Rood's Approach Explained

ROODS APPROACH
By
Dr. N. Sai Priyanka (PT)

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

INTRODUCTION
• Roods 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.
• Rood's basic assertion was that motor patterns are developed from
primitive reflexes through proper sensory stimuli to the appropriate
sensory receptors

PRINCIPLE OF ROODS APPROACH
•Roods Approach believed that motor output is
dependent upon sensory input , motor responses
follow a normal developmental sequence and the
psychic , somatic and autonomic functions are
interrelated

GOALS OF ROODS APPROACH
• Normalizing Muscle Tone :
Patients with neurological dysfunction can have tone ranging from
hypotonia to hypertonia .
Normal muscle tone flows smoothly and is constantly changed during any
activity .
To achieve this different muscles must have different work with some
muscles being predominantly used for heavy work and some being used for
light work
Light work muscles – Mobilizers – Flexors and Adductors for Skilled
movement
Heavy work muscles – Stabilizers –Extensors and Abductors for postural
Support

• Treatment Begins at the developmental level of Functioning :
The patient is evaluated developmentally and treated in a sequential
manner .
The Patient does not proceed to the next level of sensorymotor
development until some measure of voluntary ie ..,supraspinal
control is achieved .
This follows the cephalocaudal direction
The flexors are stimulated first , the extensors are second , the
adductors third and the abductors the last .

• Movement is directed towards functional goals :
Patients motivation play an important role in rehabilitation .
At first the patient must accept the activity as the meaningful event
The patient must develop a subcortical programme in his or her CNS
to perform a motor act in a coordinated manner

• Repetition is necessary for the reeducation of muscular responses :
Thousands of repetitons are necessary to form engrams
Engrams are interneuronal circuits involving specific neurons and
muscles to perform a pattern of motor activity .
Repetitions can become monotonous and therefore boring
Thus the activities that incorporate similar motor patterns add
purpose and value to the exercise .

PRINCIPLES OF SENSORY INPUT
• A fast brief stimulus produces a large synchronous motor output. This
type of stimulus is used to confirm that the reflex arc is intact .
• A fast repetitive sensory input produces a maintained response.
• A manintained sensory input produces a maintained response
• Slow , Rhythmical , Repetitive sensory input deactivates body and
mind .Any constant low frequency stimuli , such as slow rocking in a
chair , soft music , or even firm pressure to the feet or palms of the
hand , the upper lip , abdomen activates the parasympathetic system
causing a generalised calming effect .

SEQUENCES OF MOTOR DEVELOPMENT
• RECIPROCAL INHIBITION : MOBILITY
It is the early mobility pattern which subserves a protective
function
It is a phasic type of movement that requires contraction of
agonist and antagonist relaxation
This movement pattern is governed by spinal and
supraspinal centers

• CO CONTRACTION : STABILITY
Co Contraction provides stability and is considered to be a tonic
pattern .
This pattern provides the ability to hold a position or an object for a
longer duration
• HEAVY WORK :
Heavy work describes as mobility superimposed on stability
In this the proximal muscles contract and move and the distal
segment is fixed
Eg : Creeping

• SKILL :
It is the highest level of motor control and
combines the effort of mobility and stability
To execute a skilled pattern the proximal
segment is stabilized and distal segment
moves freely

ONTOGENIC MOTOR PATTRENS
• 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

CONTROLLED SENSORY INPUT
• FACILITATORY
 Light moving touch
Fast brushing
 Icing

FACILITATORY TECHNUQUES
 Proprioceptive Facilitatory techniques:
o Heavy joint compression
o Stretch
o Intrinsic stretch
o Secondary ending stretch
o Stretch pressure
o Resistance
o Tapping
o Vestibular stimulation
o Inversion
o Therapeutic vibration
o Osteopressure

INHIBITORY TECHNIQUES
• INHIBITORY
Gentle shaking or rocking
Slow stroking
 Slow rolling
 Light joint compression
 Tendinous pressure
Maintained stretch
 Rocking in developmental stages

• 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

• ICING
 A Icing Or 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

• 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.

• 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.

• Special Senses for Facilitation
pleasant odors
 unpleasant odors
Noxious substance
warm liquids
sweet foods/sweet taste

• 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
 Patient is rolled slowly from a SL position to prone and back in a
rhythmical pattern; use on both sides of the body.

• 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 :
Joint 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

Treatment planning based on ROODS
• No Rx follows set pattern
• Should planned to meet individual need
• Will be adjusted as evaluation of its effectiveness indicates Hypo
kinaesia 1. Skin brusing 2. Total movement 3. Stimuli from bone taps,
quick ice, vibrations 4. Deep muscle activated by distal end segment
fixed and apply compression , resistance to gain co contraction 5.
Rocking movements

Hypokinesia
• Skin brushing
• 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

Bradykinesia
• 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
Hyper kinaesia Includes those with low or fluctuating postural tone,
Involuntary movements and incordinations Ontogenic sequences
are used to increase postural tone

Hyperkinesia
• Includes those with low or fluctuating postural tone, Involuntary
movements and incordinations
• Ontogenic sequences are used to increase postural tone

SPASTICITY
• It varies so much in type, distribution and severity
• Require careful assessment and selection of technique

Spasticity with VC of movements
• Light brushing
• 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

Spasticity in complete cord lesion
• All except non resisted repeated contraction
• These require volitional control of neural activity
• Functional activities - transfer, dressing
• Reduce contracture and pressure
• Released grasp reflex
• Facilitation of swallowing

Use of sensory stimulation in the recovery of
movement and vital activity
• 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.
• 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

Stimulation of corticomotor area
• 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

Stimulation of anterior horn cell
• 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
• 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.
• 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, ischemic nerve block, and in rest-
induced suppression of healthy subjects.
• 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

Normalization of tone
• 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
• 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.

• 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.
• Researches have suggested that 3 minutes of slow stroking on
posterior primary rami can reduce alpha-motoneuron excitability,
which can in return, reduce spasticity

• 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
• Above researches shown that, Rood’s normalization of tone with the
use of sensory stimuli is an important part of motor recovery.

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. 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

system
• 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
• 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.

Use of purposeful movement
• 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
• Apache found through activity-based intervention gives significant
improvement in both locomotor and object control skills.

Use of repetitive movement
• 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.
• 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.

system
• 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
• 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.

system
• 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.
• 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.
• 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
• 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

The Improvement in vital activities
• Clinical evidence shows that neurophysiological facilitation can
increase ventilation of patients with decreased consciousness which
also support Rood’s clinical observation .

SCIENTIFICALLY OUTDATED COMPONENTS OF
ROOD APPROACH
• Use of the Ontogenic Sequence
• 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.
• 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.
• 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.

Frequency of stimulation of ANS
• 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
• 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, densecored vesicles.

ROODS
• 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.
• 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 .

ROODS
• 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.
• 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 of it.

ROODS
• 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.
• 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.

Rood's Approach Explained

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