In this note included Roods Approach Definition Principles Basic concepts Stages of motor control Technique

1. Roods approach
 Roods approach is a neurophysiological and development
approach that was developed by margeret rood in 1950s and
1970s
 At first it is used for CP patient later it's used at patient with motor
control problem mainly neurological conditions ,rheumatoid
arthritis , osteoarthritis , post fracture and soft tissue injury
 Roods approach believes that motor output dependent on
sensory input and it is also based on the reflex /hierarchical model
of the CNS ,where the movement is facilitated or inhibited for
rehabilitation purpose
 Motor pattern are developed from primitive reflexes which is
utilized and gradually modified through sensory stimuli until the
higher control is gain
 Appropriate sensory receptors utilized in normal sequential
development will help to elicit normal motor response
Stages of motor response
1. reflex mobility
 Nearly mobility pattern
 Primary reflex governed by spinal and supra spinal centers
 before you use hand purposefully child move his or her Extremities
reflexively
2. Stability
 Simultaneous contractions of antagonists and agonists working
together to stabilize and maintain poster of the body
 Good stability in trunk, neck and shoulder

2. 3. mobility superimposed on stability
 moment of proximal limb segments with the distal ends of limbs fixed
on the basis support
4. Skill
 Skilled work with the emphasize on the movement of distal portion
of the body in a finely coordinated pattern that require control from
the higher cortical levels
Principles of roods approach
1. normalization of tone
 Using appropriate sensory stimuli for evocating the desired muscular
response
2. Ongenic development sequence
 According to roods sensory motor control is development based so
that during treatment therapist must assess current level of
development and then try to reach next higher level of control
3. Purposeful movement
 Roods use purposeful activities which can help to get the desired
movement patterns from the patient
4. Repetition movement
 Roods encouraged to use repetitive movement for motor learning
Basic concepts of roods approach
According to roods sensory input is required for normalization of tone and
evocation of motor response

3.  Mobility and stability muscle
according to roods muscle groups are categorized according to the
type of work they do and their response to specific stimuli
Mobility muscle/ light muscle/ phasic muscle
 Muscles used for skilled movement pattern with reciprocal
inhibition of antagonists
 Example flexors ,abductors
 Superficial muscles
 Multiarthrodial
 rapidly fatigue
 High metabolic rate
Stability muscle/ heavy muscle/ tonic muscle
 Muscles responsible for joint stability with co-contraction
muscle ,which are antagonist in normal moment
 Example extensors And adductors
 Deep muscles
 Single joint
 Slow fatigue
 Low metabolic rate
 Ongenic development pattern
Roods introduced two ongenic sequence
1. Motor development sequence
2. Vital functions development
Motor development sequence
1) Supine withdrawal
2) Roll over
3) Pivot prone
4) Neck co contraction
5) Prone on elbow
6) Quadrapeud
7) Standing

4. 8) Walking
1) Supine withdrawal (Flexion):
 Total flexion response towards vertebral level T10
 Requires reciprocal innervation with heavy work of
proximal segments.
Recommended:
 patients with no reciprocal flexi
 patients dominated by extensor tone
2) Roll Over towards side lying:
 Mobility pattern for extremities & lateral trunk muscles
Recommended:
 Patients dominated by tonic reflex patterns in supine
 Stimulates semicircular canals which activates the neck &
extraocular muscles.
3) Pivot Prone:
 Combined Pattern
 Demands full range of extension or neck, snoutaers,
trunk & lower extremities.
 Position difficult to assume & mantain
 Important role in preparation for stability of extensor
muscles in upright position
 Associated with labyrinthine righting reaction of the head
 Integration: STNR & TLRs.
4) Neck Contraction:
 Real stability pattern
 Activates both flexors & deep tonic extensors
 Elicits the tonic labyrinthine righting reaction reaction when
the face is perpendicular to the floor.
Recommended:
 Patients needs neck stability & extraocular control.
5) Prone on Elbows :
 Stretches the upper trunk musculature
 Influence stability scapular & glenohumeral regions
 Gives better visibility of the environment
 Allows weight shifting from side to side.
Recommended:

