ROOD’S APPROACH
SOUNDARARAJAN K
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K. SOUNDARARAJAN, SRIHER
Objective
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At end of presentation audience able to
understand about roods various techniques,
its clinical applications
K. SOUNDARARAJAN, SRIHER
PREMISE
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“ 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
K. SOUNDARARAJAN, SRIHER
Introduction
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Rood approach is a neurophysiological approach
developed by Margaret Rood in 1940
Rood approach deals with the activation or deactivation of sensory receptors
Which is concerned with the interaction of
somatic, autonomic and psychic factors and their
role in the regulation of motor behavior.
K. SOUNDARARAJAN, SRIHER
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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.
K. SOUNDARARAJAN, SRIHER
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Rood's basic assertion was that motor
patterns are developed from primitive
reflexes through proper sensory stimuli to the
appropriate sensory receptors
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Rood Approach is one of the several
neurophysiology based neuro-facilitation
techniques used by rehabilitation specialists,
such as the Brunnstrom technique,
proprioceptive neuromuscular facilitation,
and neurodevelopmental therapy (also
known as NDT or Bobath Approach.
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Though her theory originated in the 1940s,
several revisions underwent before she died.
This revision process has continued till now
as it still deserves further consideration on
the basis of current neuro-scientific
evidences.
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The physiological exploration of Rood’s
concept was not clearly evaluated in her
time.
For example, Rood believed in the ontogenic
developmental sequence which is proved to
be a flaw in the present time
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Many researchers have suggested that
neurophysiological techniques are better
than the conventional approaches for
patients.
However, a research shows that none of
the aforementioned neurophysiological
approaches prove to be superior to
another.
K. SOUNDARARAJAN, SRIHER
RECEPTORS:
1. INTERORECEPTORS
•
Spinothalamic Tract, Dorsal Column Lemniscal
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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
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RECEPTORS :
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–
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
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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
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RECEPTORS:
–
PACINIAN CORPUSCLES
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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
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RECEPTORS:
–
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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
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PROPRIOCEPTORS
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1. CONSCIOUS
–
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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
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PROPRIOCEPTORS
2. UNCONSCIOUS
– GOLGI TENDON ORGANS (GTO)
 Greater sensitivity muscle
contraction
–
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MUSCLE SPINDLE
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Stages of Motor Control
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Mobility
Stability
Controlled Mobility
Skill
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SEQUENCE OF MOTOR DEVELOPMENT
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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
–
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2.CO-CONTRACTION (C0-INNERVATION)
a.k.a. STABILITY
– Simultaneous agonist & antagonist contraction with antagonist
supreme
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SEQUENCE OF MOTOR DEVELOPMENT
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3. HEAVY WORK
a.k.a. CONTROLLED MOBILITY
– Stockmeyer “ mobility superimposed on stability”
– creeping
4. SKILL
–
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Crawling, walking, reaching, activities requiring the coordinated use
of hands
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SUPINE WITHDRAWAL
–
–
–
–
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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
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ROLLOVER TOWARD SIDE-LYING
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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
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PIVOT PRONE
–
–
–
–
–
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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
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NECK CONTRACTION
–
–
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First real stability pattern
Activates both flexors & tonic neck extensor muscles
RECOMMENDED:
 Patients needs neck stability & extraocular control
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PRONE ON ELBOWS
–
–
–
–
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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
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QUADRUPED
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STANDING
– A skill of upper trunk because it
frees upper extremity for
manipulation
– INTEGRATION: righting
reaction & equilibrium reaction
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WALKING
– Sophisticated process requiring
coordinated movement
patterns of various parts of
body
– “support the body weight,
maintain balance, & execute
the stepping motion” - Murray
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CONTROLLED SENSORY INPUT
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FACILITATORY
–
–
–
–
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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
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INHIBITATORY
–
–
–
–
–
–
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Gentle shaking or rocking
Slow stroking
Slow rolling
Light joint compression
