Roods Approach is developed by Margaret Roods in 1940, for treating central nervous system disorders. This approach can be divided in to two category.
a) Faciliatory
b) Inhibitory
this approach is based on four basic concepts which are.
Duality,
The ontogenetic sequence
Manipulation of the autonomic nervous system
The level of excitability of the anterior horn cell.
While considering the other treatment approaches such as Brunnstornm, Bobath PNF etc. This approach is criticized for its physiologic explanations and rationales. Even though these criticisms are scientifically justifiable that does not imply this approach is not effective .
The basic concept of roods technique is the idea that all the motor responses are developed by the primitive reflexes through the proper stimulation of appropriate sensory receptors during the normal sequential development of motor system. This technique undergone many revisions since its origin.
Roods approach deals with the activation or deactivation of sensory system and its associations with somatic, autonomic and psychologic factors in regulating motor responses.
Many researchers have suggested that neurophysiological techniques are better than the conventional approaches for patient ⁽3,4⁾
PRINCIPLES
1. Normalization of tone: Normalizing Muscular responses using appropriate sensory stimuli is an important principle in Roods Approach
2. Ontogenic developmental sequence: Roods Approach recommends use of ontogenic developmental sequence to achieve optimal results.
3. Purposeful movement: Rood used purposeful activities which can help to get the desired movement pattern from the patient.
4. Repetition of movement: Rood encouraged to use repetitive movements for motor learning
BASIC CONCEPTS OF ROOD APPROCH
Rood's four basic concepts are
1. Mobility and stability muscles(Tonic and phasic)
According to Roods approach muscles are divided in to two category
Tonic Muscles, slow oxidative and deep muscle responsible for joint stabilization.
Phasic Muscle, are superficial fast glycolytic, easily fatigable muscles and usualy one joint muscle responsible for skilled movements.
2. The Ontogenic Sequence
Roods Explained Two type of ontogenic sequences.
a. The Motor development sequence The motor development sequence finally leads to skilled and finely coordinated movements. The ontogenic motor patterns are: i. Supine withdrawal ii. Roll over iii. Pivot prone iv. Neck co-contraction. v. Prone on elbow vi. Quadruped vii. Standing viii. Walking
Rood also categorized these patterns under the following four phases, using the concepts of light and heavy work: i. Mobility or reciprocal innervations: It is a nearly mobility pattern, primarily reflex governed by spinal and supraspinal centers. It includes supine withdrawal, roll over, and pivot prone. ii. Stability or co-contraction: It is defined as simultaneous contractions of antagonists and agonists, working together to stabilize and maintain the posture of the body. It includes pivot prone, neck co-contraction, prone on elbow, quadruped and standing. iii. Mobility superimposed on stability: It is defined as a movement of proximal limb segments with the distal ends of limbs fixed on the base of support. It includes weight shifting in prone on elbows, quadruped, and to and fro rocking that later on can be promoted to crawling in different directions. iv. Skill or Distal mobility with proximal stability: It is defined as skilled work with the emphasis on the movement of distal portions of the body in a finely coordinated pattern that require control from the highest cortical level.
b. The vital functions sequence
The vital functions sequence finally leads to well-articulated speech. The ontogenic patterns are: i. Inspiration ii. Expiration iii. Sucking iv. Swallowing liquids v. Phonation vi. Chewing and swallowing solids vii. Speech .
3. Appropriate sensory stimulation
Rood utilized the anterior horn cell excitability by using sensory stimulus. According to Rood, there are four types of receptors which can be stimulated and in order to get desired muscular response: i. Proprioceptive receptors ii. Exteroceptive receptors iii. Vestibular receptors iv. Special sense organs .
4. Manipulation of the autonomic nervous system
Autonomic nervous system stimulation is also a part of Rood’s concept. Different intensity and frequency of the same stimulus determined which system (whether sympathetic or parasympathetic) will be activated. Rood made the point that activation of the sympathetic nervous system is given in case of hypotonic somnolent, whereas parasympathetic nervous system activate is given in hypertonic, hyperkinetic, and hyper excitable patients. Rood recommended that the manipulation of these stimuli can be used in treatment of motor disorder patients.
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 Nervous System Stimuli: 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.
Techniques
Faciliatory Technique
Inhibitory Technique
Faciliatory techniques are used to improve postural tone in a goal directed activity. Tactile, proprioceptive and vestibular movements are used to induce or facilitate movement response. this techniques includes
Light touch
brushing
Fast strocking
Stretching
Positioning
resistance
Joint Compressions
Inhibitory Techniques are just opposite to faciliatory movement. it usually used to maintain the muscle tone.
neutral
warmth
gentle stroking
Light joint compression
Pressure
Roods Approach For incomplete nerve injury
roods facilitation techniques are used in treating incomplete nerve injury.
pattern of facilitations include
Quick Brushing
Quick icing
Vibration
Tapping
Quick Brushing
Applied for 3 to 5 times followed by 30 sec pause and repeated. The Dermatomes And myotomes should be same and skin overlying the muscles should share its root supply. its effect last up to 20 minutes.
Quick icing
immediately after quick brushing. its effect last up to 15 minutes
Vibrations
Vibrations are given at the musculotendinous junction of stretched muscle or at the muscle belly.
the high frequency vibrations are given at 100 to 200 HZ. Facilitation of muscle contractions by tonic vibration reflex effect last up to10 min
Tapping
use light force and give 3 to 5 taps applied manually over muscle tendon or muscle belly. stimulation of muscle spindle primary endings which results in reflex facilitation of the muscle via the monosynaptic reflex
Rood’s approach is a neurophysiological based approach where relevant physiology is the most important part of this approach – an aspect which was not clearly explored in her time. Though the entire Rood’s approach is not used in present time, but some Rood techniques are very common in clinical practice. Current scientific evidence shows Rood's approach has various valid components which can be justified as valid and viable. A therapist may get more effective results if they use it with physiological base.
Reference
Rood, M. S. Neurophysiological reactions as a basis for physical therapy. Physical Therapy Review. 1954;34:444-449
Rood, M. S. Neurophysiological mechanisms utilized in the treatment of neuromuscular dysfunction. American Journal of Occupational Therapy. 1956;10,220-225.
.Metcalfe, A. B., &Lawes, N. A modern interpretation of the Rood Approach. Physical therapy reviews. 1998; 3(4), 195-212.
Kawahira K, Shimodozono M, Etoh S, Kamada K, Noma T, Tanaka N. Effects of intensive repetition of a new facilitation technique on motor functional recovery of the hemiplegic upper limb and hand. Brain Injury. 2010 Sep 1;24(10):1202-13.
Rood, M. S. The use of sensory receptors to activate, facilitate, and inhibit motor response, autonomic and somatic, in developmental sequence. In C. Sauely(Ed.). 1962.
Ayres, A. J. Occupational therapy directed toward neuromuscular integration. Occupational therapy. 1963;3: 358-459.
Goff B. The application of recent advances in neurophysiology to Miss M. Rood's concept of neuromuscular facilitation. Physiotherapy. 1972 Dec 10;58(12):409.
Prepared By
Dr. Gayathri Rajeevan (PT)
BPT,MPT (Cardiorespiratory) Senior Specialist Physiotherapist, Rebounds Physiotherapy And Rehabilitation Center
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