ROODS

APPROACH
Introduction

■ Neurophysiological approach developed by Margaret Rood in 1940

■ Originally designed for CP ,now applicable to any patient with motor control
problems
■ Deals with the activation or deactivation of sensory receptors and their role in
the regulation of motor behavior
■ The approach is based on reflex/hierarchical model of the CNS
■ Rood’s basic assertion was that motor patterns are developed from primitive
reflexes through proper stimuli to the appropriate sensory receptors
Components

■ Controlled sensory Stimulation

■ Use of developmental sequences
■ Purposeful movement
Principles

1. Normalization of tone– Using controlled sensory stimuli to normalize the

muscle tone and to evoke desired muscular responses is the basic principle
of Rood approach
2. Developmental sequence -Sensorimotor control is developmentally based.
During treatment therapist must assess current level of development and
then try to reach next higher levels of control. Rood had identified several
developmental sequences
3. Purposeful movement- Rood used purposeful activities which can help to
get the desired movement pattern from the patient.
4. Repetition of movement: Rood encouraged repeated practice of sensory
motor responses for motor learning
 Basic concepts of Roods approach

■ 4 basic concepts :
■ Mobility and stability muscles: phasic and tonic muscles
■ The Ontogenic sequences : The motor development sequence finally leads to
skilled and finely coordinated movements.The vital function sequence finally
leads to well articulated speech
■ Appropriate sensory stimulation: Rood utilized the anterior horn cell excitability
by using sensory stimulus. According to Rood, there are four types of receptors
which can be stimulated and in order to get desired muscular response
■ Manipulation of the autonomic nervous system: Activation of sympathetic and
parasympathetic system can be used in treatment of motor disorder patients
Muscle groups according to type of
work they do and their responses to a
stimuli
Phasic muscles Tonic muscles
■ Aka heavy work muscles or stability
muscles
■ Aka light work muscles or mobility
muscles ■ Capable of prolonged sustained
contraction
■ For skilled mvt patterns with
reciprocal inhibition of antagonist ■ trunk muscles,proximal limb
muscles extensors
■ Eg flexors and adductors ■ Responsible for joint stability with
cocontraction of muscles
■ Fast glycolytic fibres
■ Slow oxidative fibres
■ Superficial and one joint muscle
■ Deep n usually single joint type
■ High metabolic cost and rapidly
fatigue ■ Pennate with large area of
attachment
■ Low metabolic cost and low fatigue
Ontogenic Motor patterns

A. Supine withdrawal
B. Roll over
C. Pivot prone
D. Neck cocontraction
E. On elbows
F. All fours
G. Static standing
H. Walking
 4 phases of motor control
■ Rood categorized the ontogenic patterns under 4 sequential phases
1. Mobility :

• Reflex movements governed by spinal and supra spinal centers

• Phasic or quick type of mvt with reciprocal shortening and lengthening contraction of muscles
• contraction of agonist muscles when antagonist muscle relaxes (reciprocal inhibition)
2. Stability:
• obtains through cocontraction
• simultaneous contraction of agonist and antagonist muscles, working together to stabilize and
maintain the posture of the body
• Mobility superimposed on stability.
3. Mobility superimposed on stability
It is defined as a mvt of proximal limb segments with distal ends of limbs fixed on the base of
support
Heavy work : proximal muscles contract to do heavy work

1. Skill :
• distal mobility with proximal stability.
• It is defined as skilled work with the emphasis onthe movement of distal portions of the body in a
finely coordinated pattern that require control from the highest cortical levell
■ SUPINE WITHDRAWAL
Total flexion response towards vertebral level T10
Requires reciprocal innervation with heavy work of proximal segments
Aids in integration of TLR
Recommended:
• patients with cervical flexion
• Patients dominated by extensor tone.

■ ROLLOVER TOWARD SIDE-LYING

Mobility pattern for extremities and lateral trunk muscles
Activation of lateral trunk muscles
Stimulates semicircular canals which activates the neck & extraocular muscles
RECOMMENDED:
• Patients dominated by tonic reflex patterns in supine
■ PIVOT PRONE
Demands full range extension neck, shoulders, trunk and lower extremities
Position difficult to assume and maintain
Important role in preparation for stability of extensor muscles in upright position
Associated with labyrinthine righting reaction of the head
RECOMMENDED: Integration of STNR & TLRs

■ NECK COCONTRACTION
First real stability pattern
Lift the neck in antigravity position
Activates both flexors & neck extensor muscles
RECOMMENDED: Patients needs neck stability & extraocular control
▪ PRONE ON ELBOWS
Stretches the upper trunk musculature
Improves stability for scapular and glenohumeral regions
Gives better visibility of the environment
Allows weight shifting from side to side and reaching activities
RECOMMENDED: Patients needs to inhibit STNR

■ QUADRUPED POSITION
Shoulder and hip control
Lower trunk and lower extrimity are in cocontraction
Balance training with perturbations
Mobility superimposed on stability
Recommended :
• Facilitate crawling
• Strengthen shoulder and hip muscles
• Training balance
STANDING
Weight is equally distributed on both legs
Upper extrimity is free to perform functions
Integration of righting reaction & equilibrium reaction ie.integration of balance and higher
functions

