ROODS TECHNIQUE John Christopher A. de Luna, PTRP

ROOD’S TECHNIQUE

John Christopher A. de Luna, PTRP

Motor Homunculus

SENSORY ORGANIZATION

ANTERIOR SPINOTHALAMIC TRACT & LATERAL SPINOTHALAMIC TRACT

LEMNISCAL / DORSAL COLUMNS

PROPIOCEPTIVE TRACTS

RECEPTORS:

1. INTERORECEPTORS• Spinothalamic Tract, Dorsal Column Lemniscal

2. EXTERORECEPTORS– FREE NERVE ENDINGS

Located skin and viscera non specific receptors pain, crude touch,

temperature Unmyelinated C / myelinated nerve fibers Activated with thermal or brushing techniques Causes state of arousal Ice packs & rubbing alleviates acute pain Synapse with gamma motor neuron and bias the

muscle spindle

RECEPTORS :

– HAIR END ORGANS Type of free nerve ending wrap around the base of hair follicle Activated by bending / displacement of hair A delta (group III) fibers Stimulated with light touch or stroking of the skin Bias the muscle spindle through the fusimotor system Primitive humanity and Goosebumps

– MEISSNER CORPUSCLES Found just beneath the epidermis in hairless skin Thicker A beta ( group II) fibers Responsible for fine tactile discriminination Important digital exploration and sensory substitution skills

( reading braille) Responsive to low frequency vibration

RECEPTORS:

– PACINIAN CORPUSCLES Located deep layers of the skin, viscera, mesenteries, ligaments, near

blood vessels, periosteum of long bones Most rapidly adapting receptors Respond to deep pressure but are sensitive to light touch Stimulated by high frequency vibration Plays a role tonic vibration reflex Aids desensitization of hypersensitive skin in children who exhibits

tactile defensiveness Supresses pain perception at the cutaneous level Calming effect

RECEPTORS:

– MERKEL TACTILE DISKS Found deepest epidermis in hairless skin Volar surface of fingers, lips and external genitalia Fast-conducting A beta (group II) fibers Slowly adapting touch-pressure receptors Sensitive to slow movements across the skin’s surface Related to sense of tickle and pleasurable touch sensation

PROPRIOCEPTORS

1. CONSCIOUS

– KINESIOCEPTORS / JOINT RECEPTORS Transmitted to the cerebral cortex Located joint capsule, ligaments, tendons 1. Ruffini end organs 2.Golgi –Mazzoni corpuscles 3. Vater-Pacini corpuscles 4. Golgi-type endings

PROPRIOCEPTORS

2. UNCONSCIOUS– GOLGI TENDON ORGANS (GTO)

Greater sensitivity muscle contraction

– MUSCLE SPINDLE

PREMISE

“ IF IT WERE POSSIBLE TO APPLY THE PROPER SENSORY STIMULI TO THE APPROPRIATE SENSORY RECEPTOR AS IT IS UTILIZED IN NORMAL SEQUENTIAL DEVELOPMENT. “

Rood, 1954

Stages of Motor Control

Mobility Stability Controlled Mobility Skill

SEQUENCE OF MOTOR DEVELOPMENT

1. RECIPROCAL INHIBITION (INNERVATION) a.k.a. MOBILITY

– A reflex goverened by spinal & supraspinalcenters

– Subserves a protective function– Phasic and reciprocal type of movement– Contraction of agonist and antagonist

2.CO-CONTRACTION (C0-INNERVATION) a.k.a. STABILITY

– Simultaneous agonist & antagonist contraction with antagonist supreme

SEQUENCE OF MOTOR DEVELOPMENT

3. HEAVY WORK a.k.a. CONTROLLED MOBILITY

– Stockmeyer “ mobility superimposed on stability”– creeping

4. SKILL– Crawling, walking, reaching, activities requiring the coordinated use

of hands

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 no reciprocal flexion

Patients dominated by extensor tone

ROLLOVER TOWARD SIDE-LYING

– Mobility pattern for extremities and lateral trunk muscles– RECOMMENDED:

Patients dominated by tonic reflex patterns in supine Stimulates semicircular canals which activates the neck &

extraocular muscles

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

– INTEGRATION: STNR & TLRs

NECK CONTRACTION

– First real stability pattern– Activates both flexors & tonic neck extensor muscles– RECOMMENDED:

Patients needs neck stability & extraocular control

PRONE ON ELBOWS

– Stretches the upper trunk musculature

– Influences stability scapular and glenohumeral regions

– Gives better visability of the environment

– Allows weight shifting from side to side

– RECOMMENDED: Patients needs to inhibit

STNR

QUADRUPED

STANDING– A skill of upper trunk because it

frees upper extremity for manipulation

– INTEGRATION: righting reaction & equilibrium reaction

WALKING– Sophisticated process requiring

coordinated movement patterns of various parts of body

– “support the body weight, maintain balance, & execute the stepping motion” - Murray

ROOD’S THEORY

1. Normalize muscle tone

2. Treatment begins at the developmental level of functioning

3. Movement is directed towards functional goals

4. Repetition is necessary for the re-education of muscular response

CONTROLLED SENSORY INPUT

FACILITATORY– Light moving touch– Fast brushing– Icing– Proprioceptive Facilitatory

techniques: Heavy joint compression Stretch Intrinsic stretch Secondary ending stretch Stretch pressure Resistance Tapping Vestibular stimulation Inversion Therapeutic vibration Osteopressure

