Roods approach

Facilitatory and inhibitory techniques

Done by :H. Gladys Rathinavathy 2nd year B. O. T,SCOT

Abstract :Rood approach is a neurophysiological approach developed by Margaret Rood in 1940 based on reflex or hierarchical model of the central nervous system. Rood's basic concept was that motor patterns are developed from primitive reflexes through proper sensory stimuli to the appropriate sensory receptors in normal sequential developmental pattern to improve motor performance. Basic principles of Rood approach are normalization of tone, ontogenic developmental sequence, purposeful movement and repetition or practice.

Rood approach is a neurophysiological approach developed by Margaret Rood in 1940. Rood approach deals with the activation or de-activation of sensory receptors, which is concerned with the interaction of somatic, autonomic and psychic factors and their role in the regulation of motor behavior.

Introduction

This neurophysiological approach was designed for the patient with motor control problem.According to Rood,

motor functions and sensory mechanisms are interrelated. The approach is based on reflex/hierarchical model of the central nervous system, where the movement is facilitated or inhibited for rehabilitation purpose.

To initiate a movement response we should try to increase the neuronal activity (it refers to facilitation) or to decrease the capacity to initiate a movement response we should try to decrease the neuronal activity(it refers to inhibition)

Facilitatory techniques

• Cutaneous facilitation can be used to stimulate

the exteroceptors (organs which located immediately Under the skin)

cutaneous facilitation

*Cutaneous facilitation causes protective withdrawal responses, produce state of alertness and rapid movement of limbs

*sensation transmitted are pain, temperature, and touch

• Touch is important for normal growth of the muscle

• Sends input to the limbic system

• Mediated by A delta Sensory fibres

• Stimulates A delta Sensory fibres synapses with fusiform system reciprocal

Light moving touch

Is one of the simple ways of facilitation of muscle activiIty by eliciting the muscle phasic, protective withdrawal reflex• This reaction maintained for several seconds after discharge.•

• The location of the stimulus and its intensity play the important role in the magnitude of reaction.

Mechanism:

• Mediated by A delta Sensory fibres

• Stimulates A delta Sensory fibres synapses with fusiform system reciprocal

1. Increase corticosteroid level in circulation therefore it increases the resistance against disease

2.Improves fluids and electrolyte balance mechanism

3.Activates low threshold hair end organ and free nerve ending

Effects :

4.Activates Superior mobilizing muscle 5.Increase resistance against disease

Procedure :By battery operated brush it is applied over the dermatome of same segment that supplies the muscle Effects:*it stimulates the C fiber*Sends many collateral information to retinacular activating system *The key to the fact brushing is to apply it over the dermatome of the same segment *It increases the fusiform activity of the skeletal muscle

Fast brushing

• Contraindication*Regions supplied by trigeminal nerve such as

face, pinna* High cervical spinal cord damage *Brain stem injury *sholud be carefully used in cardiac patients

Procedure :Ice is applied on the skin gently in 3 quick

Swipes and the water is blotted with towel after each swipe* it is an extreme thermal facilitation and increases ANS activity

Effects 1.It activates more myelinated A delta fibres causing a reflex withdrawal 2.Alerts the mental process -palmar surface of the finger tips

Icing

It is an high intensity nociceptor stimulus that affects the non specific C-section fibers it facilitates postural responseProcedure:The ice cube is pressed to the skin of the dermatome serving the same spinal segmentand water should be blotted

Effects :Promotes reciprocal pattern between diaphragm and abdominal muscles

Increase breathing pattern, voice production and general vitality

c -icing

*it is also known as quick icing

Mechanism :Receptor> afferent fibers

>central spinal cord >referent alpha mm>response (autonomic response or muscle contraction)

A-icing

Application

icing for 2-3sec in upper arsenal notch facilitates swallowing *when used inside the mouth it increases mucosal and closure of the mouth * when used in lips promotes opening of the mouth*upper quadrant tothe abdomen along the lower rib from midlibe to lateral Promotes breathing pattern and voice production.

contraindication :Behind the ear, should not be applied along the midline of the body causes autonomic dysreflexia, avoided in CVS problem, never be applied above the neck

joint compression is greather the the body weight is applied through the longitudinal axis of the boneWhich causes cocontration around joint under compression, it can be also applied manually Using weight cuff or sand bags

Proptioceptive facilitation:

Heavy joint compression :

TECHNIQUE :Pressure greater than body weight applied through longitudinal axis of bone .

