6 SENSORY ORGANIZATION THALAMUS CEREBRAL CORTEX 1st order neuron ANTERIOR SPINOTHALAMIC TRACT & LATERAL SPINOTHALAMIC TRACTLEMNISCAL / DORSAL COLUMNSPROPIOCEPTIVE TRACTSCEREBRAL CORTEXTHALAMUS1st order neuron2nd order neuron
7 RECEPTORS: 1. INTERORECEPTORS Spinothalamic Tract, Dorsal Column Lemniscal2. EXTERORECEPTORSFREE NERVE ENDINGSLocated skin and visceranon specific receptors pain, crude touch, temperatureUnmyelinated C / myelinated nerve fibersActivated with thermal or brushing techniquesCauses state of arousalIce packs & rubbing alleviates acute painSynapse 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 follicleActivated by bending / displacement of hairA delta (group III) fibersStimulated with light touch or stroking of the skinBias the muscle spindle through the fusimotor systemPrimitive humanity and GoosebumpsMEISSNER CORPUSCLESFound just beneath the epidermis in hairless skinThicker A beta ( group II) fibersResponsible for fine tactile discrimininationImportant 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 bonesMost rapidly adapting receptorsRespond to deep pressure but are sensitive to light touchStimulated by high frequency vibrationPlays a role tonic vibration reflexAids desensitization of hypersensitive skin in children who exhibits tactile defensivenessSupresses pain perception at the cutaneous levelCalming effect
10 RECEPTORS: MERKEL TACTILE DISKS Found deepest epidermis in hairless skinVolar surface of fingers, lips and external genitaliaFast-conducting A beta (group II) fibersSlowly adapting touch-pressure receptorsSensitive to slow movements across the skin’s surfaceRelated to sense of tickle and pleasurable touch sensation
11 PROPRIOCEPTORS 1. CONSCIOUS KINESIOCEPTORS / JOINT RECEPTORS Transmitted to the cerebral cortexLocated joint capsule, ligaments, tendons1. Ruffini end organs2.Golgi –Mazzoni corpuscles3. Vater-Pacini corpuscles4. Golgi-type endings
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 MobilityStabilityControlled MobilitySkill
17 SEQUENCE OF MOTOR DEVELOPMENT 1. RECIPROCAL INHIBITION (INNERVATION)a.k.a. MOBILITYA reflex goverened by spinal & supraspinalcentersSubserves a protective functionPhasic and reciprocal type of movementContraction of agonist and antagonist2.CO-CONTRACTION (C0-INNERVATION)a.k.a. STABILITYSimultaneous agonist & antagonist contraction with antagonist supreme
18 SEQUENCE OF MOTOR DEVELOPMENT 3. HEAVY WORKa.k.a. CONTROLLED MOBILITYStockmeyer “ mobility superimposed on stability”creeping4. SKILLCrawling, walking, reaching, activities requiring the coordinated use of hands
20 ONTOGENIC MOTOR PATTERS SUPINE WITHDRAWALTotal flexion response towards vertebral level T10Requires reciprocal innervation with heavy work of proximal segmentsAids in integration of TLRRECOMMENDED:patients with no reciprocal flexionPatients dominated by extensor tone
21 ONTOGENIC MOTOR PATTERS ROLLOVER TOWARD SIDE-LYINGMobility pattern for extremities and lateral trunk musclesRECOMMENDED:Patients dominated by tonic reflex patterns in supineStimulates semicircular canals which activates the neck & extraocular muscles
22 ONTOGENIC MOTOR PATTERS PIVOT PRONEDemands full range extension neck, shoulders, trunk and lower extremitiesPosition difficult to assume and maintainImportant role in preparation for stability of extensor muscles in upright positionAssociated with labyrinthine righting reaction of the headINTEGRATION: STNR & TLRs
23 ONTOGENIC MOTOR PATTERS NECK CONTRACTIONFirst real stability patternActivates both flexors & tonic neck extensor musclesRECOMMENDED:Patients needs neck stability & extraocular control
24 ONTOGENIC MOTOR PATTERS PRONE ON ELBOWSStretches the upper trunk musculatureInfluences stability scapular and glenohumeral regionsGives better visability of the environmentAllows weight shifting from side to sideRECOMMENDED:Patients needs to inhibit STNR
25 ONTOGENIC MOTOR PATTERS QUADRUPEDSTANDINGA skill of upper trunk because it frees upper extremity for manipulationINTEGRATION: righting reaction & equilibrium reaction
26 ONTOGENIC MOTOR PATTERS WALKINGSophisticated process requiring coordinated movement patterns of various parts of body“support the body weight, maintain balance, & execute the stepping motion” - Murray
30 ROOD’S THEORY 1. Normalize muscle tone 2. Treatment begins at the developmental level of functioning3. Movement is directed towards functional goals4. Repetition is necessary for the re-education of muscular response
36 SPECIFIC FACILITATION TECHNIQUES USED IN TREATMENT: Cutaneous StimuliMediated byProcedureEffectLight moving touchA delta sensory fiberApplied with a fingertip, camel hairbrush-apply 3-5 strokes and allow 30 seconds of rest betw strokes to prevent over stimulationActivates low threshold hair end organ and free nerve endings
37 LIGHT MOVING TOUCH Sends input limbic structure Increases corticosteroids levels in blood streamACTIVATES 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 brushingC fibersApply it over the dermatomes of the same segment the muscle supplies for 3 to 5 secs and repeated after 30 secondsStimulates C fibers which sends many collaterals in the RAS
40 SPECIFIC FACILITATION TECHNIQUES USED IN TREATMENT: A icing/quick icingA fibersIce is applied t the skin in 3 quick swipes and water blotted with a towel betw swipesFacilitation of muscle activity and ANS responseC 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 minFacilitates a maintained postural response
41 ICING A Icing a.k.a. QUICK ICING Patients hypotonia Are in state of relaxationAlerts the mental processes
42 ICINGC IcingPromotes RECIPROCAL PATTERN between diaphragm & abdominal musclesIncrease breating patterns, voice production and general vitality
43 Proprioceptive Facilitatory Technique Procedure/EffectApproximationFacilitates contraction of the jt combined with developmental patterns, done manually or use of weights and sandbags
44 Proprioceptive Facilitatory Technique 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.
45 Proprioceptive Facilitatory Technique StretchActivates the proprioceptors in selected muscles and imply the principle of reciprocal innervationa. intrinsic stretchIt promotes stability of the scapulohumeral region, bearing more weight on the ulnar side of the hands and promoting resistive graspb. Secondary ending stretchCombination 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 extensorsc. stretch pressureEffects 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 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
47 Proprioceptive Facilitatory Technique 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.
55 TechniquesProcedure/EffectNeutral 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 phenomenonTendinous PressureManual pressure applied to the tendon insertion of a muscle; can be used in spastic or tight mmApproximationJt 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 stretchRockingShifting the weight forward and backward, progressing to side to side then diagonal patterns
56 Special Senses for Facilitation pleasant odorsunpleasant odorsnoxious substancewarm liquidssweet foods/sweet taste
59 OBJECTIVES: LABORATORY 1. RETURN DEMONSTRATION ON PEDIATRIC EVALUATION2.INTEGRATION OF THE KNOWLEDGE GAINED IN PEDIATRIC REHABILITATION IN GOAL SETTING3. DEMONSTRATION – RETURN DEMONSTRATION OF ROOD’S TECHNIQUE USING PLAY THERAPY
Your consent to our cookies if you continue to use this website.