5.  Patients needs to inhibit STNR
6) Quadruped Position:
 Lower trunk & LE are in cocontraction.
 Can do weight shifts in forward/backward, side to side &
diagonal directions.
 Mobility superimposed on the stability
 Prepares equilibrium responses
7) Standing:
 Wt. Is equally distributed on both legs after that wt.
Shifting begins.
 UE are free to perform functions.
 Integration: righting reaction & equilibrium reactions.
8) Walking:
 Sophisticated process requiring coordinated movt.
Patterns of various parts of body.
 “support the body weight, maintain balance, & execute
the stepping motion “ Murray
The vital functions sequence
The vital functions sequence finally leads to well-articulated
speech. The ontogenic patterns are:
1. Inspiration
2. Expiration
3. Sucking
4. Swallowing liquids
5. Phonation
6. Chewing and swallowing solids
7. Speech

6.  Appropriate sensory stimulation
The relearning of muscular activity is based on the phenomena of
summation which Activates or deactivates the sensory Receptors, utilizing
afferent input to affect the anterior horn cell of the spinal cord. 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:
 Proprioceptive receptors
 Exteroceptive receptors
 Vestibular receptors
 Special sense organs
 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. Rood introduced two groups of
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 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.

7. Techniques
Roods approach has two main techniques
 Facilitatory techniques
 Inhibitory techniques
Facilitatory techniques
It is very important technique to improve the tone of flaccid muscles and it mainly
used in patients especially those who have hypotonia or muscle weakness. This
technique can help in normalizing tone and facilitating movements in the patient
Light moving touch
Procedure
Apply with a fingertips ,camel brush, cotton swap apply 3-5 strokes and allow 30
seconds of rest between strokes to prevent over stimulation. Mediated by a delta
nerve fibers sensory information that reaches the limbic system, which is a part
of the brain involved in emotions and memory.
Effects
 Increases Corticosteroid Levels in Bloodstream: This input can trigger the
release of corticosteroid hormones into the blood, which are involved in
stress response and regulation of metabolism.
 Activates Superficial Mobilizing Muscles: This input stimulates muscles
that perform lighter, skilled tasks, like those used for delicate movements.
 Stimulates A-delta Sensory Fibers Synapsing with Fusimotor System: A-
delta sensory fibers are nerve fibers responsible for transmitting sharp,
quick pain signals. When they synapse with the fusimotor system
(involved in muscle control), it can lead to a reflexive withdrawal response
(quickly pulling away from a stimulus).
 This sensory input can impact hormone levels, muscle activation, and
reflex responses, and it's often evaluated using specific sensory testing
tools.
Fast brushing

8. Fast brushing refers to a type of gentle, quick touch sensation applied to the skin.
Same procedure as the light moving touch and mediated by c nerve fibers Which
sends collaterals in the RAS
Effects
 Mediated by C Nerve Fibers: This sensation is transmitted through C
nerve fibers, which are a type of nerve fiber involved in transmitting
slower, chronic pain signals.
 Effect on Reticular Activating System (RAS): The C nerve fibers send
branches (collaterals) to the Reticular Activating System (RAS), which is a
network of nerve pathways in the brainstem involved in regulating
wakefulness and arousal
 Fast brushing, like light moving touch, involves gentle, quick sensations
transmitted by specific nerve fibers. These sensations can influence the
brain's arousal and wakefulness through connections with the Reticular
Activating System (RAS).
Quick icing or A- icing
Quick icing, also known as A Icing, involves applying ice or a cold stimulus to the
body.
Procedure
Ice is supplied to the skin in 3 quick swipes and water blotted with a towel
between swipes
Effect
 Effect on Patients with Hypotonia: Patients with hypotonia (low muscle
tone) may benefit from quick icing. The cold stimulus can help stimulate
and awaken muscles by triggering a reflexive response.
 State of Relaxation: Despite the stimulating effect on muscles, quick icing
can also promote relaxation in the body.
 Alerts Mental Processes: The sudden cold sensation can have a
stimulating effect on the nervous system, potentially increasing alertness
and cognitive processes.
 Quick icing is a technique that uses cold to stimulate muscles and mental
alertness, particularly useful for patients with low muscle tone. It can
provide a dual effect of muscle activation and relaxation, while also
enhancing cognitive alertness.
C Icing:

