rood’s approach dr. hassan sarsak, phd, ot. margaret rood‘s approach principles –...

Rood’s Approach

Dr. Hassan Sarsak, PhD, OT

Margaret Rood‘s Approach Principles

– Utilization of controlled sensory stimulation Provide sensory input to stimulate muscular response and normalize tone

– Utilization of developmental sequencesIndividuals are placed in various developmental postures to stimulate muscular response

Margaret Rood‘s approach Principles– Utilization of activity to demand a purposeful response

Purposeful activities are chosen to elicit desired movement patterns

– Sensorimotor control is developmentally basedTreatment must begin at the person’s current level and progress sequentially

– Repetition/practice is necessary for motor relearning

Movement Control SequenceMovement Control Sequence

Flexion.Flexion.

Extension.Extension.

Adduction.Adduction.

Abduction.Abduction.

Ulnar patterns develop before radial ones Ulnar patterns develop before radial ones

Rotation. Rotation.

Muscle WorkMuscle Work

Light work muscles:Light work muscles:

– lie superficially, laterally, or distally

– primarily the flexors and adductors, finger and wrist extensors

– activated by light stretch or low-threshold stimulation

Heavy work muscles:Heavy work muscles:

– lie close to the joint. In the body they are located proximally and medially.

– They are primarily the trunk and proximal limb extensors and abductors

– activated by heavy resistance or maintained stretch and high threshold receptor stimulation

Margaret Rood‘s approach Phases of motor control 1. Reciprocal inhibition/innervation

– Early mobility pattern that is primarily a reflex– The movement of the neonate, waving his extremities back and forth

typifies phasic movement.

2. Co-contraction – Simultaneous contraction of the agonist and antagonist around the joint

that provides stability in a static pattern – Utilized to hold a position or object for a long duration (improves

posture)

3. Heavy work– Mobility superimposed on stability – Proximal muscles contract and move and the distal segments are fixed

Margaret Rood‘s approach Phases of motor control 4. Skill

– Considered the highest level of control and combines stability and mobility

– Skill patterns consist of a stabilized proximal segment while the distal segment move in space

Sequences in Gross Motor Sequences in Gross Motor DevelopmentDevelopment

A1:A1:Supine withdrawal

Supine.Supine.

Withdrawal pattern.Withdrawal pattern.

Total flexion.Total flexion.

Bilateral.Bilateral.

Centered at 10th thoracic Centered at 10th thoracic

vertebrae.vertebrae.

A2:A2:

– Roll over.Roll over.

– Flexion top arm & leg.Flexion top arm & leg.

A3: prone extension A3: prone extension

– Total extension.Total extension.

– Bilateral.Bilateral.

– Cen. at 10Cen. at 10thth vertebrae. vertebrae.

B. Fixed Distal Segments B. Fixed Distal Segments

B1:B1:– Neck Co contraction, Neck Co contraction,

Vertebral extension.Vertebral extension.

– For head & neck For head & neck hyperkinesia.hyperkinesia.

– To stabilise eyes if To stabilise eyes if nystagmus.nystagmus.

B2: prone on elbowsB2: prone on elbows– Forearm support.Forearm support.

– Gleno humeral joint Gleno humeral joint alignment.alignment.

B3: B3: Quadruped

– All fours.All fours.

B4:B4:– Sitting.Sitting.

– Pressure on knees Pressure on knees through to heels Auto through to heels Auto facilitation.facilitation.

Margaret Rood‘s approach Sequential patterns 1. Supine withdrawal

– Position of total flexion while in the supine position

– The arms cross the chest, the legs flex and abduct

– Utilized to gain trunk stability and elicit flexion responses

2. Rollover – The arm and leg on the same side flex as the trunk rotates

– Utilized to elicit lateral trunk responses as well as for persons who are dominated by tonic reflexes

3. Prone extension – The person lies prone with upper trunk and head extension

– The shoulders abduct, extend and externally rotate, while the hips and keens extend off the support surface

Margaret Rood‘s approach Sequential patterns

4. Neck cocontraction – The individual is lying prone and encouraged to to lift the

head into extension against gravity

– Utilized to develop head control

5. Prone on elbows – A pattern of trunk extension utilized to inhibit tonic neck

reflexes as well as provide trunk and proximal limb stability

6. Quadruped – The person assumes an “on all fours” position to develop

limb and trunk cocontraction patterns

7. Standing (Standing is at first static followed by active weight shifting)

8. Walking (Gait patterns are integrated into functional activities)

Margaret Rood‘s approach Motor responses based on the sensory stimulation applied by the therapist: – Fast brief stimuli produces a reflexive, large synchronized,

output (e.g., tapping a tendon or muscle to facilitate muscular contraction)

– Fast repetitive sensory input produces a maintained response (e.g., application of high frequency vibration to a weakened muscle to evoke a tonic holding contraction)

– Maintained sensory input produces a maintained response (e.g., a prolonged manual stretch to a muscle group to inhibit overactive muscles)

