1. Rood’s Approach
Dr. Hassan Sarsak, PhD, OT

2. Margaret Rood‘s Approach
Principles
Utilization of controlled sensory stimulation
Provide sensory input to stimulate muscular response and normalize tone
Utilization of developmental sequences
Individuals are placed in various developmental postures to stimulate muscular response

3. Margaret Rood‘s approach
Principles
Utilization of activity to demand a purposeful response
Purposeful activities are chosen to elicit desired movement patterns
Sensorimotor control is developmentally based
Treatment must begin at the person’s current level and progress sequentially
Repetition/practice is necessary for motor relearning
Broken record technique: repeat your position without losing control (assertiveness training)

4. Movement Control Sequence
Flexion.
Extension.
Adduction.
Abduction.
Ulnar patterns develop before radial ones
Rotation.

5. Muscle Work Light work muscles: Heavy work muscles:
lie superficially, laterally, or distally
primarily the flexors and adductors, finger and wrist extensors
activated by light stretch or low-threshold stimulation
Heavy work muscles:
lie close to the joint. In the body they are located proximally and medially.
They are primarily the trunk and proximal limb extensors and abductors
activated by heavy resistance or maintained stretch and high threshold receptor stimulation
In treatment: heavy work muscles should be integrated before light work muscles.

6. Margaret Rood‘s approach
Phases of motor control
Reciprocal inhibition/innervation
Early mobility pattern that is primarily a reflex
The movement of the neonate, waving his extremities back and forth typifies phasic movement.
Co-contraction
Simultaneous contraction of the agonist and antagonist around the joint that provides stability in a static pattern
Utilized to hold a position or object for a long duration (improves posture)
Heavy work
Mobility superimposed on stability
Proximal muscles contract and move and the distal segments are fixed
Example on heavy work phase:
An example of this kind of motion occurs when an infant learns to assume the quadruped position but has not learned to move in that position yet; he rocks back and forth with his knees and hands planted firmly on the floor.

7. Margaret Rood‘s approach
Phases of motor control
Skill
Considered the highest level of control and combines stability and mobility
Skill patterns consist of a stabilized proximal segment while the distal segment move in space
Example of this level include walking, crawling, and use of hands

8. Sequences in Gross Motor Development
A1:Supine withdrawal
Supine.
Withdrawal pattern.
Total flexion.
Bilateral.
Centered at 10th thoracic vertebrae.

9. A2:
Roll over.
Flexion top arm & leg.

10. A3: prone extension Total extension. Bilateral.
Cen. at 10th vertebrae.

11. B. Fixed Distal Segments
Neck Co contraction, Vertebral extension.
For head & neck hyperkinesia.
To stabilise eyes if nystagmus.
Nystagmus: rapid involuntary movements of the eyes

12. B2: prone on elbows
Forearm support.
Gleno humeral joint alignment.

13. B4: B3: Quadruped All fours. Sitting.
Pressure on knees through to heels Auto facilitation.

14. Margaret Rood‘s approach
Sequential patterns
Supine withdrawal
Position of total flexion while in the supine position
The arms cross the chest, the legs flex and abduct
Utilized to gain trunk stability and elicit flexion responses
Rollover
The arm and leg on the same side flex as the trunk rotates
Utilized to elicit lateral trunk responses as well as for persons who are dominated by tonic reflexes
Prone extension
The person lies prone with upper trunk and head extension
The shoulders abduct, extend and externally rotate, while the hips and keens extend off the support surface

15. Margaret Rood‘s approach
Sequential patterns
Neck cocontraction
The individual is lying prone and encouraged to to lift the head into extension against gravity
Utilized to develop head control
Prone on elbows
A pattern of trunk extension utilized to inhibit tonic neck reflexes as well as provide trunk and proximal limb stability
Quadruped
The person assumes an “on all fours” position to develop limb and trunk cocontraction patterns
Standing (Standing is at first static followed by active weight shifting)
Walking (Gait patterns are integrated into functional activities)
-Asymmetric tonic neck reflex: fully rotate infant’s head and hold for 5 sec. extension of extremities on the face side, flexion of extremities on the skull side
-Symmetric tonic neck reflex: place infant in the crawling position and extend the head. Flexion of hips and knees

16. Margaret Rood‘s approach
Motor responses based on the sensory stimulation applied by the therapist:
Fast brief stimuli produces a reflexive, large synchronized, output (e.g., tapping a tendon or muscle to facilitate muscular contraction)
Fast repetitive sensory input produces a maintained response (e.g., application of high frequency vibration to a weakened muscle to evoke a tonic holding contraction)
Maintained sensory input produces a maintained response (e.g., a prolonged manual stretch to a muscle group to inhibit overactive muscles)
Slow, rhythmical, repetitive input produces a deactivating/calming effect (e.g., slow rocking, as in rocking chair to calm a child)