9. C Icing involves applying ice or a cold stimulus specifically to the abdominal area.
Procedure
Ice cube is pressed to the skin serving the same spinal segment of the muscle to
be stimulated, response may take as long as 30 min
Effects
 Promotes Reciprocal Pattern between Diaphragm & Abdominal Muscles:
The cold stimulus can encourage a coordinated movement pattern
between the diaphragm (a muscle involved in breathing) and the
abdominal muscles. This coordination is important for efficient breathing
and core stability.
 Increases Breathing Patterns: By enhancing the coordination between the
diaphragm and abdominal muscles, C icing can improve breathing
patterns, leading to more effective inhalation and exhalation.
 Enhances Voice Production and General Vitality: Improved breathing and
core stability can positively impact voice production and overall vitality,
contributing to better vocal control and energy levels.
 C icing targets the abdominal area to promote better coordination between
the diaphragm and abdominal muscles, resulting in improved breathing
patterns, voice production, and overall vitality. This technique can be
beneficial for individuals seeking to enhance respiratory function and vocal
performance.
Approximation
Approximation refers to a technique that facilitates muscle contraction by bringing
body parts closer together.
Effects
 Facilitates Muscle Contraction: By bringing body parts closer together,
approximation encourages muscles to contract. This can be beneficial for
strengthening and activating specific muscle groups.
 Combined with Developmental Patterns: Approximation is often integrated
with developmental movement patterns to promote natural and functional
movements.
 Done Manually or with Weights/Sandbags: Approximation can be
performed manually (by a therapist or practitioner) or with the use of
weights or sandbags placed strategically on the body to create resistance
and stimulate muscle engagement.

10.  Approximation is a technique used to promote muscle contraction and
strengthen specific muscle groups. It involves bringing body parts closer
together either manually or with added resistance (such as weights or
sandbags), often in conjunction with developmental movement patterns for
optimal effectiveness. This approach can aid in improving muscle tone,
coordination, and overall functional movement.
Stretch
1. Stretch Intrinsic (Stretch Reflex)
This technique activates proprioceptors (sensory receptors in muscles and
tendons) by stretching selected muscles.
Effects
Promotes stability in the shoulder region by shifting more weight onto the
ulnar (inner) side of the hands, encouraging a stronger grip.
2. Secondary Ending Stretch (Clasp-Knife Reflex)
Combines resistance and stretching to facilitate natural movement
patterns.
Effects
By stretching a muscle fully, it activates secondary nerve endings that
encourage flexor muscles to contract and inhibit extensor muscles.
3. Pressure Stretch (Palm Reflex)
Applies pressure and stretching to certain muscle groups, activating both
muscle spindles (proprioceptors) and external sensory receptors.
Effects
By pressing the pads of the thumb, index, and middle fingers and then
stretching them apart, this technique triggers sensory responses that can
enhance coordination and reflexes.These techniques aim to stimulate
proprioceptors and reflexes to improve muscle function, stability, and
coordination during movement. They are commonly used in therapeutic
settings to support rehabilitation and enhance motor skills.
Vibratory Stimulation
Used for tactile stimulation to desensitize hypersensitive skin and produce
changes in muscle tone. Activates muscle spindles’ sensory nerves to induce
muscle contractions and suppress the stretch reflex.