Tendinous pressure
Maintained stretch
Rocking in developmental
stages
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K. SOUNDARARAJAN, SRIHER
SPECIFIC FACILITATION TECHNIQUES USED IN TREATMENT:
Cutaneous
Stimuli
Mediated by
Procedure
Effect
Light moving A
delta Applied with a fingertip, Activates
touch
sensory
camel hairbrush-apply low
fiber
3-5 strokes and allow threshold
30 seconds of rest hair
end
betw strokes to prevent organ and
over stimulation
free nerve
endings
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LIGHT MOVING TOUCH
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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
K. SOUNDARARAJAN, SRIHER
SPECIFIC FACILITATION TECHNIQUES USED IN TREATMENT:
Fast
brushing
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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
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FAST BRUSHING
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SPECIFIC FACILITATION TECHNIQUES USED IN TREATMENT:
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A icing/quick A fibers
icing
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
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
C fibers
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ICING
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A Icing
a.k.a. QUICK
ICING
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Patients hypotonia
Are in state of relaxation
Alerts the mental
processes
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ICING
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C Icing
–
–
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Promotes RECIPROCAL
PATTERN between
diaphragm & abdominal
muscles
Increase breating patterns,
voice production and
general vitality
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Proprioceptive Facilitatory Technique
Proprioceptive
Facilitatory Technique
Approximation
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Procedure/Effect
Facilitates contraction of the jt combined with
developmental patterns, done manually or use of
weights and sandbags
K. SOUNDARARAJAN, SRIHER
Proprioceptive Facilitatory Technique
Vibration
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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.
K. SOUNDARARAJAN, SRIHER
Proprioceptive Facilitatory Technique
Stretch
Activates the proprioceptors in selected muscles and
imply the principle of reciprocal innervation
a.
intrinsic It promotes stability of the scapulohumeral region,
stretch
bearing more weight on the ulnar side of the hands
and promoting resistive grasp
b.
Secondary Combination of resistance and stretch to facilitate
ending stretch
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 Effects both exteroreceptors and Ia afferents of the mm
pressure
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.
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Proprioceptive Facilitatory Technique
Resistance
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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
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Proprioceptive Facilitatory Technique
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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.
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VIBRATION
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Gentle Shaking Rhythmical circumduction of the head and slight
or Rocking
approximation is given can also be used in the
UE and LE
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GENTLE SHAKING OR ROCKING
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Slow Rolling
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Pt is rolled slowly from a SL
position to prone and back in a
rhythmical pattern; use on both
sides of the body.
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SLOW ROLLING
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Techniques
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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
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side then diagonal patterns
Special Senses for Facilitation
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–
pleasant odors
–
unpleasant odors
–
noxious substance
–
warm liquids
–
sweet foods/sweet taste
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PRINCIPLES
1.
2.
3.
4.
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Normalization of tone
Ontogenic developmental sequence
Purposeful movement
Repetition of movement
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Normalization of tone
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Using appropriate sensory stimuli for
evocating the desired muscular response is
the basic principle of Rood approach
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Ontogenic developmental
sequence
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Rood recommended the use of ontogenic
developmental sequence. According to
Rood, sensory motor control is
developmentally based, so that during
treatment therapist must assess current level
of development and then try to reach next
higher levels of control.
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Purposeful movement
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Rood used purposeful activities which can
help to get the desired movement pattern
from the patient
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Repetition of movement
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Rood encouraged to use repetitive
movements for motor learning
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BASIC CONCEPTS OF ROOD
APPROACH
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According to Rood, sensory input is required
for normalization of tone and evocation of
desired muscular responses.
Sensory stimulus and their relationship to
motor functions play a major role in the
analysis of dysfunction and in the application
of the treatment.
K. SOUNDARARAJAN, SRIHER
Rood's four basic concepts
1.Mobility and stability muscles(Tonic & phasic)
2. The Ontogenic Sequence
3. Appropriate sensory stimulation
4. Manipulation of the autonomic nervous
system
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1. Mobility and stability muscles
(Tonic and phasic)
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According to Rood approach, muscle groups
are categorized according to the type of work
they do and their responses to specific
stimuli.