17. Margaret Rood‘s approach
Evaluation
Evaluate the distribution of muscle tone
clinical observation and palpation techniques a lot to decide whether the muscle group needs inhibition or facilitation
Determine the level of motor control based on Rood’s developmental sequence
Individuals are guided through the sequence
the point at which the subject can perform a task easily indicates his highest developmental level
Determine the therapeutic activity of choice and how to progress the individual to the next level of control

18. Margaret Rood‘s approach
Intervention
Utilize controlled sensory input (cutaneous, thermal, olfactory, gustatory, auditory, and/or visual) to evoke desired motor responses
Facilitation techniques
Inhibition techniques
Engage individual in purposeful activity to facilitate development, move to more difficulty ones

19. Margaret Rood‘s approach
Intervention
Facilitation techniques
Tactile stimuli
Light touch (stroking or A-brushing): A-size low threshold sensory fibers: stimulation of the webs of the fingers or toes or the palms of the hands or the soles of the feet elicits a fast, short lived withdrawal motion of the stimulated limb
The stroking is done at a rate of twice per second for approximately 10 seconds
After a rest period this procedure can be repeated 3 to 5 times
When the reflex response occurs, resistance to the movement is usually given to reinforce it and to help develop voluntary control over it

20. Margaret Rood‘s approach
Facilitation techniques
Tactile stimuli
Fast brushing (C-brushing) (battery operated brush)
Brushing the hairs or the skin over a muscle with a soft camel hair paintbrush
Brushing is done for 5 seconds for each area, followed by a rest period
If there is no response after 30 seconds, the brushing of each area should be repeated 3 to 5 times

21. Margaret Rood‘s approach
Facilitation techniques
Tactile stimuli
Fast brushing (C-brushing) (battery operated brush)
Rood proposed that the effect of fast brushing is nonspecific, latent for 30 seconds, and reaches its maximum facilitative state 30 to 40 minutes after stimulation
Short effect for 30 or 45 sec.
Precautions:
fast brushing of the pinna stimulates vagal cardiorespiratory response (slower heart, and constrict smooth muscles of the bronchial tree)
fast brushing or scratching the back skin at level S2-4 may cause bladder emptying
Don’t use mechanical tools
Pinna: external part of the ear (the auricle)
Fast brushing is thought to stimulate the C – size sensory fibers, that influence activity of muscles involved in the maintenance of posture.
brushing applied to both non affected and the affected sides would probably be beneficial.
As soon as the patient is able to voluntarily control movement, stroking (brushing) is no longer an effective or appropriate treatment.

22. Margaret Rood‘s approach
Facilitation techniques
Thermal:
Quick icing over a muscle group to stimulate
Proprioceptive:
Stretch and tendon tapping (quick manual tapping with the therapist hand to apply a quick stretch to the desired muscle)
High frequency vibration ( cycles per second)
Cutaneous brushing prior to vibrator  effective
Heavy joint compression (applied manually and longitudinally through a joint in weight bearing position)
Resistance utilizing gravity or via the therapist’s hands stimulates muscle recruitment
Touching the lips with ice opens the mouth (a withdrawal response), but ice applied to the tongue and inside the lips closes the mouth.
Heavy joint compression activates high-threshold joint receptors

23. Margaret Rood‘s approach
Inhibition techniques
Gentle rocking (in a chair or in therapist’s arms = generalized relaxation response)
Slow stroking over the posterior rami of the spine (generalized relaxation)
Slow rolling (from supine to sidelying and back in rhythmical pattern = generalized calming effect)
Maintained stretched to an overactive muscle group (inhibition to spastic muscles)
Neutral warmth (maintaining body heat by wrapping a person or body part in a blanket for min. = relaxation response)
Prolonged icing (over a muscle group)
Icing precautions:
Behind ear  sudden ↓ of blood pressure
Left shoulder in cardiac diseased
The difference between inhibition and facilitation is in the mode of application rather than the kind of stimuli:
Light joint compression/joint approximation can be used to inhibit spastic muscles.

24. To normalize the muscle tone
So ….
Facilitatory technique:
--To normalize the muscle tone from a flaccid state.
--Quick icing, fast brushing, tapping, stroking, quick stretch.
Inhibitory technique:
--To normalize the muscle tone from hypertonic or spastic state.
--Deep pressure, slow rolling, and slow rocking.

27. Isometric
Isotonic

29. Full body Isometric contraction

30. Shoulder isotonic flexion with movement
Resistance
Movement
Shoulder isotonic flexion with movement

31. Shoulder isometric flexion with no movement
Resistance
Shoulder isometric flexion with no movement

32. Special Cases Partial tear Complete tendon rupture Tendonitis
Rotator cuff muscles:
Partial tear: pain, muscle weakness
Complete tendon rupture: painless, muscle weakness
Tendonitis: pain, NO muscle weakness

33. In Cardiac Patients Know MET levels! (medical chart) NO isometrics
Downgrade activity
Stop activity when
Dyspnea
Chest pain
Light-headedness
Diaphoresis
Dyspnea ضيق تنفس
Diaphoresis تعرق شديد