11. Procedure
 Vibratory stimuli are applied over muscle bellies using a high-frequency
vibrator (100-300 cycles per second).
 This activates muscle spindles’ primary sensory nerves (la afferents),
causing muscle contractions and inhibiting the stretch reflex (tonic
vibration reflex).
 Each application should last 1-2 minutes to avoid heat and friction buildup.
 Prone position (lying face down) may be suitable for vibrating flexor
muscle groups, while the supine position (lying face up) may enhance
extensor muscles
Resistance (Rood's Approach)
Rood's approach uses heavy resistance to stimulate both primary and
secondary endings of the muscle spindle.It is employed in an isotonic (constant
muscle tension) fashion during developmental activities to influence stabilizing
muscles.
Procedure
Resistance is applied during specific developmental movements or exercises to
target stabilizing muscles.The goal is to enhance muscle proprioception
(awareness of muscle position and movement) and improve motor control.
Resistance is applied during specific developmental movements or exercises to
target stabilizing muscles.The goal is to enhance muscle proprioception
(awareness of muscle position and movement) and improve motor control.
Effect on Muscle Spindles
 When a muscle contracts against resistance, it shortens, causing the
muscle spindles (sensory receptors within muscles) to adjust to this new
length.
 This process, known as "biasing" the muscle spindle, makes it more
sensitive to subsequent stretch.
Tapping (Percussive Stimulation)
Tapping involves using fingertips to gently percuss or tap a muscle area 3-5
times. This technique can be applied before or during voluntary muscle
contractions by the patient.
Effect

12.  Acts on the sensory nerve endings (afferents) of muscle spindles within
the muscles.
 Increases muscle tone (the baseline level of muscle tension) in the
targeted muscles.
Vestibular Stimulation
Vestibular stimulation refers to the activation of the vestibular system, which is
responsible for balance and spatial orientation.
Effects
 Activates Antigravity Muscles: The vestibular system activates muscles
that help maintain posture against gravity.
 Influences Muscle Tone: It affects muscle tone by engaging both
antigravity muscles and their antagonists (opposite muscles).
 Impact on Balance and Directionality: Vestibular stimulation helps regulate
balance, spatial awareness, and the ability to sense direction.
 Role in Protective Responses: The system contributes to protective
reflexes and responses to sudden movements or changes in position.
 Involvement in Cranial Nerve Function: The vestibular system influences
cranial nerves, which are important for sensory and motor functions of the
head and neck.
 Supports Bilateral Integration: It assists in coordinating movements
between both sides of the body.
 Contribution to Auditory and Language Development: Vestibular input is
linked to auditory processing and language development.
 Enhances Eye Pursuits: Stimulating the vestibular system can improve
eye movements and tracking abilities.
Types of Stimulation
 Linear Acceleration/Deceleration: Movements in horizontal and vertical
planes, such as walking or riding in a car.
 AngularAcceleration/Deceleration: Rotational movements like spinning,
rolling, or swinging.
Effect of Stimulation Speed
 Fast Stimulation: Quick movements tend to stimulate the vestibular
system.

13.  Slow Rhythmic Rocking: Gentle, rhythmic rocking motions have a calming
and relaxing effect.
Static Vestibular System in the Inverted Position
The static vestibular system refers to the part of the vestibular system that helps
maintain balance and posture during still or stationary positions. Being in an
inverted (upside-down) position activates this system.
Effects
 Increased Muscular Tonicity: In the inverted position, the static vestibular
system increases muscle tone (tonicity) in specific muscle groups.
 Muscles Activated: This includes muscles of the neck, midline trunk
extensors (muscles along the spine), and selected extensors in the limbs
(muscles that straighten the arms and legs).
 Normal Head Alignment: It’s important to maintain normal alignment of the
head with the neck to optimize the effects of the static vestibular system
Inhibitory technique
Gentle shaking or rocking
Rhythmical circumduction of the head and slight approximation is given can also
be used in the UE and LE
Rhythmical Circumduction: This involves making rhythmic circular movements.
For the head, this could mean gently rotating the head in a circular motion.
Similarly, for the upper extremities (UE) and lower extremities (LE), it would
involve circular movements of the arms or legs.
Slight Approximation: This refers to bringing joints closer together, usually by
applying gentle pressure or compression. In the context of the technique:
- For the head: Lightly pressing the chin towards the chest or bringing the head
slightly forward.
- For UE: Bringing the shoulders or elbows slightly closer to the body.
- For LE: Bringing the knees or ankles slightly closer together.
Purpose
 Inhibition of Muscle Tone: The rhythmic, repetitive movements and gentle
compression are believed to have an inhibitory effect on excessive muscle
tone, helping to relax hypertonic (overly tense) muscles.

