ROODS TECHNIQUE

History & Background

system of therapeutic exercises enhanced by cutaneous stimulation for patients with
neuromuscular dysfunctions
Sensory motor technique that depends heavily on tactile stimulation to control tone and
contraction of muscle groups
Involves exteroceptive stimulation of nerve, muscle, and bone to produce and reinforce muscle
contractions
developed by Margaret S. Rood in 1954
both an occupational and physical therapist
was developed in approximately the same time period as the NDT protocols
incorporates many concepts similar to NDT but focuses much more on tactile stimulation
and more specific functional movement patterns
It was based on many neurophysiological theories and experiments
a detailed study of the neurophysiology of receptor function and the effects of sensory
stimulation on the motor system
The approach recognized duality of nervous system function
a) somatic / autonomic
b)sensory / motor
was not developed for use in children, but rather for rehabilitation following brain injury
Rood first used her techniques effectively with children with cerebral palsy
Now has been widely applied to children with CP
 Basic Principles & Assumptions
1. Sensory input is required for normalization of tone and evocation of
desired muscular responses.
Sensory stimuli affects motor response
Utilize controlled sensory input to evoke desired motor responses
Must have normal tone for normal MS movement

2. Movement occurs in developmental sequences

tx follows ontogenic stages ( i.e cephalocaudal, proximodistal rule)
Positioning is a primary concern, especially when little voluntary control exists
Can use mats, bolsters, balls, and other specialized equipment to position the patient

3. Movement is purposeful, & engagement in activities is required to

produce a normal response.
Use of an activity to demand a purposeful response or functional carryover
Movement patterns can be incorporated into games (motivation factor) to provide a focus to
regaining motor control (ex. Tug of war)
Muscular responses of the agonists, antagonists, and synergists are believed to be
reflexively programmed according to a purpose or plan

4. Repetition/ practice of (correct) movement is necessary for learning

1. Afferent stimuli
2. Muscles
3. Reflexes
4. Ontogenic patterns of development
5. Vital functions
 Afferent Stimuli
Utilize controlled sensory input to evoke desired motor responses
applied to skin, muscles and joints normalize tone produce desired movement
2 types of sensory stimulation utilized
Cutaneous: stimuli to skin
Proprioception: stimuli to joint and ms
Techniques of stimulation
Facilitatory: used to activate, facilitate or inhibit motor response; increase the neuronal activity
light stroking, fast brushing, icing, tapping, heavy joint compression, quick stretch
Inhibitory: used to inhibit unwanted movement; decrease the capacity to initiate a movement response;
decrease the neuronal activity
joint approximation (light compression), neutral warmth, (deep) pressure on tendon insertion, and
slow rhythmical movement (rolling or rocking)
The difference between inhibitory & facilitation techniques is in the mode of application rather than the type
of stimuli
Rules on sensory input
A fast, brief stimulus produces a large synchronous movement
A fast, repetitive stimulus produces a maintained response
Slow, rhythmical, repetitive sensory input deactivates the body
Stimulus can be applied to agonist or antagonistic par to either stimulate or inhibit their response
Positioning is a primary concern, especially when little voluntary control exists
Stimulus is used with a sequence of positions and activities that go through a normal ontogenic motor
development
 Afferent Stimuli
The techniques are classified according to the type of sensory receptors activated
Proprioceptive stimulation techniques
stretch, vibration, joint approximation, jt. compression, pressure
Extroceptive stimulation techniques
Touch, brushing, neutral warmth, prolonged icing, slow stroking
Vestibular stimulation techniques
Rocking, rolling
Special senses ( vision, hearing, smell and taste ) stimulation techniques
Multi-sensory stimulation techniques
Use of more than one ortwo sensory systems simulatneously
Autonomic nervous system stimulation techniques
Techniques that produce parasympathetic response
1. Slow stroking over the paravertebral areas will cause inhibition.
2. Inverted tonic labyrinthine therapy.
3. Slow, smooth, passive movement within pain free range.
4. Maintained deep pressure on the abdomen, palms, soles of the feet,
peroneal area, and skin rostral to the top lip may cause a reduction of tone
or hyperactivity
Review of Anatomy
 RECEPTIVE FIELD
(small = well
STIMULUS RECEPTOR LOCATION ADAPTATION
localized)

