Professional Documents
Culture Documents
Mechanoreceptio
n
Touch,
Free nerve ending Hair root Variable
pressure
Steady pressure,
Merkel receptor Small Slow
texture
Superficial
Flutter, stroking Meissner corpuscle Rapid
Thermoreception
Cold
Free nerve ending Superficial Small Rapid
Warm
Nociception
Thermal Small Rapid
Mechanical Large Slow
Free nerve ending Superficial
Polymodal (esp.
Large Slow
chemical)
A-alpha nerve fibers - carries information
related to proprioception
- A fibers (Nociceptors
of neospinothalamic tract)
Pain Free nerve ending
- C fibers (Nociceptors
of paleospinothalamic tract)
Reflexes
an automatic response to a stimulus
Rood stresses the importance of early reflexes in the
relearning of motor control
She believed that a baby use reflexes to move initially but
modifies them and eventually replace the reflexes worth
voluntary movement
Motor patterns are developed from fundamental
patterns/reflexes which are refined and controlled as an
individual matures
In addition to stimulation of specific receptors to
produce responses, other reflexes can be used in
therapy to assist or retard the effects of sensorimotor
stimulation
e.g. tonic labyrinthine reflexes, tonic neck, vestibular reflexes,
withdrawal patterns
Muscles
Muscles have different functions
classified according to whether they are for 'light work muscle action' or 'heavy
work muscle action
light work ms
Mobilizers
more distal
Phasic
flexors and adductors
Skilled movement
heavy work ms
Stabilizers
more proximal
Tonic
extensors & abductors
Maintenance of posture
Note:
Heavy work muscles should be integrated before light work muscles
The sequence of muscle stimulation according to cephalocaudal rule:
Flexors-extensors-ADD-ABD
Sequence of motor development
Sensorimotor control is developmental
Motor development typically occurs in an orderly sequence from head to trunk
to hands to feet, from midline to extremities, and from gross to fine muscles.
Stable posture and sensory input facilitate controlled and refined movements
and mobility (Martin, 2002)
Motor skills progress from large muscle use (such as leg and arm movements
for walking, pushing) to small muscle use (discrete hand movements for
writing)
1. Mobility
Refers to an early mobility pattern (seen in newborn)
resembles the phase of child development from 0 to 3 years old
Contains the following patterns:
dorsal flexion (sucking pattern)
integrates under central control the cervical and labyrinthic tonic reflexes
allows the release of bilateral movements of upper extremities
total extension (posture of the tall doll)
first movement around the central axis (lateral rolling)
Involves reciprocal inhibition/innervation
Phasic or quick type of movement
Serves a protective function
Stimulus: low threshold, A fiber type
quick, light stretch or stroking of the distal parts
Sequence of motor development
III. Based on levels of motor control
2. Stability
the maintenance of body position or of its segments in stable
postures (such as on four limbs, on the knees etc.)
Foundation for postural control
Tonic or static type of movement
Involves co-contraction (aka coinnervation)
simutaneous contraction of the agonist and antagonist
provides stability in a static pattern
utilized to hold a position or obj. for a long duration
Becomes evident as infant develops increasing postural tone
Stimulus: high threshold, C fiber type
Joint compression, stretch (esp of intrinsic ms of hand & feet), fast
brushing, resistance
Sequence of motor development
III. Based on levels of motor control
3. Controlled mobility
"mobility superimposed on stability; AKA heavy work
in these patterns, proximal muscles move while distal segments are fixed
involves integration of complex movements and activities in space, fact which
implies balance, coordination and development of orientation senses, all from
stability positions
Example: upright stance and gait development
Stimulus: high threshold from spindle & joint receptors
4. Skill
the highest level of control
combines stability & mobility
proximal ms are fixed/ stable while distal ms move in space
contains the phase of perfected movements, stimulation of balance reactions,
forms of facilitation in order to obtain the passing from one posture and movement
to another as easily as possible
Example: use of upper limbs and hands and advanced balance and gait
Sequence of motor development
IV. Based on ontogenic motor pattern
Gross movement
1. Supine withdrawal (supine flexion)
total flexion or withdrawal pattern in supine position
arms cross the chest, legs flex & abduct
utilized to gain trunk stability and elicit flexion responses
Tonic heavy work
Reciprocal innervation
Bilateral
Centered at 10ththoracic vertebrae
2. Roll over (segmental rolling)
flexion of arm and leg on the same side and roll over as the trunk rotates
utilized to elicit lateral trunk responses, and for persons who are dominated by tonic