14.  Promotion of Relaxation: By engaging in these controlled movements and
positions, the technique aims to induce a state of relaxation in the muscles
and joints.
Slow rolling
“Slow Rolling,” is a therapeutic method within Rood’s Approach used to facilitate
movement patterns and sensory input. The patient starts lying on one side (side-
lying position, SL). The therapist gently rolls the patient from the side-lying
position to a prone (on the stomach) position and back again, in a slow and
rhythmic manner. The rolling motion is performed with a consistent and steady
rhythm, promoting a predictable sensory experience for the patient.
Purpose
 Vestibular Stimulation: Slow rolling provides controlled vestibular input,
stimulating the inner ear’s vestibular system. This input can help regulate
muscle tone and influence postural control.
 Proprioceptive Feedback: The rolling movement also engages
proprioceptive receptors, which provide feedback about body position and
movement in space.
 Muscle Relaxation and Activation: The rhythmic rolling can promote
muscle relaxation in some muscles while engaging others to facilitate
movement transitions.
Neutral warmth
“Neutral Warmth,” is a method used in Rood’s Approach to help reduce muscle
tone and promote relaxation in patients with hypertonia.
The patient lies down in a recumbent (lying down) position. The therapist wraps
the patient with a blanket that is at a neutral or comfortable temperature.The
patient remains wrapped in the blanket for a period of 5 to 20 minutes.
Purpose
 The warmth affects temperature receptors in the hypothalamus (part of the
brain that regulates body temperature) and stimulates the
parasympathetic nervous system (PSNS), promoting relaxation.
 Muscle Tone Reduction: The neutral warmth helps to decrease muscle
tone in patients with hypertonia.
 Relaxation: Patients typically experience a sense of relaxation and comfort
during the procedure.

15.  Thermal Input: The application of neutral warmth provides a sensory input
that can help modulate the patient’s nervous system, leading to a
reduction in muscle tone.
 Parasympathetic Response: The warmth activates the parasympathetic
nervous system, which is responsible for promoting rest, relaxation, and
digestion.
Slow stroking
“Slow Stroking,” is a specific method used in Rood’s Approach to provide
sensory stimulation and influence muscle tone. The patient lies face down
(prone) on a surface.
The therapist applies a rhythmic, deep pressure with slow stroking movements
along the length of the spine, from the base of the skull (occiput) to the tailbone
(coccyx). The pressure is targeted over the dorsal distribution (back) of the
posterior rami (nerve branches) of the spine.The stroking should be done in a
slow and deliberate manner, and each session should not exceed 3 minutes.
Purpose
 Sensory Stimulation: Slow stroking aims to provide specific sensory input
to the nervous system, affecting muscle tone and sensory perception.
 Muscle Tone Modulation: The rhythmic deep pressure can help to
influence and regulate muscle tone.
 Rhythmical Movements: The therapist maintains a consistent and rhythmic
pace during the stroking, which is essential for its therapeutic effect.
 Targeted Area: By focusing on the dorsal distribution of the posterior rami,
the technique directly affects the sensory nerves and associated muscles
in the back.
 Caution with Duration: Limiting each session to 3 minutes helps to avoid
potential negative effects such as the rebound phenomenon.
 Rebound Phenomenon: Prolonged or excessive stroking can lead to a
rebound effect where muscle tone increases after the stimulus is removed.
Keeping the duration within limits helps to prevent this.
 Therapeutic Use: Slow stroking is used as a sensory technique to prepare
the nervous system for other therapeutic interventions or to promote
relaxation.
 Patient Response: Monitoring the patient’s response and comfort during
the procedure is important to ensure its effectiveness.