Mechanoreceptio
n
Touch,
Free nerve ending Hair root Variable
pressure
Steady pressure,
Merkel receptor Small Slow
texture
Superficial
Flutter, stroking Meissner corpuscle Rapid

Vibration Pacinian corpuscle Extremely rapid

Deep Large
Stretch Ruffini ending Slow

Thermoreception

Cold
Free nerve ending Superficial Small Rapid
Warm
Nociception
Thermal Small Rapid
Mechanical Large Slow
Free nerve ending Superficial
Polymodal (esp.
Large Slow
chemical)
 A-alpha nerve fibers - carries information
related to proprioception

A-beta nerve fibers - carries information related to

touch, vibration, and hair deflection
-originate from hair follicles, Meissner's corpuscles,
Pacinian corpuscles, Merkle cell endings, and Ruffini
endings
-large-diameter, myelinated nerves
- fast-conducting & has a relatively low threshold
(making it easy to stimulate)

A-delta nerve fibers - carries information related to pain and temperature

-transmit information from warm and cold receptors, a few hair receptors, and free nerve endings
-The free nerve endings supplied by A-delta fibers primarily respond to noxious mechanical
stimulation such as pinching, pricking, and crushing
-myelinated, but are smaller than A-beta fibers and thus have a slower conduction velocity

C-nerve fibers - carries information related to pain, temperature and itch

-smallest afferent peripheral nerves that are associated with pain
-Unmyelinated
-include the efferent postganglionic fibers of the sympathetic nervous system
-Those fibers that originate at deep receptors are primarily mechanoreceptors and nociceptors
-A few type C afferents are themoreceptors
-the slowest of the sensory nerve fibers in conduction and require a greater stimulation than the
others to elicit a response
 Modality Type Fiber type

-Rapidly adapting mechanoreceptors

-Meissner corpuscle, Pacinian
Touch A fibers
corpuscle, hair follicle, some free
nerve endings

-Slowly adapting mechanoreceptors

-A fibers (Merkel and Ruffini's)
Touch & pressure -Merkel and Ruffini corpuscle,
some free nerve endings
-A fibers (free nerve endings)

Vibration Meissners and Pacinian corpuscle A fibers

- A fibers (cold receptors)

Temperature Thermoreceptors
- C fibers (warmth receptors)

- A fibers (Nociceptors
of neospinothalamic tract)
Pain Free nerve ending
- C fibers (Nociceptors
of paleospinothalamic tract)
 Reflexes
an automatic response to a stimulus
Rood stresses the importance of early reflexes in the
relearning of motor control
She believed that a baby use reflexes to move initially but
modifies them and eventually replace the reflexes worth
voluntary movement
Motor patterns are developed from fundamental
patterns/reflexes which are refined and controlled as an
individual matures
In addition to stimulation of specific receptors to
produce responses, other reflexes can be used in
therapy to assist or retard the effects of sensorimotor
stimulation
e.g. tonic labyrinthine reflexes, tonic neck, vestibular reflexes,
withdrawal patterns
Muscles
Muscles have different functions
classified according to whether they are for 'light work muscle action' or 'heavy
work muscle action
light work ms
Mobilizers
more distal
Phasic
flexors and adductors
Skilled movement
heavy work ms
Stabilizers
more proximal
Tonic
extensors & abductors
Maintenance of posture

Note:
Heavy work muscles should be integrated before light work muscles
The sequence of muscle stimulation according to cephalocaudal rule:
Flexors-extensors-ADD-ABD
 Sequence of motor development
Sensorimotor control is developmental
Motor development typically occurs in an orderly sequence from head to trunk
to hands to feet, from midline to extremities, and from gross to fine muscles.
Stable posture and sensory input facilitate controlled and refined movements
and mobility (Martin, 2002)
Motor skills progress from large muscle use (such as leg and arm movements
for walking, pushing) to small muscle use (discrete hand movements for
writing)

Sequence of motor development identified by Rood: (should be strictly followed in

the application of stimuli)
I. Based on muscle function
Rood believed that neuromuscular integration is most normal if each muscle
learned to contract first as it would be used
should be made to contract based on their primary function
i.e. if it a stabilizer, it should be made to contract in such manner (& not in
mobilizing pattern)

II. Based on cephalocaudal & proximodistal rule

Flexion precedes extension; adduction precedes abduction
Ulnar patterns develop before radial patterns; rotation develop last
 Sequence of motor development
III. Based on levels of motor control

