Rood's approach | Physiosimplified

ROOD'S APPROACH

Rood’s approach is a neurophysiologic and developmental treatment approach that was developed by Margret Rood to improve tone of muscles (both flaccid and spastic).

PRINCIPLES

Utilization of controlled sensory stimulation.
Utilization of developmental sequences.
Utilization of an activity to demand a purposeful response.
Normalization of tone and muscular responses are achieved via controlled sensory stimulation.
Sensor motor control is developmentally based.
Muscular responses of agonists, antagonists and synergists are believed to be reflexively programmed according to purpose or plan.
Repetition/practice is necessary for motor learning.

ONTOGENIC DEVELOPMENTAL PATTERN-

These are normal developmental patterns which were used as a basis for therapy. These patterns have beneficial effects when combined with occupational engagement and can be used for inhibiting or facilitating by positioning in these patterns.

Supine withdrawal (Supine flexion)- Total flexion response toward the vertebral level of T10. this position is protective because flexion of the neck and crossing of the arms and legs protect the anterior surface of the body. this pattern is recommended for individuals dominated by extensor tone.
Rollover (Toward side lying)- Rollover is a mobility pattern for extremities and activates the lateral trunk musculature. it is encouraged for individuals who are dominated by tonic reflex patterns in the supine position.
Pivot prone ( prone extension)- This position demands full range extension of neck, shoulders, trunk, and lower extremities. it is both a stability and mobility pattern. it plays an important role in preparation for stability of the extensor muscles in the upright position.
Neck co-contraction (co-innervation)- This action is thought to activate both flexors and deep tonic extensors of the neck. this position elicits tonic labyrinthine righting reaction and also promotes stability and extra ocular control.
On elbows (prone on elbows)- Bearing weight on elbows stretches the upper trunk musculature to influence stability of the scapular and gleno-humeral regions. this position is inhibitory to symmetrical tonic neck reflex.
All fours (quadruped position)- The lower trunk and lower extremities are brought into a co contraction pattern.the weight shifting is preparatory to equilibrium responses.
Static standing- Assuming the bipedal position. this position brings about higher level neurological integration, such as righting reactions and equilibrium reactions.
Walking- Walking includes stance phase, push off, swing, heel strike and stride length. it is a sophisticated process requiring coordinated movement patterns of various parts of body including weight shifting.

Rood’s approach has two techniques which are as follows -

Facilitatory techniques to improve tone of flaccid muscles

Tactile stimulation – Fast brushing, Light stroking
- Fast brushing is the brushing of hair of skin over the muscle by soft paint brush or battery operated brush. Brushing is always directed on skin of muscle to be stimulated. Fast brushing is high intensity stimulus. The effect is non specific and reaches maximum in 30 – 40 minutes after stimulation. Precautions – over pinna of the ear (stimulation of vagus nerve may influence CVS), over posterior primary rami of L1, L2 (may create voiding), over S2, S3 (may cause bladder retention), S4 (used for patients with incontinence)
- Light touch – it is given by using fingers or cotton swabs. Low threshold receptors are usually stimulated by facilitation of extra fugal motor system.
Thermal facilitation – A icing, C icing
- A – Icing – application of quick swipes of ice cubes to evoke reflex withdrawal similar to light touch.
- C - icing – increased threshold stimulus. Done by ice cube pressed for 15 – 20 minutes either on muscle belly or dermatome area. Precautions – same as brushing
- It is also suggested that brushing and icing have bilateral effects. Thus, stimulation of the unaffected side in hemiplegic patients prior to stimulation of affected side is beneficial.
Quick light stretch – low threshold stimulus which activates phasic response of the same muscle stretched. Effect of quick stretch is immediate.
Tapping – tapping over tendon or muscle belly is useful in facilitating the muscle.
Pressure – pressure on muscle belly places stretch on muscle spindles and hence activates stretch response.
Heavy joint compression – it facilitates co-contraction of muscle around the joint. It is applied to longitudinal axis of bone. It can be given using manual compression or weight bearing positions. E.g. Prone on hand.
Pressure on bony prominence
Facilitatory techniques to specialize special senses – includes olfactory and gustatory stimulus.

Inhibitory techniques to reduce tone of spastic muscles

Light joint compression – also called as joint approximation. Used to inhibit tone in hypertonic muscles.
Slow stroking – slow stroking of posterior rami with a firm but slow pressure inhibits the tone. It is done for 3-5 minutes until patient relaxes.
Slow rolling of the patient from supine to side lying or slow rocking movements may be done.
Neutral warmth – it refers to maintaining the body heat by wrapping the specific area to be inhibited. It is done for 10 – 20 minutes.
Neutral heat is used as heat greater than body temperature is used as a rebound effect.
Pressure on insertion of a muscle inhibits that muscle through the receptors located there.
A maintained stretch or maintenance of a lengthened position for a period of time ranging from several minutes to several weeks relapse the muscle spindle to longer positions. The balance of tone between agonists and antagonists will be disturbed if prolonged positioning is allowed.
Unresisted contraction can be used to inhibit the agonists by way of low threshold GTOs; this would reciprocally facilitate the antagonists.

REFERENCES

Occupational Therapy Interventions - Catherine Mariano, Donna Latello
Cash’s Textbook of Neurology by Physiotherapists