16. Tendinous pressure
The therapist applies manual pressure directly to the tendon insertion point of a
muscle. The therapist locates the tendon insertion point, which is typically where
the tendon attaches to bone. Manual pressure is then applied to this specific area
using the therapist’s fingers or hand. Tendinous pressure is particularly useful for
muscles that are spastic (excessively contracted) or tight due to neurological
conditions or muscle imbalances. By targeting the tendon insertion, the technique
can help interrupt abnormal muscle contraction patterns and promote relaxation.
Purpose
 Tendinous pressure aims to provide sensory input and influence the
muscle’s neural activity, leading to a reduction in muscle tone or tightness.
 Localized Pressure: The pressure is applied directly at the tendon
insertion site, focusing on a specific area to influence neural signaling.
 Sensory Input: The pressure provides proprioceptive and tactile sensory
input, which can help modulate muscle tone and promote neuromuscular
relaxation.
 Therapist Technique: The therapist adjusts the pressure level based on
the patient’s response, ensuring effectiveness without causing discomfort.
Approximation
Approximation involves applying gentle joint compression using a force that
is less than or equal to the body weight (BW) to inhibit spastic muscles
around the joint.
Purpose
 The goal of approximation is to provide deep sensory input to the
joint receptors, which can help modulate neural activity and reduce
hypertonicity (excessive muscle tone).
 Joint compression through approximation helps to stimulate
proprioceptors (sensory receptors) within the joint, providing
feedback to the nervous system.
 This sensory input can lead to a temporary reduction in spasticity and
promote relaxation of the surrounding muscles.

17.  Joint-Specific: Approximation targets specific joints where spasticity
or hyper tonicity is present.
 Sensory Feedback: The compression provides proprioceptive
feedback, influencing neural pathways involved in muscle tone
regulation.
 Therapist Control: The therapist adjusts the amount and duration of
compression based on the patient’s response and tolerance level.
Maintained stretch
Maintained Stretch involves positioning a muscle in an elongated or
lengthened position and maintaining this stretch over a period of time.
Purpose
 The goal of Maintained Stretch is to cause lengthening of the muscle
fibers, which can help reset the sensitivity of muscle spindles
(sensory receptors within muscles) to stretch.
 Muscle spindles are proprioceptive receptors that detect changes in
muscle length. When a muscle is held in a lengthened position for an
extended period, the muscle spindles adapt to this new length.
 Over time, the muscle spindles become less sensitive to stretch,
which can lead to a reduction in muscle tone and spasticity.
Duration and Intensity: The duration and intensity of the stretch should be
tailored to the patient’s needs and response.
Consistency: Regular application of Maintained Stretch may be necessary to
achieve and maintain optimal muscle lengthening and tone reduction.
Complementary Techniques: Combining Maintained Stretch with other
therapeutic interventions, such as sensory techniques or motor re-
education, can enhance its effectiveness.

18. Rocking
Rocking is an inhibitory method used in Rood’s Approach to promote
relaxation and reduce muscle tone. Rocking involves shifting the body’s
weight rhythmically in various directions—initially forward and backward,
then progressing to side-to-side and diagonal patterns.
Purpose
 The goal of rocking is to provide rhythmic sensory input to the body,
which can have a calming effect on the nervous system and help
decrease muscle tone.
 Rhythmic Movement Rocking is characterized by rhythmic and
repetitive weight shifts, which contribute to its inhibitory effects on
muscle tone.
 Whole Body Involvement Rocking engages multiple muscle groups
and joints, promoting overall relaxation and coordination.