1. Mobility
Refers to an early mobility pattern (seen in newborn)
resembles the phase of child development from 0 to 3 years old
Contains the following patterns:
dorsal flexion (sucking pattern)
integrates under central control the cervical and labyrinthic tonic reflexes
allows the release of bilateral movements of upper extremities
total extension (posture of the tall doll)
first movement around the central axis (lateral rolling)
Involves reciprocal inhibition/innervation
Phasic or quick type of movement
Serves a protective function
Stimulus: low threshold, A fiber type
quick, light stretch or stroking of the distal parts
 Sequence of motor development
III. Based on levels of motor control

2. Stability
the maintenance of body position or of its segments in stable
postures (such as on four limbs, on the knees etc.)
Foundation for postural control
Tonic or static type of movement
Involves co-contraction (aka coinnervation)
simutaneous contraction of the agonist and antagonist
provides stability in a static pattern
utilized to hold a position or obj. for a long duration
Becomes evident as infant develops increasing postural tone
Stimulus: high threshold, C fiber type
Joint compression, stretch (esp of intrinsic ms of hand & feet), fast
brushing, resistance
 Sequence of motor development
III. Based on levels of motor control

3. Controlled mobility
"mobility superimposed on stability; AKA heavy work
in these patterns, proximal muscles move while distal segments are fixed
involves integration of complex movements and activities in space, fact which
implies balance, coordination and development of orientation senses, all from
stability positions
Example: upright stance and gait development
Stimulus: high threshold from spindle & joint receptors

4. Skill
the highest level of control
combines stability & mobility
proximal ms are fixed/ stable while distal ms move in space
contains the phase of perfected movements, stimulation of balance reactions,
forms of facilitation in order to obtain the passing from one posture and movement
to another as easily as possible
Example: use of upper limbs and hands and advanced balance and gait
 Sequence of motor development
IV. Based on ontogenic motor pattern

Gross movement
1. Supine withdrawal (supine flexion)
total flexion or withdrawal pattern in supine position
arms cross the chest, legs flex & abduct
utilized to gain trunk stability and elicit flexion responses
Tonic heavy work
Reciprocal innervation
Bilateral
Centered at 10ththoracic vertebrae
2. Roll over (segmental rolling)
flexion of arm and leg on the same side and roll over as the trunk rotates
utilized to elicit lateral trunk responses, and for persons who are dominated by tonic
reflexes
Phasic movement
3. Pivot prone (prone extension)
prone with hyperextension of head, trunk and legs, shoulder abduct, extend, and
externally rotate
results in an isometric contraction of the extensors and abductors
Total extension pattern
Bilateral
Center at 10th vertebrae
 Sequence of motor development
IV. Based on ontogenic motor pattern

Fixed distal segments

4. Neck Co-contraction
Ability to lift head into extension against gravity while in prone position
co-contraction of vertebral muscles
utilized to develop head control and vertebral extension
For head & neck hyperkinesia
To stabilize eyes if there is nystagmus
5. Prone On elbows
Involves trunk extension
utilized to inhibit tonic neck reflexes & provide trunk and proximal limb stability
Check for glenohumeral joint alignment
Forearm support
6. Quadruped
assumes an "on all fours" position
used to develop limb and trunk cocontraction patterns
static weight shift crawl
7. Standing
static active weight shifting
8. Walking
gait patterns are integrated into functional activities (stance, push off, heel strike
etc. )
Vital functions
A developmental sequence of vital
functions is followed
Respiration sucking swallowing
phonation chewing speech
Note: Head control should be facilitated
before swallowing & speech therapy
Techniques of brushing, icing and
pressure are used
Major reactions in response to
stimulation of specific receptors
1) Homeostatic responses:
via autonomic nervous system
(increase or decrease arousal level)
2) Protective responses:
via spinal and brain stem circuits
(protective withdrawal responses)
3) Adaptive responses:
integrate multiple regions of the
nervous system
1. Fast brushing
2. Light touch/ stroking
3. Thermal facilitation or icing
4. Heavy joint compression
5. Stretch (quick light & secondary)
6. Resistance
7. Tapping (tendon or muscle belly)
8. Pressure (muscle belly or bony prominence)
9. Auditory & visual
10. Fast rolling/ rocking
Fast brushing
Form of tactile stimulation
will have immediate and long latency
responses
effects last even after the stimulus is
removed from the body
enhances static holding postural extensors and
Modalities:
applied via a battery operated brush or
soft camel paint brush
Target area:
Stimulus is applied on skin over the muscle
to be stimulated, or
on the dermatome served by the same
spinal segment as those muscles
Application:
Stimulus is applied 5-10 seconds for each
area
Wait 30 seconds for the effect
Repeat 3-5x
Mechanism:
Stimulates C sensory fibers
Note:
First manifestation of effects may be
on opposite side of body (esp in LE)
effective over Poor circulation
Avoid applying on pinna of ear
Stimulates vagus nerve slows
HR, constricts bronchial airways,
stimulates bronchial secretion
Brushing over posterior primary rami
of L1-L2
Will cause voiding
Brushing over posterior primary rami
of S2
Will cause retention
Avoid in patients with brainstem injury
because of central inhibition
Not advised to be used in infants (may
cause seizures) use stroking instead
Light touch/ slow stroking
Is one of the simple ways of facilitation of muscle activity
Effect a fast, short lived response
The location of the stimulus and its intensity plays an important role in the
magnitude of reaction
Target area:
same as fast brushing
Application:
Rhythmically for 3 minutes
Mechanism:
Activates A fibers
by eliciting the phasic, protective withdrawal reflexes