Most commonly used through long bonesMay be accomplished in combination with Ontogenic motor Patterns ( prone on elbows, quadruped, standing )

resistance must be used to maintain the contraction

Contraindication : inflamed joints

HeavyJoint compression

Tapping is the use of a light force applied manually over a tendon or muscle belly to facilitate a voluntary contraction

Tapping is used to assess reflex activity with a normal response being a brisk muscle contraction. Rood recommended three to five taps over the muscle belly to be facilitated.

It acts on muscle spindle and increases the tone of underlying skeletal muscles

Tapping

May be applied in two ways; high and low frequency.The high frequency : vibration is driven from vibratorthat optimally operates at a frequency of 100 200 Hz and at amplitude of 1 2 mA. This type of vibration produce facilitation of muscle contraction through what is known as tonic vibration reflex. This facilitatory effect sustained for a brief time after application. Therefore it can be used for stimulating muscles whose primary function is one of tonic holding.The low frequency: stimulation 5 -50 Hz has an inhibitory effect on muscle through its activation of spindle secondary endings and golgi tendon organs.

Vibration

Generates heat at the point of applicationCan potentially damage skin, particularly at high amplitude

Bishop et al (1974) identified three motor effects achieved through muscle vibration:

Sustained contraction of the vibrated muscle via tonic vibration reflexDepression of the othor neurones innervating the antagonistic muscles via reciprocal inhibition or antagonistic inhibitionSuppression of the monosynaptic stretch reflexes of the vibrated muscle while being vibrated.

May be applied in three ways; quick, prolonged, and maintained stretch.Application of this technique may include tapping which is commonly used in three forms; on tendon, on muscle belly and with the use of gravity. It is used in preceding passive movement.

Quick stretch :produce a relatively short lived contraction of the agonist muscle and short lived inhibition of the antagonist muscle. It is applied by holding the proximal bony prominence of the limb to be stretched while moving distal joint in One Direction

Stretch

Effects :

1.Facilitates or enhances agonist contraction, inhibits antagonists and facilitates synergists .

2. Quick stretch evokes a low threshold phasic response ,shot- lived

add résistance to maintain muscle contraction

Intrinsic stretch

It promotes stability of the scapulohumeral region, bearing more weight on the ulnar side of the hand promoting resistive grasp Example: onelbows shoulder stability is enhancedsecondary ending stretch

It is an combination of resistance and maintained stretch to facilitate development pattern, for instance to promote the supine withdrawal pattern a patient placed on supine, knee flexed

Any time the muscle is put in to full stretch it fires the secondary ending which is always facilitatory to flexors and inhibit extensors

stretch pressure

pressure is applied during stetching a muscle Effects both on exteroceptors and afferent of the muscle spindle Procedure : pads of the tumb, Index finger, and middle finger are used to give stretch pressure downwards And stretched motion is achieved when the thumb moves away from the other fingers

stretch pressure

Resistance

Heavy resistance is used to stimulate both primary and secondary ending of the muscle spindle It is used in isotonic fashion in developmental fashion to influence the stabilizers.Effects:When muscle contracts against resistance It assumes 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

The vestibular stimulation technique is a proprioceptive unique sensory system with multi-sensory function.According to the type of stimulus we can use the vestibular system to achieve many treatment alternatives.Total body inhibition can be achieved by slow rocking, slow anterior-posterior movement, slow horizontal movement, slow vertical movement and slow linear movement. Total body facilitation can be achieved by rolling patterns, a rocking pattern on elbows and extended elbows and crawling.

vestibular stimulation :

The vestibular stimulation technique is a proprioceptive unique sensory system with multi-sensory function. According to the type of stimulus we can use the vestibular system to achieve many treatment alternatives.