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Phasic muscles (also known as light work
muscles or mobility muscle) are the muscle
groups responsible for skilled movement
patterns with reciprocal inhibition of
antagonist muscles e.g. the flexors and
adductors.
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Tonic muscles (also known as heavy work
muscles or stability muscle) are the muscle
groups responsible for joint stability with cocontraction of muscles which are antagonists
in normal movement
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Though some muscles perform both light and
heavy work functions, Rood mentioned
specific properties of phasic and tonic
muscles.
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Phasic muscles are fast glycolytic fiber type,
superficial and usually one joint muscle.
They have high metabolic cost and rapidly
fatigue.
Tonic muscles are different from phasic. The
muscles are slow oxidative fibre type, deep
and usually single joint type. These are
Pennate, the large area of attachment
muscle, has low metabolic cost and slow
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fatigue.
2. The Ontogenic Sequence
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Rood introduced two categories of ontogenic
sequences
a. The Motor development sequence
b. The vital functions sequence
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a. The Motor development
sequence
The motor development sequence finally leads
to skilled and finely coordinated movements. The
ontogenic motor patterns are:
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i. Supine withdrawal
ii. Roll over
iii. Pivot prone
iv. Neck co-contraction.
v. Prone on elbow
vi. Quadruped
vii. Standing
viii. Walking
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Rood also categorized these patterns under
the following four phases, using the concepts
of light and heavy work:
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Mobility or reciprocal innervations: It is a
nearly mobility pattern, primarily reflex
governed by spinal and supraspinal centers.
It includes supine withdrawal, roll over, and
pivot prone.
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Stability or co-contraction: It is defined as
simultaneous contractions of antagonists and
agonists, working together to stabilize and
maintain the posture of the body. It includes
pivot prone, neck co-contraction, prone on
elbow, quadruped and standing
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Mobility superimposed on stability: It is
defined as a movement of proximal limb
segments with the distal ends of limbs fixed
on the base of support. It includes weight
shifting in prone on elbows, quadruped, and
to and fro rocking that later on can be
promoted to crawling in different directions.
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Skill or Distal mobility with proximal
stability: It is defined as skilled work with the
emphasis on the movement of distal portions
of the body in a finely coordinated pattern
that require control from the highest cortical
level.
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b. The vital functions
sequence
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The vital functions sequence finally leads to wellarticulated speech. The ontogenic patterns are:
i. Inspiration
ii. Expiration
iii. Sucking
iv. Swallowing liquids
v. Phonation
vi. Chewing and swallowing solids
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vii. Speech
3. Appropriate sensory stimulation
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The relearning of muscular activity is based
on the phenomena of summation which
activates or deactivates the sensory
receptors, utilizing afferent input to affect the
anterior horn cell of the spinal cord
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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:
i. Proprioceptive receptors
ii. Exteroceptive receptors
iii. Vestibular receptors
iv. Special sense organs
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4. Manipulation of the autonomic
nervous system
Autonomic nervous system stimulation is also
a part of Rood’s concept. Different intensity
and frequency of the same stimulus
determined which system (whether
sympathetic or parasympathetic) will be
activated.
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Rood made the point that activation of the
sympathetic nervous system is given in case
of hypotonic,
whereas parasympathetic nervous system
activate is given in hypertonic, hyperkinetic,
and hyper excitable patients.
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Rood recommended that the manipulation of
these stimuli can be used in treatment of
motor disorder patients
 Rood introduced two groups of autonomic
nervous system stimuli:
i. Sympathetic
ii. Parsympathetic
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i. Sympathetic Nervous System Stimuli: It
includes icing, unpleasant smells or tastes,
sharp and short vocal commands, bright
flashing lights, fast tempo and arrhythmical
music
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ii. Parasympathetic Nervous System Stimuli:
It includes slow, rhythmical, repetitive
rocking, rolling, shaking, stroking the skin
over the paravertebral muscles, soft and low
voice, neutral warmth, contact on palms of
hands, soles of feet, upper lip or abdomen,
decreased light, soft music and pleasant
odors.
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Treatment planning based on
ROODS
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No Rx follows set pattern
Should planned to meet individual need
Will be adjusted as evaluation of its
effectiveness indicates
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Hypo kinaesia
1.
