Rood Approach

Original Editor - Salma Ashraf Top Contributors - Salma Ashraf and Kim Jackson

Introduction

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

Rood’s approach is based on the 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 symmetric and Asymmetrical Tonic Neck Reflex to generate tone in the flexors and extensors.

-Rood’s approach was based on four basic principles :

• Normalisation of muscle tone using sensory stimulationion .
• Ontogenic developmental pattern.
• Repetition.
• purposeful movement.

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.

- In Rood approach ,sensory stimulation causes ;

1. trophic change by axoplasmic flow in nerve processes over period of time.
2. as well as immediate effect by transmission of nerve impulses.
3. sensory stimulation can activate or deactivate the receptor by facilitation or inhibition, which makes it possible to get the desired muscular response.

Principles

• Utilisation of controlled Sensory stimulation.
• Ontogenic developmental sequences, Rood recommended the use of ontogenic developmental sequence. According to Rood, sensory motor control is developmentally based ,so that during treatment therapist must assess current level of development and then try to reach next higher levels of control.
• Utilisation of an activity to demand a purposeful response.
• Normalisation of tone and muscular responses , Using appropriate sensory stimuli for evacuating the desired muscular response is the basic principle of Rood approach.
• 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 Control and Learning.  

Autonomic nervous system stimuli

• Sympathetic Nervous System Stimuli: It includes icing, unpleasant smells or tastes, sharp and short vocal commands, bright flashing lights, fast tempo and arrhythmical music.
• Parasympathetic system: It includes slow, rhythmical, repetitive rocking, rolling, shaking, stroking the skin over the paravertebral muscles, soft and low voice, neutral warmth, contact on palms of hands, soles of feet, upper lip or abdomen, decreased light, soft music and pleasant odors.

Facilitatory technique

1. Fast tactile stimulation Exteroceptors are stimulated by Fast Brushing, fast icing, quick stretching, mild stroking, and rubbing the skin, which results in a protective withdrawal response and consequent movement of the extremities.
2. Proprioceptors, such as the Golgi Tendon Organ, Muscle Spindles, and receptors around the joint, are stimulated by tapping and touching the skin, which causes muscular contraction. Rubber, tapping on the belly of the muscle, and short stretches can all activate these sensory organs.
3. Heat-facilitating icings A and C. ( A): Icing: apply ice cubes quickly in order to trigger a reflex withdrawal that resembles light touch. (C) icing, or elevated stimulus threshold. Ice cubes are applied to the Dermatomes or the belly of the muscle for 15 to 20 minutes.
4. There is co-contraction around the Joint when there is severe joint compression exerted along the bone's longitudinal axis. It can be coupled with an ontogenetic pattern, including standing, sitting, quadrupedal stance, or prone on the Elbow. There are two ways to apply pressure: manually and via weight cuffs.
5. rapid light stretch and low threshold stimuli that cause the stretched muscle to initiate a phasic response. The rapid stretch has an instantaneous effect.
6. It helps to facilitate the muscle by tapping over the Tendon or Muscle.
7. Stretch reaction is triggered when pressure is applied to the belly of the muscle, stretching the muscle spindles.
8. force applied on the prominence of the bones.

Inhibitory techniques

1. Joint approximation is another term for light joint compression. used in hypertonic muscl to suppress tone.
2. Slow stroking: The tone is inhibited by gently pressing on the posterior rami slowly and firmly. After three to five minutes, the patient is allowed to relax.
3. It is possible to roll the patient slowly from a supine position to a side laying position or to rock them slowly.
4. Maintaining body heat by encircling the targeted area to be inhibited is referred to as neutral warmth. For 10 to 20 minutes, it is completed.
5. Heat that is higher than body temperature is employed as a rebound effect, so neutral heat is used.
6. Through the presence of receptors, pressure applied to a muscle's insertion inhibits that muscle.
7. Stretching continuously for a few minutes to several weeks causes the muscle spindle to relapse into longer positions. Allowing lengthy positioning will upset the antagonistic and agonistic tonal equilibrium.
8. Low threshold Golgi Tendon Organ be employed to inhibit the agonists by unresisted contraction; this would facilitate the antagonists in return.

Basic concepts

Rood's four basic concepts are;

• Mobility and stability muscles(Tonic And phasic).
• Motor development sequence .
• Appropriate sensory stimulation.
• Manipulation of the Autonomic Nervous System.

Its role with stroke patients

Rood’s approach is significant in improving the ability of independent self-care. The two components of Rood’ treatment may be the cause of this significant improvement which are ;

• Facilitation or inhibition of proprioceptors, exteroceptors, and vestibular stimulation excite the cortical level and give motor recovery.
• stimulation, another component of Rood’s approach, can also stimulate the motor activity of vital organs as well as the skeletal muscles.

Rood's approach uses different types of exercises and activities to help people recover after a Stroke. These exercises involve stimulating different parts of the body and repeating movements.Stimulating the senses and doing purposeful activities helps people get better at taking care of themselves on their own. Other research studies have also shown that these types of exercises can improve motor skills in stroke patients. For Example, for the arms, they might have to wipe a table or try to open a jar. And for the legs, they might have to stand up from a sitting position or kick a ball. so it can prevent various morbidities and mortality, including Deep Vein Thrombosis, decubitus ulcers, Pneumonia, and Contractures .