Total body inhibition can be achieved by slow rocking, slow anterior-posterior movement, slow horizontal movement, slow vertical movement and slow linear movement.

Total body facilitation can be achieved by rolling patterns, a rocking pattern on elbows and extended elbows and crawling

Spinning induces tonal responses and causes a strong facilitation of movement through the overflow of impulses to higher centres.

Facilitation of postural extensors is another effect of vestibular stimulation if it is used by a rapid way anterior-posterior or angular acceleration of the head and body while the child in prone position.

Inverted position is commonly used now to achieve a total body inhibition, while it may be used to increase to in certain extensors.

To alter the muscle tone in selected muscle and extreme Care to cardiovascular disease

Mechanism :It produces a static vestibular stimulation Which increases the tone (neck, trunk extensors, lower limb extensors muscles)

Inversion

It is defined as the pressure on the bony prominence to facilitate or inhibit voluntary muscle

Osteopressure

Inhibitory techniques

1.Gentle rocking or shaking 2.slow rolling 3.slow stroking. 4.Neutral warmth 5.Tendinuous pressure 6.Maintained stretch 7.Rocking in developmental pattern. 8.Maintained stretch 9.Approximation

1. It is another technique used to producesa generalized calming effect by activation of ANS.2. It may be applied by using a flat hand over the paravertebral muscles from cervical to sacral regions.3.The generally calming effect can decrease muscle tension .

3-5 minutes are a sufficient period to produce effect.

Slow stroking

May result in inhibition of muscle control.It can be applied manually and/or through devices such as splints.Positioning may be used to achieve an inhibitory pressure, e.g. quadruped position to inhibit the quadriceps muscle and the long finger flexors of the hand

Tendinious pressure

*It is generalised technique combines traction and light joint compression *Provides segmental relaxation *positioning and support is important*This is used in hemiplegic patients to alleviate pain and temporary muscle imbalance

Gentle rocking or shaking

• The patient is placed in a side lying position (the hemiplegic patient should first lie with the uninvolved Side down)

• The therapist kneels behind the patient and places the hand on rib cage or shoulder

• The patient is rolled slowly a sleeping to prone position and back again in rhythmic motion

• The technique should be used on both side

slow rolling

Facilitates posture extensors which are needed to stabilize the body.*joint compression less than Or equal to the body weight to inhibit Spastic muscle membrane around the jointApproximation can be applied slowly to inhibit muscle control or in jerky manner to facilitate muscle control.The application may be manually and/or by using weight bearing postures. Joint awareness may be improved by approximation which will lead to enhancing motor control.

Approximation

Light Compression: Normal body weight being applied through the long axis of the bone which is thought to inhibit (relax) muscle spasticity

Rocking In developmental pattern

shifting the weight forward and backward, progressing to side to side then diagonal pattern

Neutral warmth:

* It is one of the most common way to inhibit postural tone and muscle activity.

*It acts through stimulating the thermo receptors and activating of parasympathetic responses.*Usually 10-20 minutes are sufficient period to produce effect.*The application may be by wrapping body part with towels, hot packs, tepid baths and air splints.

Positioning is the elongated position to cause lengthening of the muscle spindle to reset the afferent of the muscle spindle to a longer position so they become less sensitive to stretch

Resistance can be applied manually or mechanically or by using of gravity and body weight. Resistance facilitates muscle contraction which is directly proportional to the amount of resistance applied.Improving kinesthetic awareness and increasing strength are another two

benefits gained from resistance.

Maintained stretch

Reference :

Occupational therapy practice skills for physical Dysfunctional pedreetti -4th edition

International Journal of Health Sciences and Researchwww.ijhsr.org ISSN: 2249-9571Review ArticleScientific Reconciliation of the Concepts and Principles of Rood Approach

Neurodevelopment technique phumysio pedia https Physiopedia. Com

Dr. Maheshwari harishchandran PPT Roods approach