Rood Approach

Definition

Rood’s approach is a neurophysiological and developmental treatment approach that was developed by Margret Rood to improve tone of muscles (both flaccid and spastic).

Rood’s approach is based on known physiological facts that sensory stimulation provides desired muscular response and was specially designed for patients with motor control problem. developmental sequences are used, i.e. from lower to higher levels, and practice of sensory-motor response until learning is achieved. The rules of sensory input are: 1) a fast, brief stimulus produces synchronous movement output, 2) a fast, repetitive stimulus produces a sustained response, 3) a maintained sensory input produces a sustained response, 4) and a slow, repetitive, and rhythmical stimulus decreases the tone in muscle response. Additionally, we can use neck flexion, extension, rotation, and side-bending of the neck to stimulate the vestibular receptors. We can even use symmetrical and asymmetrical tonic neck reflexes to generate tone in the flexors and extensors.

Rood’s approach was based on four basic principles - (1) normalization of muscle tone using sensory stimulation, (2) ontogenic developmental pattern, (3) repetition and (4) purposeful movement. According to Rood, sensory stimulation can activate or deactivate the receptor by facilitation or inhibition, which makes it possible to get the desired muscular response.16-17 Sensory stimulation causes - (1) trophic change by axoplasmic flow in nerve processes over period of time as well as (2) immediate effect by transmission of nerve impulses.

Rood clarified four types of receptors which can be stimulated to acquire desired muscular response - proprioceptive receptors, exteroceptive receptors, vestibular receptors and special sense organs. According to Rood, muscles have different duties, most of them are a combination, some predominant in light work or phasic and others in heavy work or tonic muscle. Rood categorized all flexors and adductors muscle groups as phasic or mobility muscle and all extensors and abductors are categorized as tonic or stability muscles.

Principles

• Utilization of controlled sensory stimulation.
• Utilization of developmental sequences.
• Utilization of an activity to demand a purposeful response.
• Normalization of tone and muscular responses are achieved via controlled sensory stimulation.
• Sensor motor control is developmentally based.
• Muscular responses of agonists, antagonists and synergists are believed to be reflexively programmed according to purpose or plan.
• Repetition/practice is necessary for motor learning.  

facilitatory technique to improve tone of flaccid muscles

1. Tactile stimulation, Fast Brushing the skin, quick icing, quick stretch , light stroking , and rubbing of the skin causes stimulation of exteroceptors and produces a protective withdrawal response and hence movement in the extremities.
2. Tapping muscle and rubbing the skin cause stimulation of proprioceptors including stimulation of Muscle Spindles, Golgi Tendon Organ, and receptors around the joint which results in muscle contraction. These sensory organs can be stimulated by quick stretch, tapping over the muscle belly, and rubbing.
3. Thermal facilitation – A icing, C icing
   • A – Icing – application of quick swipes of ice cubes to evoke reflex withdrawal similar to light touch.
   • C - icing – increased threshold stimulus. Done by ice cube pressed for 15 – 20 minutes either on muscle belly or dermatome area. Precautions – same as brushing .
4. Heavy joint compression is applied through the longitudinal axis of the bone causing co-contraction around the joint. It can be combined with an ontogenetic pattern such as prone on the elbow, quadruped position, sitting, or standing. Pressure can be applied manually and by weight cuffs also.
5. quick light stretch , low threshold stimulus which activates phasic response of the same muscle stretched. Effect of quick stretch is immediate.
6. tapping over tendon or muscle belly is useful in facilitating the muscle.
7. pressure on muscle belly places stretch on muscle spindles and hence activates stretch response.
8. Pressure on bony prominence.

inhibitory techniques to reduce tone of spastic muscles

1. Light joint compression , also called as joint approximation. Used to inhibit tone in hypertonic muscles.
2. slow stroking of posterior rami with a firm but slow pressure inhibits the tone. It is done for 3-5 minutes until patient relaxes.
3. Slow rolling of the patient from supine to side lying or slow rocking movements may be done.
4. Neutral warmth , it refers to maintaining the body heat by wrapping the specific area to be inhibited. It is done for 10 – 20 minutes.
5. neutral heat is used as heat greater than body temperature is used as a rebound effect.
6. Pressure on insertion of a muscle inhibits that muscle through the receptors located there.
7. A maintained stretch for a period of time ranging from several minutes to several weeks relapse the muscle spindle to longer positions. The balance of tone between agonists and antagonists will be disturbed if prolonged positioning is allowed.
8. Unresisted contraction can be used to inhibit the agonists by way of low threshold GTOs; this would reciprocally facilitate the antagonists.

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