THE ROOD APPROACH

The Rood Approach developed by Margaret S. Rood in 1954

 PREMISE
 "IF IT WERE POSSIBLE TO APPLY THE PROPER SENSORY STIMULI TO THE APPROPR
IATE SENSORY RECEPTOR AS IT IS UTILIZED IN NORMAL SEQUENTIAL DEVELOPM
ENT."

The Rood Approach

 use of SENSORY STIMULATION to
evoke a motor response and the use of
developmental postures to promote
changes in muscle tone
 sensory stimulation is applied to muscles
and joints to elicit a specific motor
response
 stimulation has the potential to have
either an INHIBITORY or a
FACILITATORY effect on muscle tone

 Four Principles of Rood’s Theory

 Normalization of tone and evocation of desired muscular responses are accomplished through the
use of certain, appropriately applied sensory stimuli
 Sensorimotor control is developmentally based. Therefore, therapy must start at the patient’s
current level of development and progress sequentially to higher levels of control
 Movement is purposeful:
o Rood used purposeful activity to demand a response from the patient to elicit unconsciously
the desired movement pattern
o The responses of agonists, antagonists and synergists were believed to be reflexively
programmed according to purpose or plan.
o The sensation that occurs as a result of the movements involved in the activity helps the
patient learn the movements
 Repetition (practice) of sensorimotor responses is necessary for motor learning.

o Activities are used not only to elicit purposeful responses but also to motivate repetition

 Traditional and Reconstruction of Rood

Summary of Main Concepts of Rood’s Work

Traditional Rood Reconstruction of Rood
 Normalization of muscle tone is a prerequisite
for movement
Treatment begins at the developmental level of
functioning.
Reeducation of muscular responses occurs
through repetition.
Movement is directed toward functional goals.
Approximation of real life context increases
treatment effectiveness and generalizability.
Therapeutic use of self should match client
needs.
Muscle tone and motor control coeffect each
other.
Flexion and extensions patterns coeffect each
other.
Repetition of muscular responses creates
movement patterns.
Intention or goal direction coeffects movements.
Approximation of real life context increases
treatment effectiveness and generalizability.
Therapists use somatic markers to select
interaction methods with clients.

 Reconstruction of Rood

1. Muscle tone and motor control coeffect each other

 refers to the relationship that exists between the tone of ms. and execution of the motor act
 muscle tone is NOT the only prerequisite for motor control and that those relative degrees of
motor control can exist in spite of poor or inadequate muscle tone
2. Flexion and extension patterns coeffect each other
 refers to the dynamic relationship between flexion and extension patterns experienced through
everyday occupations
 balance or imbalance between flexion and extension patterns influence each other in a dynamic
system of postural patterns
3. Repetition of muscular response creates movement patterns
 refers to the learning that occurs through repeated neuromuscular actions that lay down the
engrams for the repertoire of motor behavior available to a given individual
4. Intention or goal direction coeffects movement
 intent of a motor action influences the nature and quality of motor action
5. Activities that provide approximation of real life context increase treatment effectiveness and
generalizability
 real life or simulated contexts increases effectiveness of practice and therapy itself
6. Therapists use somatic markers to select interaction methods with clients
 somatic marker: feelings/emotional tone of a person at any given time in a learned response to a
given situation

Four Components of Motor Control

 reciprocal inhibition (innervation) a.k.a. mobility, co-contraction (co-innervation) a.k.a. stability,
heavy work a.k.a. controlled mobility and skill

1. Reciprocal Inhibition
 early mobility pattern that serves as a protective function
 it is a phasic (quick) type of movement that requires contraction of the agonist muscle as the
antagonist muscle relaxes
 if the sensory stimulus is applied during the course of an ongoing movement, the quality of the
action can be modulated and improved.

2. Co-contraction/Co-innervation
 provides stability and is considered a tonic (static) muscle pattern
 provides ability to hold a position or object for a longer duration
  simultaneous contraction of agonist muscle and antagonist muscle
 needed for feeding, early activities using standing tables

3. Heavy Work
 “mobility superimposed on stability”
 proximal muscles contract and move where as the distal segment is fixed
 e.g. creeping

4. Skill
 highest level of motor control and combines the effort of mobility and stability
 proximal segment is stabilized while distal segments moves freely
 e.g. crawling, walking, reaching, activities requiring the coordinated use of hands