Note:
If applied to neck sacrum over center of back will chorea athetosis or
excessive muscle tone
As soon as patient is able to voluntarily control movement, stroking and
brushing is no longer an appropriate technique
Brief Icing
C icing A icing
High threshold stimulus Used for flaccid types only
Modalities: Modalities:
Ice cube or ice popsicles
Application: Target area:
Pressed over the skin for 3-5 palms, soles or dorsal web space
sec, then water is wiped away of hands or feet
Target area: Application:
same as fast brushing Quick swipes of ice
Mechanism: Mechanism:
Used to stimulate postural, tonic Evoke a reflex withdrawal
responses via C fibers
Precautions
Note:
Same as those in fast brushing
Avoid applying over sympathetic
Resistance to movement is
chain (e.g. posterior primary usually given to reinforce it and
rami along the back) to avoid help develop voluntary control
SNS response over it
Precautions to icing
Behind ear ->sudden of blood pressure
Sole , Palm->nociceptive(avoid in children &emotionally unstable)
over posterior primary rami which shares nerve supply to vessels supplies
organ
Left shoulder in cardiac diseased

Note:
If applied to palm of hand-> mental process
- application to lips , tongue->suck, swallow, speech
- Rebound effect to icing is noted ~ 30 seconds after application
- i.e the muscle stimulated is temporarily inhibited
Heavy joint compression
High threshold stimulus
Facilitate cocontraction of muscles around a
joint
Target area:
Longitudinal axis of bones
Application:
greater than BW
Thru joint in a weightbearing position
Mechanism:
Stimulates joint receptors
Stretch
1. Quick, light stretch
Low threshold stimulus
Applied over the desired muscle before or
during voluntary contraction
Mechanism:
Activates an immediate phasic stretch reflex of
the muscle stretched & inhibits its antagonist
produce a relatively short lived contraction of the
agonist muscle and short lived inhibition of the
antagonist muscle
2. Secondary stretch
Maintained stretch at the end of the range
Resistance
A form of stretch
Application:
Resistance to isotonic movement
Manually or mechanically using gravity or BW
Mechanism:
More motor units are recruited to fire
(overflow)
muscle contraction is directly proportional to the
amount of resistance applied
Improving kinesthetic awareness and
increasing strength are another benefits
gained from resistance
Tapping
Target area:
Tendon or muscle belly
Application:
Area is percussed 3-5 times using fingertips
Mechanism:
Activates an immediate phasic stretch reflex
of the muscle stretched & inhibits its
antagonist
Pressure (muscle belly or bony prominence)

Target area: Target area:

Muscle belly
Application:
Uses manual pressure or
any equipment that
presses on the muscle
Mechanism:
Elicits a stretch response
by placing a stretch on
muscle spindle
Bony prominence
Application:
Example:
Lateral aspect of
calcaneus
Mechanism:
Stimulates
mechanoreceptors
Both facilitatory &
inhibitory
(in the example given:
facilitates medial DF &
inhibits calf muscle)
High Frequency Vibration
Use of mechanical vibrator
100-300 hz (cycles per second) at an amplitude
of 1 2 mA
Facilitates muscle contraction through stimulation
of Muscle spindle stim->tonic vibratory reflex
facilitatory effect is sustained for a brief time
after application
can be used for stimulating muscles whose
primary function is one of tonic holding
Visual system
can be used as an alternative if sensory component of the tactile,
proprioceptive or vestibular system has been lost or severely
damaged
facilitatory
bright colors (i.e. Red, yellow, orange, pink, deep purple)
bright light
random color scheme
inhibitory & calming effect
Cool colors (i.e. Blue, green, softer shades of purple (lavender,
lilac, violet)neutral colors (brown);
a darkened room
monotone color schemes
Auditory system
Can be either facilitatory or inhibitory
depends on the quality, quantity and effect of voice or through
music
depends on intact auditory system
facilitatory
Music with fast beat
Loud voice
inhibitory & calming effect
slow beat, soft music (lullabye etc.)
Smell & taste
May be used as a treatment modality especially during feeding
procedures
Some odors such as vanilia and banana facilitate sucking
movement
Withdrawal patterns can be facilitated with ammonia and vinegar
Ammonia->nose-> Parkinson mask
Lemon juice->salivation->swallowing , clear secretion from throat
Therapist should use olfactory system as a treatment technique
under restricted precautions because of its arousal and emotional
effect
1. Approximation (light joint compression)
2. Slow stroking
3. Slow rolling
4. Neutral warmth
5. Pressure (tendon)
6. Maintained stretch
7. Prolonged icing
Slow Approximation
For spastic muscle
Application:
light joint compression
Slow stroking
used to produce a generalized calming effect
by activation of ANS
Target area:
Distribution of posterior primary rami
paravertebral muscles from cervical to sacral
regions
Application:
Slow, rhythmical stroking of vertebral muscles
using alternate hands
Done for 3-5 min or until the patient relaxes
Mechanism:
Calms the sympathetic chain
Slow rolling/ rocking
Slow, rhythmical movement from supine
to sidelying, anterior-posterior movement
Use of rocking chair is a variation
Has calming effect and may be beneficial
for patients with high tone or agitation
Neutral warmth
one of the most common way to inhibit postural tone and muscle
activity
Maintains body heat
for hypertonia, spasticity, rigidity
Application:
Wrap the area to be inhibited for 10-20 min.
Modalities:
Cotton blanket, comforter, towel, hot packs, air splint, tepid bath
Mechanism:
stimulates the thermo receptors and activates parasympathetic
responses

Note:
If heat is > than that of the body, a rebound effect can occur in 2-
3 hours
Prolonged icing
more than 20 min
Application of the prolonged ice can be
used clinically by four types
ice chips
ice wraps
ice pack
immersion in cold water
Low frequency vibration
5 -50 Hz
effect on muscle through its activation of
spindle secondary endings and golgi
tendon organs.
Pressure (tendon)
stimulates pacinian corpuscles
It can be applied manually and/or through
devices such as splints
Positioning may be used to achieve an
inhibitory pressure
e.g. quadruped position to inhibit the
quadriceps muscle and the long finger
flexors of the hand
Maintained stretch
Application:
Maintained stretch in the lengthened
position (~5 min)
Mechanism:
Rebiases the spindle to the longer position
produces inhibition of muscle responses
which may help in reducing hypertonus,
(Bobath's neuro-developmental technique,
inhibitory splinting and casting technique)
Maintained touch
It can be used to produce a general
calming effect and generalized inhibition
Firm manual contacts (pressure to midline
abdomen, back) are the common used
techniques
Rood's evaluation procedures
1. Assess patients sensation and perception
2. Identify precaution/ contraindications to
treatment (i.e. circulatory defects)
3. Evaluate distribution of muscle tone
thru clinical observations and palpation
techniques
4. Determine level of motor control and postural
reaction
based on Rood's developmental sequence
5. Determine therapeutic activities
Selection of the treatment methods
depends upon the understanding of many
aspects, such as:
The neuro-physiological bases of each method.
The biomechanical influencing of the treated
body part(s), segment(s), or body as a whole
on the applied method, and the mechanical
effect of the intervention on the treated part
The nature of pathology and symptoms
affecting the patient's activity
The individual characters of each patient