Rood 4 principles of Treatment
- Use reflexes to influence tone: reciprocal innervation, contraction of agonist as antagonist relaxes. Allows for mobility.
- Sensory stimulation can produce desired results. Co-contraction allows stability. Simultaneous contraction of agonist & antagonist.
- Heavy work: mobility on stability. Proximal muscles move while distal segments are fixed (rocking on all fours)
- Skill: highest level of control. Combines efforts of mobility & stability (walking while transporting items)
Rood Approach
Assumption that appropriate sensory stimulation can elicit specific motor responses. Developmental ontogenic pattern & sequence. Cephalo to caudal; proximal to distal
Rood facilitation techniques (increase low tone)
- Tapping muscle belly 3-5x quickly before and during activity.
- Vibration over muscle belly w/ sweeping motion in direction of motion desired. Use light pressure, this adds strength to a contraction of weak muscle.
- Slow stroking facilitators withdrawal.
- Fast brushing. Icing quickly stimulates muscle and withdrawal response.
- Heavy joint compression (quadruped, prone on elbows).
- Quick stretch ( push forearm into flexion quickly)
Weightbearing
Normalizes tone, good for high & low tone, both facilitory and inhibitory tech.
Rood: Inhibitory techniques
- used for high tone muscles
- light jt compression
- maintained stretch: maintain lengthened position for several mins., can be done through splinting. Muscle spindles will reset to new length.
- neutral warmth: wrap in blanket or towel, used with children & serial casting
- deep pressure to tendon insertion to relax muscle
Brunnstrom’s approach
Stages of recovery
Patterns of synergy(group of muscles acting as a unit & pt muscles cannot act alone)
Includes associated movements & associated reactions
Brunnstrom’s 6 stages (arm)
- Flaccidity, inability to perform any movement
- Beginning development of spasticity; limb synergies begin to appear as associated reactions
- Spasticity increasing; synergy patterns or some components can be performed voluntarily
- Spasticity declining; movement combination deviating from synergies are now possible
- Synergies no longer dominant; more movement combinations deviating from synergies performed with greater ease
- Spasticity absent except when performing rapid movements; isolated jt movements performed with ease
Use of synergies
Flexion more common in UE; extension more common in LE.
Synergies are reinforced by pt voluntary efforts through visual feedback and auditory stim.
Associated movements
Normal: seen when first learning a new skill or with a challenging task ( I.e. Children using scissors often stick out their tongues )
Can stop associated movements at any time
Associated reactions
Abnormal: involuntary movement of involved extremity. I.E. Affected arm flexes while unaffected arm performs an activity such as putting on a shoe.
Brunnstrom used associated reactions to elicit synergies in early stages of recovery
CIMT (constraint induced movement therapy)
“Learned non-use” after stroke of upper extremity.
After a CVA, restraining unaffected side to force affected side to be used.
CIMT Use
- use 3 months post stroke
- 10x10x10
- cannot have severe cog deficits or aphasia (difficulty speaking).
- pt must be able to understand instructions and safety during program
- restraint to unaffected arm 90 % of waking hours
- 2-3 week daily program
- repetitive training
- behavioral agreement & treatment diary involved