 Ontogenic Motor Patterns

a) Supine Withdrawal
o total flexion response towards vertebral level T10
o requires reciprocal innervation with heavy work of proximal segme n
ts
o aids in integration of TLR
o RECOMMENDED: patients with no reciprocal flexion; patients do
minated by extensor tone

b) Rollover
o mobility pattern for extremities and lateral trunk muscles
o RECOMMENDED: Patients dominated by tonic reflex patterns in sup in
e; stimulates semicircular canals which activates the neck & extraocul ar
muscles

c) Pivot Prone
o demands full range extension neck, shoulders, trunk and lower
o position difficult to assume and maintain
o important role in preparation for stability of extensor muscles in u
pright position
o associated with labyrinthine righting reaction of the head
o INTEGRATION: STNR & TLRs

d) Neck Co-Contraction
o first real stability pattern
o activates both flexors & tonic neck extensor muscles
o RECOMMENDED: patients needs neck stability & extraocular c
ontrol
 e) Prone on Elbows
o stretches the upper trunk musculature
o influences stability scapular and glenohumeral regions
o gives better visability of the environment
o allows weight shifting from side to side
o RECOMMENDED: Patients needs to inhibit STNR

f) All Fours (Quadruped)

o follows stability of the neck and shoulders
o lower trunk and LE are brought into a cocontraction pattern
o initially position is static and abdomen may sag at T10 level
which causes stretching of trunk and limb girdles
o shifting wt provides controlled mobility and may be preparatory
to equilibrium responses

g) Static Standing
o skill of the upper trunk because it frees the UE for
prehension and manipulation
o weight is first equally distributed on both legs and
then wt. shifting begins

h) Walking
o the gait pattern unites mobility, stability and skill
o normal locomotion entails the ability to support the
body wt., maintain balance and execute the
stepping motion
o sophisticated process requiring coordinated mov’t
patterns of various parts of the body including wt. shifting
 Controlled Sensory Input
CUTANEOUS FACILITATORY INHIBITORY
 Light moving touch  Gentle shaking or rocking
 Fast brushing  Slow stroking
 Icing  Slow rolling
 Light joint compression
PROPRIOCEPTIVE FACILITATORY  Tendinous pressure
 Heavy joint compression  Maintained stretch
 Stretch  Rocking in developmental stages
 Intrinsic stretch
 Secondary ending stretch
 Stretch pressure
 Resistance
 Tapping
 Vestibular stimulation
 Inversion
 Therapeutic vibration
 Osteopressure

 CUTANEOUS FACILITATORY TECHNIQUE

 Light Moving Touch

o sends input to the limbic structure
o increases corticosteroids levels in blood stream
o activates superficial mobilizing muscles (light work group that performs skilled task)
o stimulates a delta sensory fibers → synapses with fusimotor system reciprocal innervation
(phasic withdrawal response)
o STD: camel hair, finger tip, brush, cotton swab
 Fast Brushing
 Icing
o A Icing or Quick Icing
 patients with hypotonia
 are in state of relaxation
 alerts the mental processes
o C Icing
 promotes RECIPROCAL PATTERN between diaphragm & abdominal muscles
 increase breathing patterns, voice production and general vitality
CUTANEOUS MEDIATED
PROCEDURE EFFECT
STIMULI BY
 applied with a fingertip, camel
activates low
hairbrush-apply
Light moving A delta threshold hair end
 3-5 strokes and allow
touch sensory fiber organ and free
 30 seconds of rest between strokes to nerve endings
prevent over stimulation
Fast brushing C fibers apply it over the dermatomes of the same stimulates C fibers
segment the muscle supplies for 3 to 5 secs which sends many
 collaterals in the
and repeated after 30 seconds
RAS
ice is applied to the skin in 3 quick swipes facilitation of
A icing/
A fibers and water blotted with a towel between muscle activity and
quick icing
swipes ANS response
ice cube is pressed to the skin serving the
facilitates a
same spinal segment of the muscle to be
C Icing C fibers maintained
stimulated, response may take as long as
postural response
30 minutes