2.
3.
4.
5.
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Skin brusing
Total movement
Stimuli from bone taps, quick ice, vibrations
Deep muscle activated by distal end
segment fixed and apply compression ,
resistance to gain co contraction
Rocking movements
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Brady kinaesia
1.
2.
3.
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Semilunar canal stimualted by revolving chair,
passive/ active head , shoulder rotation,
punching targeted place
Arm and leg rhythm facilitated by use of pole,
progress stand to walk
To modify rigid walking frame to provide
tactile and auditory stimulus
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Hyper kinaesia
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Includes those with low or fluctuating
postural tone, Involuntary movements and
incordinations
Ontogenic sequences are used to increase
postural tone
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spasticity
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It varies so much in type, distribution and
severity
Require careful assessment and selection of
technique
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Spasticity with VC of movements
1.
2.
3.
4.
5.
6.
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Light brusing
Follow sequence, adapt according to need.
Ex: omit total extension and pivot pattern if
extensor tone is strong
Slow stretch
Non resisted repeated contraction
Weight bearing exercise
Repeated sensory stimuli ex : tapping
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Spasticity in complete cord lesion
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All except non resisted repeated contraction
These require volitional control of neural
activity
Functional activities - transfer, dressing
Reduce contracture and pressure sore
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Released grasp reflex
Facilitation of swallowing
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SCIENTIFICALLY RELEVANT
COMPONENTS OF ROOD APPROACH
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1. Mobility & stability or phasic &
tonic Muscles
No muscle can be a purely tonic or phasic.
According to Garnett et al., motor units could
be divided into three classes on the basis of their
mechanical properties –
(i) type S units are slow, small, fatigue resistant,
(ii) type FR units are fast, intermediate in size, and
fatigue resistant
(iii) type FF units are fast, large and fatigable.
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3.
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Burke et al categorized motor unit types into
three classes,
slow fatigue resistant (tonic and postural),
fast fatigable (phasic and powerful)
fast fatigue resistant (phasic)
the study indicates that all of the muscle
fibers in a given motor unit have the same
histochemical profile.
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Though Rood’s classification of muscle
activity (based on protection and
stabilization) recognized that this is an
oversimplification of muscle histochemistry,
above researches are similar to its
approximation
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2. Use of sensory stimulation in the recovery
of movement and vital activity
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Various researchers have found that sensory
stimulation is effective for development of
skill and movement.
Jarus and Loiter, found that the effect of
kinaesthetic stimulation on the acquisition of
a lower extremity skill, performance and
learning were significant.
K. SOUNDARARAJAN, SRIHER
The sensory stimulation helps in the recovery
of movement and vital activities in the
following ways:
a) Stimulation of the corticomotor area
b) Stimulation of the anterior horn cell
c) Normalization of tone
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a) Stimulation of corticomotor area
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Rood used various kind of stimulations
including but not limited to kinaesthetic
stimulations and stretch.
According to Stinear et al., kinesthetic
stimulation can excite the corticomotor area
primarily at the supraspinal level.
Day et al. attributed the stretch induced
facilitatory effect onto motor evoked
potentials in the muscles to the cortical level
K. SOUNDARARAJAN, SRIHER
B) Stimulation of anterior horn
cell
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According to McDonough, sensory
stimulation upon the anterior horn cell
through circuitry working at a variety of levels
through both short and long latency reflex
loops, affect the local spinal cord level and
the brain
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Few researches demonstrate sensory
feedback with sensory stimulation of muscles
can stimulate pathways from the cerebral
cortex.
This can be done to stimulate single anterior
horn cells while the neighbouring anterior
horn cells remain depressed.
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Moreover various studies were conducted
earlier in order to study the effects of anterior
horn cell excitability on the F waves
generated in cases of upper and lower limb
amputees, spinal cord injuries, ischaemic
nerve block, and in rest-induced suppression
of healthy subjects.