INHIBITATORY– Gentle shaking or rocking– Slow stroking– Slow rolling– Light joint compression– Tendinous pressure– Maintained stretch– Rocking in developmental

stages

SPECIFIC FACILITATION TECHNIQUES USED IN TREATMENT:

Cutaneous Stimuli

Mediated by Procedure Effect

Light moving touch

A delta sensory fiber

Applied with a fingertip, camel hairbrush-apply 3-5 strokes and allow 30 seconds of rest betw strokes to prevent over stimulation

Activates low threshold hair end organ and free nerve endings

LIGHT MOVING TOUCH

Sends input limbic structure Increases corticosteroids levels in blood stream ACTIVATES SUPERFICIAL MOBILIZING MUSCLES (light

work group that performs skilled task) STIMULATES A delta sensory fibers synapses with fusimotor

system reciprocal innervation ( phasic withdrawal response) STD: camel hair, finger tip, brush, cotton swab

Fast brushing

C fibers Apply it over the dermatomes of the same segment the muscle supplies for 3 to 5 secs and repeated after 30 seconds

Stimulates C fibers which sends many collaterals in the RAS


FAST BRUSHING

A icing/quick icing

A fibers Ice is applied t the skin in 3 quick swipes and water blotted with a towel betw swipes

Facilitation of muscle activity and ANS response

C Icing C fibers Ice cube is pressed to the skin serving the same spinal segment of the muscle to be stimulated, response may take as long as 30 min

Facilitates a maintained postural response


ICING

A Icing a.k.a. QUICK

ICING– Patients hypotonia– Are in state of relaxation– Alerts the mental

processes

C Icing– Promotes RECIPROCAL

PATTERN between diaphragm & abdominal muscles

– Increase breating patterns, voice production and general vitality

ICING

Proprioceptive Facilitatory Technique


Procedure/Effect

Approximation Facilitates contraction of the jt combined with developmental patterns, done manually or use of weights and sandbags

Vibration It can be used for tactile stimulation to desensitize by hypersensitive skin and to produce tonal changes in muscles. Vibratory stimuli applied over a muscle belly to activate the Ia afferent of muscle spindle, causing contraction of that muscles and suppression of the stretch reflex. This response is called the tonic vibration reflex and is 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. It is best to have the pt in a warm environment because the skin receptors are at a lower threshold for firing.


Stretch Activates the proprioceptors in selected muscles and imply the principle of reciprocal innervation

a. intrinsic stretch

It promotes stability of the scapulohumeral region, bearing more weight on the ulnar side of the hands and promoting resistive grasp

b. Secondary ending stretch

Combination of resistance and stretch to facilitate ontogenic patterns. Once a muscle is put on a full stretch ,secondary nerve endings which is facilitatory to the flexors and inhibitory to the extensors

c. stretch pressure

Effects both exteroreceptors and Ia afferents of the mm 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 Rood uses heavy resistance to stimulate both primary and secondary endings of the muscle spindle. It is used in isotonic fashion in developmental fashion to influence the stabilizers. 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


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. This stimulus acts on the afferent of the muscle spindles and increases the tone of the underlying muscles.

Vestibular Stimulation Vestibular stimulation is a powerful type of proprioceptive unit. The vestibular system is found to activate the antigravity muscles and their antagonist muscle before the stretch reflex of the muscle spindles. The system affects tone, balance, directionality, 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 In the inverted position, static vestibular system produces increased tonicity of the muscles of the neck, midline trunk extensors and selected extensors in the limbs. The head must be in normal alignment with the neck.


VIBRATION

Gentle Shaking or Rocking

Rhythmical circumduction of the head and slight approximation is given can also be used in the UE and LE

GENTLE SHAKING OR ROCKING

Slow Rolling Pt is rolled slowly from a SL position to prone and back in a rhythmical pattern; use on both sides of the body.

SLOW ROLLING

Techniques Procedure/Effect

Neutral warmth Affects the temperature receptors in the hypothalamus and PSNS, used for pxs with hypertonia. Px in recumbent and wrapped with a blanket for 5-20 minutes. Pt feels relax and decreased in 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 because it causes a rebound phenomenon

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 mm around the joint.

Maintained Stretch Positioning in the elongated position to cause lengthening of the mm. Spindle to reset the afferents of the mm 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

Special Senses for Facilitation

– pleasant odors

– unpleasant odors

– noxious substance

– warm liquids

– sweet foods/sweet taste

Cases:

SOURCES:

TROMBLY, OCCUPATIONAL THERAPY PEREDENTTI, OCCUPATIONAL THERAPY REHABILITATION SPECIALIST

OBJECTIVES: LABORATORY

1. RETURN DEMONSTRATION ON PEDIATRIC EVALUATION

2.INTEGRATION OF THE KNOWLEDGE GAINED IN PEDIATRIC REHABILITATION IN GOAL SETTING

3. DEMONSTRATION – RETURN DEMONSTRATION OF ROOD’S TECHNIQUE USING PLAY THERAPY

Documents

ROODS TECHNIQUE John Christopher A. de Luna, PTRP