 PROPRIOCEPTIVE FACILITATORY TECHNIQUE

 Approximation
o facilitates contraction of the joint combined with developmental patterns
o done manually or use of weights and sandbags
 Vibration
o used for tactile stimulation to desensitize hypersensitive skin and to produce tonal changes in
muscles
o applied over a muscle belly to activate the Ia afferent of muscle spindle which caused the
tonic vibration reflex
 best elicited by a high frequency vibrator = 100-300Hz
 duration: should not exceed 1-2 min per application
 position: prone or supine
 must be done in a warm environment
 Resistance
o uses heavy resistance to stimulate both primary and secondary endings of the muscle spindle
o used in isotonic fashion in developmental fashion to influence the stabilizers
o when a muscle contracts against resistance, it assumes a shortened length that causes the mus
cle spindle to contract so they readjust to the shortened length thus called "biasing"
 Stretch
o activates the proprioceptors in selected muscles and imply the principle of reciprocal innervat
ion
 Intrinsic Stretch - promotes stability of the scapulohumeral region, bearing more
weight on the ulnar side of the hands and promoting resistive grasp
 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
 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
 Tapping
o with the use of fingertips percussed 3-5 times and may be done before or during the time the
px is voluntarily contracting the muscles
o acts on the afferent of the muscle spindles and increases the tone of the underlying muscles
 Vestibular Stimulation
o powerful type of proprioceptive unit
o vestibular system is found to activate the antigravity muscles and their antagonist muscle bef
ore the stretch reflex of the muscle spindles
o stimulated through linear acceleration and deceleration in horizontal and vertical planes and a
ngular acceleration and deceleration such as spinning, rolling or swinging
o fast stimulation tends to stimulate while slow rhythmical rocking tends to relax

 Inversion
o 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
o head must be in normal alignment with the neck

 INHIBITORY
 Gentle Shaking or Rocking
o rhythmical circumduction of the head and slight approximation is given can also be used in th
e UE and LE
 Slow Rolling
o pt is rolled slowly from a sidelying position to prone and back in a rhythmical pattern; use on
both sides of the body
 Neutral warmth

o affects the temperature receptors in the hypothalamus and PSNS

o used for pts with hypertonia
o pt in recumbent and wrapped with a blanket for 5-10 minutes
o pt feels relax and decreased in tone
 Slow stroking
o pt prone while the therapist provides a rhythmical, moving deep pressure over the dorsal distr
ibution of the posterior rami of the spine
o done from occiput to coccyx and alternated and should not exceed 3 minutes because it caus
es a rebound phenomenon
 Tendinous Pressure
o manual pressure applied to the tendon insertion of a muscle can be used in spastic or tight
muscles
 Joint Approximation
o joint compression less than or equal BW to inhibit spastic muscle around the joint
o commonly applied to the shoulder; ABD = 35 - 45 degrees
 Maintained Stretch
o positioning in the elongated position to cause lengthening of the muscle
o limb is held so that the muscle is steadily kept at its greatest length for more than 20 seconds,
until letting go is felt as the muscle adjusts to the longer length
 Rocking
o shifting the weight forward and backward, progressing to side to side then diagonal patterns
 Prolonged Icing
o 50°F (10°C) decreases the monosynaptic stretch reflex excitability
o cold pack is applied for 20 minutes

 Special Senses for Facilitation

 pleasant/unpleasant odors
 colorful/bright multistimulus environment
 noxious substance
 warm liquids
 sweet food/sweet taste
 therapist's voice and manner of speech

 PRECAUTIONS
1) Fast brushing of the pinna of the ear stimulates the vagal parasympathetic fibers, which influence
cardiorespiratory functions. Activation of these fibers slows the heart, constricts the smooth muscles
of the bronchial tree, and increases bronchial secretions. Fast brushing or scratching of the skin over
the back at the level of S2-4 may cause bladder emptying
2) In the application of C-icing, the distribution of the posterior primary rami along the back is avoided
because it may cause a sympathetic nervous system fight or flight protective response.
3) Icing of the pinna causes vagal responses, including cardiovascular reactions such as low blood
pressure. Ice to the back at the level of S2-4 may cause voiding.
4) Prolonged icing is contraindicated for patients with Raynaud’s phenomenon or circulatory disorders,
including hypertension.
5) Vibration applied on tendons can be conducted to adjacent muscles via the bone, and this possibility
must be attended to and prevented.
6) Vibration should not be maintained longer than 1–2 minutes in any one place because of the heat that
develops from the friction and potential for tearing thin skin. Vibration over areas previously
immobilized can dislodge a blood clot and cause an embolism.
7) Scapulohumeral rhythm must be adhered to during all upper extremity range of motion (UE ROM)
movements to prevent damage to the shoulder muscles and development of pain syndromes.
8) Isometric contractions may produce the Valsalva maneuver, resulting in tachycardia and increased
blood pressure, followed by reflexive bradycardia. Patients with cardiac conditions must be closely
monitored.
9) Application of quick stretch (QS) in diagonal patterns must be carefully applied. If a muscle is very
near its full anatomical range application of too great a stretch may damage the muscle. Neck muscles
are also close to their full anatomical range at the beginning of patterns.
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