ROODS APPROACH

ROODS APPROACH

 Rood's technique can be categorized as one of facilitation

and inhibition of movement. It is one of the several
neurophysiologic approaches.

 She believed that baby uses reflexes to move initially but

modifies them and eventually replaces the reflex with
voluntary movement
 Roods approach includes 3 components:

Controlled sensory stimulation

Use of developmental sequences

The use of activity to demand a purposeful response.

 The 4 principles of Roods theory are:

1.Normalisation of muscle tone

2.Sensorimotor control is developmentally based, therapy

should start from current level of development and
progress to higher levels of control

3.Movement is purposeful
Muscles
 Heavy work:  Light work:
Tonic Phasic
Slow oxidative Fast glycolytic
Deep Superficial
Single joint muscle Multi arthrodial
Pennate Fusiform or strap
Large area of attachment Small area of attachemnt
Rich blood all time Blood supply inc during activity
Low metabolic cost High metabolic cost
Slow fatigue Rapid fatique
Extensors and abductors Flexors and adductors
Stages of motor control

 Mobility

 Stability

 Controlled mobility

 Skill
 Sequence of motor development

 reciprocal inhibition- mobility

A reflex governed by spinal and supra spinal centers
Sub serves as protective function
Contraction of agonist and antagonist

 Co-contraction- stability
Simultaneous agonist and antagonist contraction with
antagonist activity higher
 Controlled mobility- heavy work
“mobility superimposed on stability”
Creeping

 Skill
Crawling, walking, reaching and activities requiring the coordinated
use of hands.
Level 1 mobility Level 2 stability 3 mobility on Skill
stability
skeleta vital skeletal vital skeletal vital skeletal Vital
l
1.Supi 1.Inspirat 4.Pivot 5.Phon 6.NC 4.Swallo 9.PE- 5.Phon
ne with ion prone (held) ation (orient w fluids arm free ation
drawal head in
space)
2.Roll 2.expirati 5.Neck 3.sucki 8.Prone 6.Chewin 12.Quadr 8.
over on cocontractio ng on elbows g ued- arm Speech
n (Shifts) free,
7.Prone on creep,
elbows rotate
3.Pivot 10.Quadrup 11.Quadru 7.Swallo 15.Stand
prone ed ped w solids ing and
(assu (shifting) walking
me)
13.standing 14.Standin
g (WS, uni
 Examination

 1. identification of the patient’s developmental level.

Treatment starts at the point at which the patient has
struggle

 2. the plan- lower level skill to higher level. Assist the

patient- desired pattern if necessary

 3. identification of muscles – facilitated or inhibited

Treatment- controlled sensory
input

 Cutaneous, thermal, olfactory, gustatory, auditory,

visual, proprioceptive stimulus to facilitate or inhibit
motor response.
 Facilitatory Inhibitory
 Moving touch  Gentle shaking or
 Fast brushing rocking

 Icing  Neutral warmth

 Quick stretch  Slow stroking

 Tapping  Joint compression

 Vestibular stimulation  Tendinous pressure

 Vibration  Maintained stretch

 Resistance
Cutaneous Mediated by procedure Effect
stimuli
Moving touch A delta sensory Hair brush 3-5 Activates low
fiber- limbic sys- strokes, 30 sec of rest threshold hair
light work m bet strokes to prevent end organ and
over stimulation free nerve
endings
Fast brushing C fibers Dermatome 3-5 sec Collaterals in
repeat after 30 sec RAS
Quick icing A fibers Skin 3 quick swipes ANS response
vibration 1a afferent of Vibrator 100-300c/s Prone used
muscle spindle 1-2 min – more time flexor muscle.
heat and friction
Quick stretch Proprioceptors in
Muscle spindle
Resistance Primary and Stabilizers
secondary endings
of MS
Tapping Afferents of MS 3-5 times
stimulus Procedure/Effect
Gentle shaking or Rhythmical circumduction of head and slight
rocking approximation UE, LE
Neutral warmth Temperature receptors in hypothalamus . 5-20
min
Slow stroking Dorsal distribution of the posterior rami of
spine from occiput to coccyx. <3min
Tendinous pressure Tendon insertion
Approximation Inhibit Muscles around joint- less or equal BW

Maintained stretch Spindle to reset the afferents of MS- less

sensitive to stretch
Rocking Forward, backward, progressing to side to side
then diagonal patterns
JOHNSTONE APPROACH
 Margaret Johnstone, physiotherapist and Founder of the
Johnstone Approach died on the 13th of April 2006 in
Peeblesshire, Scotland.

 Margaret Johnstone, FCSP, Scottish physiotherapist,

neurological rehabilitation.

 Her contributions to the world of stroke rehabilitation are

very much appreciated by a lot.
 Her first job was in a war-time neurological rehabilitation
unit near Edinburgh under the inspiring direction of Prof.
Norman Dott.

 This was followed by two years general experience and 17

years in orthopaedics with children and polio patients.

 The valuable knowledge she had accumulated then

influenced her future training ideas when faced with acute
stroke patients in her next career move.
 In 1966 Margaret started using inflatable air splints. It was
the result of a simple and practical way to address the
consequences of poor rehabilitation of the arm and hand,
and limited resources for professional follow up.

 The use of splints and other tools in therapy sessions

empowered patients. Margaret paid specific attention to
keep the hemiplegic limb out of compensatory patterns

 The Urias Johnstone air splints.

CONDUCTIVE APPROACH
 Conductive Education (CE) is an educational system of
rehabilitation for children and adults with motor disorders.

 Dr Andras Peto, believed that human brain development is

holistic and learning occurs in an integrated way,
encompassing the sensory, motor, cognitive, communication
and socio-emotional development
 Conductive Rehabilitation (Peto Method) is a highly
developed therapeutic approach for children and adults with
neurological conditions as Cerebral Palsy, Stroke Survivors,
Multiple Sclerosis, Parkinson’s disease, and Acquired Brain
Injury.

 The philosophy of Conductive Education is that all people

who have motor disorders of neurological origin can learn.
 The Components of the Process
Intentional Active Learning
Motivation
Complexity
Task Analysis
Rhythmical Intention
Conductor- regular exs to necessary skills and capabilities
Group
Family Involvement
 Conductive Rehabilitation (Peto Method) can help with
• Increasing range of movement (ROM)
• Improving awareness of body in space

• Developing symmetrical body posture

• Weight bearing and weight transferring

• Improving of balancing skills in all positions

• Forcing the ability to produce isolated and combined movements

• Developing and rebuilding of fine motor skills

• Developing eye-hand and general coordination

• Establishing security and confidence

• Introducing breathing techniques for pain reducing
• Promoting verbal and non-verbal communication skills