Mobility pattern for the extremities and activates the lateral trunk musculature.
• Stimulation of the semicircular canals, which in turn activates neck and
extraocular muscles.
It is useful for patients who are dominated by tonic reflex patterns in the supine
position
3. Pivot prone- It is both a mobility pattern and a stability pattern.
• In this pattern there is a full range of extensions of the neck, shoulders, trunk
and lower extremities.
• This position is difficult to assume and hold.
• It prepares the extensor muscles for upright positions and indicates integration
of the symmetric tonic neck reflexes and the tonic labyrinthine reflexes.
4. Neck co-contraction -It activates both flexors and deep tonic
extensors of the neck.
• It is the first real stability pattern.
• This pattern elicits the tonic labyrinthine righting reaction when the face is
perpendicular to the floor and also promotes neck stability and extra-ocular
control.
5. Prone on elbows- Weight bearing on elbows stretches the upper
trunk musculature to influence the stability of the scapular and
glenohumeral regions,
• In this position patient has better visibility of the environment and
can do weight shift from side to side.
• The symmetric tonic neck reflex gets inhibited in this position.
6. Quadruped position- In this pattern lower trunk and lower
extremities are in co-con-traction.
• The patient can do weight shifts in forward/backward, side to
side, and diagonal directions.
• This provides mobility superimposed
7. Standing- In this position weight is equally distributed on both legs after that
weight shifting begins.
• The upper extremities are free to perform functions.
• Also standing brings in the integration of righting reactions and equilibrium
reactions.
8. Walking- Murray (1967) described gait as a normal locomotion that entails the
ability to support the body weight, maintains balance and execute the stepping
motion.
• Walking requires coordinated mobility and stability.
FACILITATION TECHNIQUES
1. Tactile (Cutaneous) stimulation - causes stimulation of exteroceptors (end organs
under the skin in subcutaneous tissues). These receptors respond to the external
environment causing protective withdrawal responses and producing states of
alertness and rapid movements of the limbs.
a. Light-moving touch- Touch is important for normal growth and development
(Montague A, 1978).
It has the following effects:
• Increases corticosteroid levels in the bloodstream.
• Increases resistance against disease,
• Increases tissue repair.
• Improves fluid and electrolyte balance.
Margaret Rood used a light-moving touch or stroking of the skin to activate the
superficial mobilizing muscles.
• Application: Fingertips, camel hair brush, or cotton swab.
• Frequency: 3-5 strokes, 30 seconds rest period between strokes.
• Area: The first area is the area from the nose to the chin, (after several
stimulations infants may show a response of flexion pattern of the upper extremity
and perhaps lower extremity.
• Light stroking from the corner of the lip to the cheek. It activates neck muscles
and the head tilts laterally toward the side of the stimulus.
• Light moving touch to the navel or dermatome T10 in the midline to lateral
direction activates unilateral flexion pattern.
• Light moving touch to the dorsal web spaces of the fingers and toes activates a
withdrawal pattern of the extremities.
• Light moving touch to the tips of the fingers or soles of feet facilitates a tickle
withdrawal response of great magnitude.
b. Fast brushing- Fast brushing by battery-operated brush (introduced by Margaret
Rood in 1964) is applied over the dermatomes of the same segment that supplies the
muscle (myotome) to be facilitated.
• For e.g.-Stimulation of L3.4 dermatomes leads to the facilitation of
quadriceps, tibialis anterior, and detrusor urinae.
• The effect of fast brushing lasts for 30 minutes. The stimulus is applied for 3
to S seconds and repeated after 30 seconds.
c. Icing- Ice is an extreme in thermal facilitation and has been used for the
facilitation of muscle activity and autonomic nervous system responses (Margaret
Rood, 1954), Margaret Rood described three uses of ice:
• Quick icing for patients having hypotonia (3 swipes, blott water after each
swipe)
• Pressing ice cubes to the skin of a dermatome corresponding to myotome to be
stimulated
• Ice stimulates the sympathetic nervous system and probably glandular output
of the thyroid and adrenal glands. Ice should be used cautiously, especially in
patients having cardiac problems
Note: The exteroceptive stimulation can be unpredictable. In the 1970s M. Rood began to
abandon the use of these stimuli and endorse the use of proprioceptive stimuli.