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These studies demonstrated that sensory
stimulation are effective in exciting anterior
horn cells for generating the required F
waves which can cause change in motor
evoke potential in a variety of patients
K. SOUNDARARAJAN, SRIHER
c) Normalization of tone
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Normalization of tone using sensory stimuli is
a basic principle of Rood approach.
Sensory stimulation can facilitate and inhibit
muscle activity which helps in the
normalization of muscular tone
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According to Linkous et al., tactile stimulation
can enhance muscular tone in hypotonic
disorder patient
Manual skin brushing has an inhibitory effect
on H-reflex excitability in normal subjects,
which can be used as one of the facilitatory
technique for eliciting muscle tone in
neurological disorders.
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Stretching has been extensively used in
clinical practice, which has abundance
benefit in decreasing muscle tone.
Cryotherapy with ice packs and cubes has
been suggested to have an antispastic effect
by increasing pain threshold and reducing
receptor sensitivity of low-threshold afferents.
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Researches have suggested that 3 minutes
of slow stroking on posterior primary rami
can reduce alpha-motoneuron excitability,
which can in return, reduce spasticity.
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Various researches reported that
effectiveness of vibratory stimuli to spastic
muscles, which gives significant
improvement in muscle tone and motor
recovery.
Tendon pressure is also used to reduce
motoneuron excitability in the central nervous
system disorder patient
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Above researches shown that, Rood’s
normalization of tone with the use of sensory
stimuli is an important part of motor recovery.
K. SOUNDARARAJAN, SRIHER
3. Use of purposeful movement
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Rood’s utility of purposeful movement is very
common nowadays in rehabilitation practice.
Various research works showed that the
practice of purposeful movements or activity
based movement is an integral part of
improving functional status
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Apache found through activity-based
intervention gives significant improvement in
both locomotor and object control skills.
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4. Use of repetitive movement
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Repetition or practice of movement is a basic
component of Rood approach.
Studies show motor learning employ large
amounts of practice.
According to Lang et al., repetitions
performed during therapy sessions were
relatively lower than the numbers of
repetitions performed in animal plasticity and
human motor learning studies.
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Studies have shown to reverse the
detrimental changes due to a cortical lesion,
repetition is essential for learning a motor
skill which can alter the cortical
representation.
Hence, it is clear that without repetition, it
is difficult to gain motor recovery in motor
disorder patients.
K. SOUNDARARAJAN, SRIHER
5. Manipulation of the autonomic
nervous system
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According to Metcalfe and Lawes, though
autonomic nervous system association with
emotion is an old concept,
it has a great influence what kind of
information is reached to the related circuits
governing emotional state in the CNS,
thus on what movement will develop in
response.
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Various studies show that autonomic
nervous system manipulation by giving
sensory stimulation can cause vital functions
activation.
musical stimuli can influence autonomic
responses in an unconscious patient.
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The autonomic response was characterized
by an increase in of vagal response, and
contextually, a reduction of heart rate
complexity of increasing Formal Complexity
and General Dynamic parameters.
Various researches also reported that a
pleasant and unpleasant odour can alter the
cortical and autonomic responses.
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Pleasant odors caused significant decrease
in the blood pressure, heart rate, and skin
temperature, which indicated a decrease in
autonomic arousal.
Rocking movements caused a vestibulorespiratory adaptation leading to an increase
in respiration frequency.
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Coloured light can influence the autonomic
nervous system which can improve heart
rate variability, skin conductance, standard
deviations of normalized NN (SDNN)(beat-tobeat) intervals, very low (VLF) and low
frequency (LF) levels, decreased heart rate.
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It has been demonstrated that stimuli such as
neutral warmth, contact on palms of hands,
soles of feet, upper lip or abdomen can
activate the parasympathetic nervous system
which supports Rood’s concept
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6. Improvement in vital
activities:
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Clinical evidence shows that
neurophysiological facilitation can increase
ventilation of patients with decreased
consciousness which also support Rood’s
clinical observation
K. SOUNDARARAJAN, SRIHER
SCIENTIFICALLY OUTDATED
COMPONENTS OF ROOD APPROACH
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1. Use of the Ontogenic Sequence
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Rood's ontogenetic sequential phases of
motor control are not valid based on present
developmental studies.