WALKING
Sophisticated process requiring coordinated movement patterns of various parts of body
Mobility, stability and skill
“support the body weight, maintain balance, & execute the stepping motion”
A very important ADL of life
 Rood’s techniques
Facilitatory Inhibitory
■ Light moving touch ■ Gentle shaking or rocking
■ Fast brushing
■ Slow stroking
■ Icing
■ Slow rolling
■ Proprioceptive Facilitatory
techniques: ■ Neutral warmth
– Heavy joint compression ■ Light joint compression
– Stretch
– Resistance
■ Tendinous pressure
– Tapping ■ Maintained stretch
– Vestibular stimulation ■ Rocking in developmental stages
– Inversion
– Therapeutic vibration
Light touch
■ Application : Finger tips ,camel hair brush , or cotton swab applied over the
dermatomes of desired muscle.
■ Procedure: 3 -5 strokes, followed by 30s rest . Ask the pt to do activities
■ Physiology : Stimulus perceived by the hair end organs or free nerve endings
(receptors) are transmitted by A delta fibres (afferent) to the spinal cord (centre)
■ Then stimulates alpha motor neurons and facilitate muscle fibres
■ Response : Withdrawal pattern of extremities
Fast brushing
■ Mediated by C fibers
■ Procedure : By battery operated brush or brush with thick strand is applied over
the dermatomes of the same segment that supplies the muscles to be facilitated.
Eg. Is applied for 3 to 5 seconds & repeated after 30 sec.
■ Effects :
– Lasts for 30 minutes,
– stimulates C fibers which sends many collaterals in the RAS. Improves cortical
activity which keads to arousal
– Activates muscles and improves sensory function
Icing
■ Types: A icing & C icing.
■ A icing/quick icing :
• mediated by A fibers to cortex and spinal cord
• Facilitation of muscular activity & ANS responses.
• Patients with hypotonia
• Alerts the mental processes
• Ice is applied t the skin in 3 quick swipes and water blotted with a towel between
swipes
■ C Icing-
– High threshold stimulus
– Mediated by C fibers
– Ice cube is pressed to the skin serving the same spinal segment of the muscle to
be stimulated
– Facilitates a maintained postural response
Proprioceptive facilitatory
techniques
Facilitation of muscle spindles, GTO, Joint receptors and vestibular apparatus

Approximation / heavy joint compression

■ ie Joint compression > body wt applied through the longitudinal axis of bone
■ Effect : cocontraction around joint under compression and facilitates contraction
■ Procedure :compression of joints in ontogenic patterns (prone on elbow, quadruped,
sitting and standing
■ Can be applied manually or by weighted cuffs or sand bags
■ Stimulates the proprioceptors and increase tone in stabilizing muscle
Vibration

■ Vibratory stimuli applied over a muscle belly to activate the A alpha afferent of
muscle spindle, causing contraction of that muscles and suppression of the stretch
reflex.
■ Best elicited by a high frequency vibrator that delivers 100-300c/s.
■ The duration of the vibration should not exceed 1-2 min per application because
heat and friction will result.
■ The prone position may be best while vibrating flexor muscle groups and the
supine position may enhance the extensor muscles.
 Stretch
■ Activates the proprioceptors in selected muscles and imply the principle of
reciprocal innervation
■ Intrinsic stretch : Stretch to intrinsic muscles of hand. It promotes stability of the
scapulohumeral region, bearing more weight on the ulnar side of the hands and
promoting resistive grasp
■ Secondary ending stretch: Combination of resistance and stretch to facilitate
ontogenic patterns.
■ Stretch pressure : Effects both exteroreceptors and Ia afferents of the muscle
spindle, pads of the thumb, index and middle finger are given firm, downward
pressure and stretching motion is achieved if the thumb moves away from the
finger.
 Resistance

■ uses heavy resistance

■ 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 spindle to contract so they readjust to the shortened length.
■ This is called “biasing” the muscle spindle so it is more sensitive to stretch
■ Better facilitation of muscle on stretching
Tapping

■ Tapping with the fingertips or percussed 3-5 times and may be done before or
during the time the px is voluntary contracting the muscles
■ stimulus acts on the afferent of the muscle spindles and increases the tone of the
underlying muscles
Vestibular stimulation

■ a powerful type of proprioceptive unit.

■ activates the antigravity muscles and their antagonist muscle before the stretch
reflex of the muscle spindles.
■ Improves tone, balance, protective response, cranial nerve function, bilateral
integration, auditory language development and eye pursuits.
■ It is stimulated through linear acceleration and deceleration in horizontal and
vertical planes and angular acceleration and deceleration such as spinning, rolling
or swinging.
■ Fast stimulation tends to stimulate while slow rhythmical rocking tends to relax.
Inversion

■ Produces static vestibular Stimulation

■ increased tonicity of the muscles of the neck, midline trunk extensors and selected
extensors in the limbs. (ie antigravity muscles)
■ Better control of neck,trunk and limb extensors
■ The head must be in normal alignment with the neck.
Inhibitory techniques

■ Gentle Shaking or Rocking : Rhythmical circumduction of the head and slight

approximation is given. can also be used in the UE and LE
■ Slow Rolling : Pt is rolled slowly from a sidelying position to prone and back in a
rhythmical pattern; use on both sides of the body.
■ Neutral warmth : most common method used to inhibit postural tone and muscle
activity. Px in recumbent and wrapped with a blanket for 5-20 minutes. Stimulates
the temperature receptors in the hypothalamus and PSNS, used for pxs with
hypertonia. Pt feels relax and reduced tone
■ Slow stroking : Pt prone while the therapist provides a rhythmical, moving deep
pressure over the dorsal distribution of the posterior rami of the spine; done from
occiput to coccyx and alternated and should not exceed 3 minutes.
■ Tendinous Pressure : Manual pressure applied to the tendon insertion of a muscle;
can be used in spastic or tight mm
■ Approximation : Jt compression less than or equal BW to inhibit spastic muscle
around the joint.
■ Maintained Stretch : Positioning in the elongated position to cause lengthening of
the muscle spindle to reset the afferents of the muscle spindle to a longer position
so they become less sensitive to stretch
■ Rocking : Shifting the weight forward and backward, progressing to side to side
then diagonal patterns