TREATMENT APPROACH

Roods approach- ( sensiromotor approach)

● INTRODUCTION

● Rood approach is a Neurophysiological approach developed by Margaret Rood

in1940.
● This neurophysiological approach was designed for the patient with motor Control
problem. According to Rood,motor functions and sensory mechanisms are
interrelated.
● Roods basic assertion was that motor pattern are developed from primitive reflexes
through proper sensory stimuli to appropriate sensory receptor.roods exploited
normal sequential development to get motor responses.
● Prinicpal-

● 1)Normalization of tone - using appropriate sensory stimuli to get

desired muscular response.

● 2)Ontogenic developmental sequence - According to Rood, sensory

motor control is developmentally based,so that during treatment first
assess current level of development and then try to reach next higher
level of control .

● 3) Purposeful movement - Roods used purposeful activities which can

help to get the desired movement pattern from the patient .

● 4)Repetition of movement- Roods encouraged to use repetitive

movements for motor learning .
 ● BASIC CONCEPTS OF ROOD Approach-

According to Rood, sensory input is Required for normalization of tone and evocation of
desired muscular responses.
Rood's four basic concepts are-

1. Mobility and stability muscles(Tonic and phasic)

According to Rood approach, muscle groups are categorized according to the type of work
they do and their responses to specific stimuli.
● Phasic muscles (also known as light work muscles or mobility muscle) are the muscle
groups responsible for skilled movement patterns with reciprocal inhibition of antagonist
muscles e.g. the flexors and adductors.phasic muscles arefast glycolytic fibre type,they
have high metabolic cost and rapidly fatigue.
● Toniic muscles (also known as heavy work muscles or stability muscle) are the muscle
Groups responsible for joint stability with co-contraction of muscles which are
antagonists in normal movement. This muscles are slow oxidative fibre type ,they have
low metabolic cost and slow fatigue
2) Ontogenic sequences
● Motor developement sequence-

1) Supine withdrawal
2) Roll over
3) Pivot prone
4) Neck co- contraction
5) prone on elbow
6) Quadruped
7) standing
8) walking

● The vital function sequence-

1) Inspiration
2) Expiration
3) Sucking
4) Swallowing liquid
5) Phonation
6) Chewing and swallowing solid
7) Speech
3) Manipulation of the autonomic nervous system
Autonomic nervous system stimulation is depend on intensity and frequency of applied stimulus
Roods made the point that activation of sympathetic nervous system is given in case of hypotonic
patient,whereas parasympathetic nervous system activate in hypertonic ,hyperkinetic and hyper
excitable patient.
Roods recommeded that the manipulation of these stimulican be used in treatment of motor
disorder patients.

i. Sympathetic Nervous System Stimuli:

It includes icing,unpleasant smells or tastes, sharp and short vocal commands, bright flashing
lights, fast tempo and arrhythmical music.

ii.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 odour.
4) Appropriate sensory stimuation -

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
Vojta Technique-
Vojta-Therapy is a dynamic neuromuscular treatment method based on the
developmental kinesiology and principles of reflex locomotion.This method is supposed
to treat patients with disorders of central nervous system and musculoskeletal system.
It was developed by child neurologist prof.vaclav vojta.

What is a Reflex Locomotion????

Reflex is an involuntary movement as a response to external stimuli. Locomotion is

defined as an ability to perform a movement from one place to another. In reflex
locomotion, there is a coordinated, rhythmic activation of the total skeletal musculature
and a CNS response at various circuit levels.

Vojta establish the global pattern of movement form the basis of relfex locomotion It
involves pressure or massage on one part of body ,stimulates related motor pattern of
stored movement acitivity as in creeping ,crawling or walking.
Vojta therapy requires an evaluation of the medical aspects of the
child’s development,before designing the appropriate treatment.
The medical evaluation considers three areas-
1) Automatic postural reactivity
2) Kinesiological analysis of the spontaneous motor function
3) Reflexology.

Vojta suggest that his therapy exercise which induce the primitive
reflexe of baby ,may be relearned by central nervous system later in
life .
Vojta therapy aim

● Modify the reflex activity by introducing a different neurological

activity to give a new physical awareness, or muscular
proprioception(balance)
● modify spinal reflxes involved in co-ordinating a movement
● Improve breathing to increase eficiency of functions
● promote growth of innate anatomical locomotor systems
● Encourage development of movement-associated neural pathways
● prevent orthopaedic degradation in severe pathological conditions
● delay degenerative neurological function.

In the practical application, there are two basic co-ordination complexes

● reflex creeping( lying flat with chest Down and backup)

● reflex rolling(lying flat with chest Up and back down )
The basic treatment is to use trigger points on the trunk and extremities to
initiate reflex movement ,which produce crawling rolling and other specific
movement .Vojta establish 18 points in body for stimulation and use the
position of reflex crawling and reflex rolling .
Indication

According to Vojta, this therapy can be applied to the patients of any age group and can be
used as standard therapy in physiotherapy for almost every movement disturbance and for
numerous illnesses:

● Stroke
● Cerebral palsy
● Lumbosciatica
● Hip dysplasia
● Respiratory distress syndrome (RDS)
● Migraine
● Peripheral paralysis of the extremities (e.g. plexus paresis, spina bifida, paraplegia, etc.)
● Various myopathies
● Problems in the breathing, swallowing and chewing functions.
● Neuro Developmental Treatment (NDT) /Bobath
approach -
(Opposite to Brunnstorm approach )
Developed by Berta Bobath,( PT )and Karel Bobath(pediatric neurologist, )
Main patient populations include,adult CVA/hemiplegia, and Cerebral Palsy.

IIT is an “problem solving approach “.it involves task specific

Posture and movement .the main aim of NDT is to improve the
Quality of life of patients by optimize their daily life activity.

During developmental and functional activities sensory

feedback (manual contact, visual integration, somatosensory
reinforcement) is essential to recovering function treatment
includes looking at the whole person and specific functional
needs; recovery vs. compensation
Essentials for Treatment Effectiveness

● Therapists must be able to observe and

distinguish normal from abnormal alignment
and movement patterns
● Therapists must be able to make the
functional retraining activities meaningful
to the patient, task specific
● Therapists must be able to select the optimal
practice method, feedback, and environment
for maximum function and independence
● Therapists must have stable footwear, good
flexibility in lumbar spine and lower extremities
for optimal body mechanics during mat
activities.
Thank you