According to developmental studies,
relearning of movement not occurs from
proximal to distal.
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It always emerges from a sequence of
interactions between inherited tendencies
and experience dependent learning.
According to Thelen, the developmental
changes occur due to the unity of perception,
action and cognition, along with the role of
exploration and selection in the emergence
of new behaviour.
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As per Rood’s expectations, the
developmental motor sequence was neither
followed invariably by developing children
nor adhered to by adults when rising from
supine to erect posture.
K. SOUNDARARAJAN, SRIHER
2. Frequency of stimulation of ANS
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According to Rood Approach, the low
intensity and frequency of stimulation
activates the parasympathetic system.
The same stimuli at a high frequency and
intensity activate the sympathetic system.
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Metcalfe suggested the concept of frequency
of the stimulation in manipulation of
autonomic nervous system is unnecessary
because low-frequency stimulation of a
neuron tends to release conventional
excitatory amino acid transmitters from small
clear vesicles,
since high frequency stimulation of the same
neuron releases peptides from large, denseK. SOUNDARARAJAN, SRIHER
cored vesicles.
ROODS
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Earlier, Rood had theorized based on clinical
experience that sensory stimulation can be
provided therapeutically to 'wake up' motor
responses from the cortex.
Herein, purposeful movement, repetition of
activity, or practice, plays a part in learning
motor skills to reverse the detrimental
changes due to a cortical lesion.
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During application of sensory stimulation,
muscles have to be divided into
light work (mobility muscle- flexor and
adductor)
heavy work (stability muscle- extensors and
abductors)
This will help to normalize the muscular tone
and motor recovery.
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Rood suggested that appropriate stimuli are
selected based on whether facilitation or
inhibition is anticipated and the type of
movement that is required.
Proprioceptors, exteroceptors vestibular and
special sense organ, which receptors are
targeted for required motor response
activation.
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Rood’s theory is also complemented by the
fact that ANS stimulation is not only involved
in motor activity of vital organs, but also
affects the somatosensory system and
sensorimotor integration.
Various researchers have found where ANS
stimulation is effective in motor and vital
organ stimulation, whereas the frequency
and intensity of stimulation is not a valid part
K. SOUNDARARAJAN, SRIHER
of it.
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Rood’s developmental sequence is generally
accepted as outdated
Because developmental studies show that
normal human development is not related to
different movement pattern.
It depends on perception, action, cognition,
exploration, inherited tendencies and
experience dependent learning.
K. SOUNDARARAJAN, SRIHER
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According to Metcalfe, Rood’s approach is a
modular model approach, which is capable of
adapting to advancing knowledge.
Hence, therapist can deduct the ontogenic
developmental sequence part in the
application of Rood’s approach.
K. SOUNDARARAJAN, SRIHER
CONCLUSION
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Rood’s approach is a neurophysiological
based approach where relevant physiology is
the most important part of this approach – an
aspect which was not clearly explored in her
time.
Though the entire Rood’s approach is not
used in present time, but some Rood
techniques are very common in clinical
practice.
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Current scientific evidence shows Rood's
approach has various valid components
which can be justified as valid and viable.
A therapist may get more effective results if
they use it with physiological base.
K. SOUNDARARAJAN, SRIHER
Source
1.
2.
3.
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4.
5.
Stockmeyer, S. A. An interpretation of the approach
of Rood to the treatment of neuromuscular
dysfunction. American journal of physical medicine
& rehabilitation. . 1967;46(1), 900-956.
Rood, M. S. The Treatment of Neuromuscular
Dysfunction: Rood Approach. Lecture given in
Boston. 1976, July 9-11.
CASH NEUROLOGY FOR PT
PUBMED, PEDRO
TROMBLY, PEREDENTTI, OT
K. SOUNDARARAJAN, SRIHER
Vol.8; Issue: 9; September 2018
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K. SOUNDARARAJAN, SRIHER
Indian Journal of Physiotherapy and Occupational Therapy.
January-March 2016, Vol. 10, No. 1
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THANK YOU
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