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ROODS TECHNIQUE John Christopher A. de Luna, PTRP.

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Presentation on theme: "ROODS TECHNIQUE John Christopher A. de Luna, PTRP."— Presentation transcript:

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2 ROODS TECHNIQUE John Christopher A. de Luna, PTRP

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5 Motor Homunculus

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7 SENSORY ORGANIZATION ANTERIOR SPINOTHALAMIC TRACT & LATERAL SPINOTHALAMIC TRACT LEMNISCAL / DORSAL COLUMNS PROPIOCEPTIVE TRACTS

8 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

9 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

10 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

11 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 skins surface Related to sense of tickle and pleasurable touch sensation

12 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

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

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16 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

17 Stages of Motor Control Mobility Stability Controlled Mobility Skill

18 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

19 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

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21 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

22 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

23 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

24 NECK CONTRACTION – First real stability pattern – Activates both flexors & tonic neck extensor muscles – RECOMMENDED: Patients needs neck stability & extraocular control

25 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

26 QUADRUPED STANDING – A skill of upper trunk because it frees upper extremity for manipulation – INTEGRATION: righting reaction & equilibrium reaction

27 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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31 ROODS 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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34 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

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37 SPECIFIC FACILITATION TECHNIQUES USED IN TREATMENT: Cutaneous Stimuli Mediated byProcedureEffect 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

38 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

39 Fast brushing C fibersApply 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 SPECIFIC FACILITATION TECHNIQUES USED IN TREATMENT:

40 FAST BRUSHING

41 A icing/quick icing A fibersIce 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 IcingC fibersIce 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 SPECIFIC FACILITATION TECHNIQUES USED IN TREATMENT:

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

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

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

45 VibrationIt 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. Proprioceptive Facilitatory Technique

46 StretchActivates 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. Proprioceptive Facilitatory Technique

47 ResistanceRood 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 Proprioceptive Facilitatory Technique

48 Tappingwith 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 StimulationVestibular 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. InversionIn 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. Proprioceptive Facilitatory Technique

49 VIBRATION

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

53 GENTLE SHAKING OR ROCKING

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

55 SLOW ROLLING

56 TechniquesProcedure/Effect Neutral warmthAffects 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 strokingPt 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 PressureManual pressure applied to the tendon insertion of a muscle; can be used in spastic or tight mm ApproximationJt compression less than or equal BW to inhibit spastic mm around the joint. Maintained StretchPositioning 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 RockingShifting the weight forward and backward, progressing to side to side then diagonal patterns

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

58 Cases:

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

60 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 ROODS TECHNIQUE USING PLAY THERAPY


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