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John Christopher A. de Luna, PTRP

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1 John Christopher A. de Luna, PTRP
ROOD’S TECHNIQUE John Christopher A. de Luna, PTRP

2 Sensory - Motor System C.N.S. SPINAL CORD BRAIN BRAIN STEM CEREBELLUM
CEREBRAL CORTEX PYRAMIDAL EXTRAPYRAMIDAL

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4 Motor Homunculus

5 MOVEMENT SENSORY + MOTOR =

6 SENSORY ORGANIZATION THALAMUS CEREBRAL CORTEX 1st order neuron
ANTERIOR SPINOTHALAMIC TRACT & LATERAL SPINOTHALAMIC TRACT LEMNISCAL / DORSAL COLUMNS PROPIOCEPTIVE TRACTS CEREBRAL CORTEX THALAMUS 1st order neuron 2nd order neuron

7 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

8 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

9 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

10 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

11 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

12 PROPRIOCEPTORS 2. UNCONSCIOUS GOLGI TENDON ORGANS (GTO)
Greater sensitivity muscle contraction MUSCLE SPINDLE

13 Margaret Rood P.T. O.T.

14 Clinician Researcher

15 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

16 Stages of Motor Control
Mobility Stability Controlled Mobility Skill

17 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

18 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

19 ONTOGENIC MOTOR PATTERS

20 ONTOGENIC MOTOR PATTERS
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

21 ONTOGENIC MOTOR PATTERS
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

22 ONTOGENIC MOTOR PATTERS
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

23 ONTOGENIC MOTOR PATTERS
NECK CONTRACTION First real stability pattern Activates both flexors & tonic neck extensor muscles RECOMMENDED: Patients needs neck stability & extraocular control

24 ONTOGENIC MOTOR PATTERS
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

25 ONTOGENIC MOTOR PATTERS
QUADRUPED STANDING A skill of upper trunk because it frees upper extremity for manipulation INTEGRATION: righting reaction & equilibrium reaction

26 ONTOGENIC MOTOR PATTERS
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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30 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

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32 What do we do now? EVALUATION GOAL-SETTING PT PLAN OF CARE ROOD'S NDT

33 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

34 WILL I USE FOR MY PATIENT?
WHICH SENSORY INPUT WILL I USE FOR MY PATIENT? MEDIATED BY: PROCEDURE: EFFECT:

35 Rood's Technique's FACILATATORY

36 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

37 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

38 Stimulates C fibers which sends many collaterals in the RAS
SPECIFIC FACILITATION TECHNIQUES USED IN TREATMENT: 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

39 FAST BRUSHING

40 SPECIFIC FACILITATION TECHNIQUES USED IN TREATMENT:
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

41 ICING A Icing a.k.a. QUICK ICING Patients hypotonia
Are in state of relaxation Alerts the mental processes

42 ICING C Icing Promotes RECIPROCAL PATTERN between diaphragm & abdominal muscles Increase breating patterns, voice production and general vitality

43 Proprioceptive Facilitatory Technique
Procedure/Effect Approximation Facilitates contraction of the jt combined with developmental patterns, done manually or use of weights and sandbags

44 Proprioceptive Facilitatory Technique
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 c/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.

45 Proprioceptive Facilitatory Technique
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.

46 Proprioceptive Facilitatory Technique
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

47 Proprioceptive Facilitatory Technique
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.

48 VIBRATION

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50 INHIBITATORY TECHNIQUES
Rood's Technique's INHIBITATORY TECHNIQUES

51 Gentle Shaking or Rocking
Rhythmical circumduction of the head and slight approximation is given can also be used in the UE and LE

52 GENTLE SHAKING OR ROCKING

53 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.

54 SLOW ROLLING

55 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

56 Special Senses for Facilitation
pleasant odors unpleasant odors noxious substance warm liquids sweet foods/sweet taste

57 Cases:

58 SOURCES: TROMBLY, OCCUPATIONAL THERAPY
PEREDENTTI, OCCUPATIONAL THERAPY REHABILITATION SPECIALIST

59 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


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