– Slow, rhythmical, repetitive input produces a deactivating/calming effect (e.g., slow rocking, as in rocking chair to calm a child)

Margaret Rood‘s approach Evaluation a. Evaluate the distribution of muscle tone

clinical observation and palpation techniques a lot to decide whether the muscle group needs inhibition or facilitation

b. Determine the level of motor control based on Rood’s developmental sequence Individuals are guided through the sequence the point at which the subject can perform a task easily indicates his

highest developmental level

c. Determine the therapeutic activity of choice and how to progress the individual to the next level of control

Margaret Rood‘s approach

Intervention a. Utilize controlled sensory input (cutaneous, thermal,

olfactory, gustatory, auditory, and/or visual) to evoke desired motor responses

b. Facilitation techniques

c. Inhibition techniques

d. Engage individual in purposeful activity to facilitate development, move to more difficulty ones

Margaret Rood‘s approach Intervention Facilitation techniques

Tactile stimuli

– Light touch (stroking or A-brushing): A-size low threshold sensory fibers: stimulation of the webs of the fingers or toes or the palms of the hands or the soles of the feet elicits a fast, short lived withdrawal motion of the stimulated limb

– The stroking is done at a rate of twice per second for approximately 10 seconds

– After a rest period this procedure can be repeated 3 to 5 times

– When the reflex response occurs, resistance to the movement is usually given to reinforce it and to help develop voluntary control over it

Margaret Rood‘s approach Facilitation techniques

Tactile stimuli

– Fast brushing (C-brushing) (battery operated brush)

– Brushing the hairs or the skin over a muscle with a soft camel hair paintbrush

– Brushing is done for 5 seconds for each area, followed by a rest period

– If there is no response after 30 seconds, the brushing of each area should be repeated 3 to 5 times

Margaret Rood‘s approach Facilitation techniques

Tactile stimuli

– Fast brushing (C-brushing) (battery operated brush)

– Rood proposed that the effect of fast brushing is nonspecific, latent for 30 seconds, and reaches its maximum facilitative state 30 to 40 minutes after stimulation

– Short effect for 30 or 45 sec.

– Precautions:

fast brushing of the pinna stimulates vagal cardiorespiratory response (slower heart, and constrict smooth muscles of the bronchial tree)

fast brushing or scratching the back skin at level S2-4 may cause bladder emptying

Don’t use mechanical tools

Margaret Rood‘s approach Facilitation techniques

Thermal:

Quick icing over a muscle group to stimulate

Proprioceptive:

Stretch and tendon tapping (quick manual tapping with the therapist hand to apply a quick stretch to the desired muscle)

High frequency vibration (100-300 cycles per second)

– Cutaneous brushing prior to vibrator Cutaneous brushing prior to vibrator effective effective

Heavy joint compression (applied manually and longitudinally through a joint in weight bearing position)

Resistance utilizing gravity or via the therapist’s hands stimulates muscle recruitment

Margaret Rood‘s approach Inhibition techniques

Gentle rocking (in a chair or in therapist’s arms = generalized relaxation response)

Slow stroking over the posterior rami of the spine (generalized relaxation)

Slow rolling (from supine to sidelying and back in rhythmical pattern = generalized calming effect)

Maintained stretched to an overactive muscle group (inhibition to spastic muscles)

Neutral warmth (maintaining body heat by wrapping a person or body part in a blanket for 10-20 min. = relaxation response)

Prolonged icing (over a muscle group) – Icing precautions:

Behind ear Behind ear sudden ↓ of blood pressure sudden ↓ of blood pressure

Left shoulder in cardiac diseasedLeft shoulder in cardiac diseased

To normalize the muscle toneTo normalize the muscle tone

So ….So ….

Facilitatory technique:

--To normalize the muscle tone from a flaccid state. --To normalize the muscle tone from a flaccid state.

--Quick icing, fast brushing, tapping, stroking, quick stretch.--Quick icing, fast brushing, tapping, stroking, quick stretch.

Inhibitory technique:

--To normalize the muscle tone from hypertonic or spastic state. --To normalize the muscle tone from hypertonic or spastic state.

--Deep pressure, slow rolling, and slow rocking.--Deep pressure, slow rolling, and slow rocking.

Isotonic Isometric

Full body Isometric contraction

Shoulder isotonic flexionwith movement

Resistance Movement

Shoulder isometric

flexion with no movement

Resistance

Special Cases Special Cases Partial tearPartial tear

Complete tendon ruptureComplete tendon rupture

Tendonitis Tendonitis

In Cardiac Patients In Cardiac Patients

Know MET levels! (medical chart)Know MET levels! (medical chart)

NO isometrics NO isometrics

Downgrade activityDowngrade activity

Stop activity whenStop activity when– DyspneaDyspnea– Chest painChest pain– Light-headednessLight-headedness– Diaphoresis Diaphoresis