reflexes
Phasic movement
3. Pivot prone (prone extension)
prone with hyperextension of head, trunk and legs, shoulder abduct, extend, and
externally rotate
results in an isometric contraction of the extensors and abductors
Total extension pattern
Bilateral
Center at 10th vertebrae
Sequence of motor development
IV. Based on ontogenic motor pattern
Note:
If applied to neck sacrum over center of back will chorea athetosis or
excessive muscle tone
As soon as patient is able to voluntarily control movement, stroking and
brushing is no longer an appropriate technique
Brief Icing
C icing A icing
High threshold stimulus Used for flaccid types only
Modalities: Modalities:
Ice cube or ice popsicles
Application: Target area:
Pressed over the skin for 3-5 palms, soles or dorsal web space
sec, then water is wiped away of hands or feet
Target area: Application:
same as fast brushing Quick swipes of ice
Mechanism: Mechanism:
Used to stimulate postural, tonic Evoke a reflex withdrawal
responses via C fibers
Precautions
Note:
Same as those in fast brushing
Avoid applying over sympathetic
Resistance to movement is
chain (e.g. posterior primary usually given to reinforce it and
rami along the back) to avoid help develop voluntary control
SNS response over it
Precautions to icing
Behind ear ->sudden of blood pressure
Sole , Palm->nociceptive(avoid in children &emotionally unstable)
over posterior primary rami which shares nerve supply to vessels supplies
organ
Left shoulder in cardiac diseased
Note:
If applied to palm of hand-> mental process
- application to lips , tongue->suck, swallow, speech
- Rebound effect to icing is noted ~ 30 seconds after application
- i.e the muscle stimulated is temporarily inhibited
Heavy joint compression
High threshold stimulus
Facilitate cocontraction of muscles around a
joint
Target area:
Longitudinal axis of bones
Application:
greater than BW
Thru joint in a weightbearing position
Mechanism:
Stimulates joint receptors
Stretch
1. Quick, light stretch
Low threshold stimulus
Applied over the desired muscle before or
during voluntary contraction
Mechanism:
Activates an immediate phasic stretch reflex of
the muscle stretched & inhibits its antagonist
produce a relatively short lived contraction of the
agonist muscle and short lived inhibition of the
antagonist muscle
2. Secondary stretch
Maintained stretch at the end of the range
Resistance
A form of stretch
Application:
Resistance to isotonic movement
Manually or mechanically using gravity or BW
Mechanism:
More motor units are recruited to fire
(overflow)
muscle contraction is directly proportional to the
amount of resistance applied
Improving kinesthetic awareness and
increasing strength are another benefits
gained from resistance
Tapping
Target area:
Tendon or muscle belly
Application:
Area is percussed 3-5 times using fingertips
Mechanism:
Activates an immediate phasic stretch reflex
of the muscle stretched & inhibits its
antagonist
Pressure (muscle belly or bony prominence)
Note:
If heat is > than that of the body, a rebound effect can occur in 2-
3 hours
Prolonged icing
more than 20 min
Application of the prolonged ice can be
used clinically by four types
ice chips
ice wraps
ice pack
immersion in cold water
Low frequency vibration
5 -50 Hz
effect on muscle through its activation of
spindle secondary endings and golgi
tendon organs.
Pressure (tendon)
stimulates pacinian corpuscles
It can be applied manually and/or through
devices such as splints
Positioning may be used to achieve an
inhibitory pressure
e.g. quadruped position to inhibit the
quadriceps muscle and the long finger
flexors of the hand
Maintained stretch
Application:
Maintained stretch in the lengthened
position (~5 min)
Mechanism:
Rebiases the spindle to the longer position
produces inhibition of muscle responses
which may help in reducing hypertonus,
(Bobath's neuro-developmental technique,
inhibitory splinting and casting technique)
Maintained touch
It can be used to produce a general
calming effect and generalized inhibition
Firm manual contacts (pressure to midline
abdomen, back) are the common used
techniques
Rood's evaluation procedures
1. Assess patients sensation and perception
2. Identify precaution/ contraindications to
treatment (i.e. circulatory defects)
3. Evaluate distribution of muscle tone
thru clinical observations and palpation
techniques
4. Determine level of motor control and postural
reaction
based on Rood's developmental sequence
5. Determine therapeutic activities
Selection of the treatment methods
depends upon the understanding of many
aspects, such as:
The neuro-physiological bases of each method.
The biomechanical influencing of the treated
body part(s), segment(s), or body as a whole
on the applied method, and the mechanical
effect of the intervention on the treated part
The nature of pathology and symptoms
affecting the patient's activity
The individual characters of each patient