2. Proprioceptive stimulation- It refers to the facilitation of:
• Muscle spindles
• Golgi tendon organs
• Joint receptors and the vestibular apparatus.
Joint gives more control over the motor response. Proprioceptors adapt more slowly than
exteroceptors and can produce sustained postural patterns (Buchwald J, 1967).
a. Heavy joint compression- It is defined as joint compression greater than body
weight applied through the longitudinal axis of the bone (Ager J, 1974).
• It causes co-contraction around the joint under compression.
• This procedure can also be combined with ontogenetic patterns such as prone on
elbows, quadruped, sitting, and standing positions.
• The joint compression can be applied manually or by weighted cuffs or sand-bags.
 b. Stretch- According to Rood stretch is a physiologic stimulus used to activate the
proprioceptors in selected muscles of the body.
• Intrinsic stretch: According to Rood it is the use of the intrinsic muscles to
promote stability of the scapulohumeral rhythm. E.g.- In prone on elbows, resistive
grasp can enhance shoulder stability. Resistance is a form of stretching as that
increases fusimotor activity of the muscle spindle.
• Resistance: Rood emphasized the use of heavy resistance to stimulate both
primary and secondary endings of the muscle spindle.
When a muscle contracts against resistance it assumes a shortened length that
causes the muscle spindles to contract so they readjust to the shorter length.
According to Rood intermittent resistance graded to the desired motion is better
than manual stretching for alleviating tight muscles.
• Stretch pressure: It affects both the exteroceptors and the la afferent of the
muscle spindle. The degree of stretch and pressure should be strong enough to
cause deformation of skin and underlying superficial muscle:
• lubricants can be used.
• time of stimulus < 3 seconds.
• can be applied directly over muscle or dermatomically.
• use thumb, index, and middle finger to stretch with pressure.
• Tapping: It acts on the muscle spindle (afferent) and increases the tone of the
underlying skeletal muscles
• It is done by tapping over the belly of muscles with fingertips
• 3-5 times over the muscle to be facilitated
• Vestibular stimulation: According to De Quiros JB vestibular stimulation is a
powerful proprioceptive input.
Therapeutic uses:
• to promote extensor patterns of the neck, trunk and extremities (Static
labyrinthine system) –
• to elicit subcortical responses, such as protective extension - to
activate antigravity muscles and their antagonist
• fast stimulation such as rocking stimulates while slow rhythmic
rocking causes relaxation
• vestibular stimulation affects tone, balance, protective responses,
bilateral integration, and auditory language development.
• Vibration:
• Frequency- High frequency-1:00 to 300 cycles/second.
• Low frequency —50 to 60 cycles/ second.
• Uses:
• High-frequency vibration is used to elicit tonic vibration reflex which stimulates
contraction of muscle if applied directly over the belly, It also inhibits contraction of
antagonist muscle and suppresses the stretch reflex.
• Low-frequency vibration suppresses pain perception and desensitizes hypersensitive
skin.
• Other factors:
• Vibration should be applied parallel to muscle fibers.
• Do not apply vibration over the tendon, it may stimulate surrounding muscle through
bone.
• Do not apply vibration with deep pressure as it is inhibitory.
• Duration of application should not be more than 1 to 2 minutes (to avoid heat
formation)
• Osteopressure: It is defined as pressure on bony prominences to
facilitate or inhibit voluntary muscles.
• According to Margaret Rood, osteo pressure produces a slower reaction and
needs to be preceded by a light-moving touch.
• E.g.—if light moving touch is applied to dermatome C, of the arm and
pressure is applied over the lateral epicondyle of the elbow, the arm extends.
• The underlying neurophysiology has not been understood properly.
• Inhibition Techniques: According to Rood following techniques may
be used for inhibiting abnormal tone.
• Gentle shaking or rocking.
• Slow rolling
• Light joint compression
• Tendinous pressure
• Maintained stretch
• rocking in a developmental pattern.
• Use of special senses for inhibition/ facilitation: M. Rood used
olfactory and gustatory stimuli to facilitate cranial nerves and to
influence.
• Autonomic nervous system: Though she did not provide specific
guidelines for their uses:
Clinically following can be used:
• pleasant orders for a calming effect.
• unpleasant order to produce primitive protective responses
• noxious substances (such as vinegar) for activating muscles of mastication