I. Overview
Rood was founded by Margaret Rood, PT and OT, in the 1950’s. It is a rehabilitation technique that emphasizes the use of controlled sensory stimuli to elicit purposeful responses through the application of certain actions in the order of individual development.
Rood believed that all human activities are developed from pre-existing reflexes after birth and are continuously modified by repeated sensory stimulation until the highest level of control is achieved at the level of cortical awareness.
II. Basic theory
The salient feature of Rood therapy is the facilitation or inhibition caused by the stimuli applied to the skin. That is, mechanical stimulation or temperature stimulation is applied to areas of the skin where the motor endplates are more abundant (generally the muscle belly) to induce or inhibit skeletal muscle movement, with the goal of restoring normal muscle movement patterns. Motor patterns are based on innate primitive reflex patterns, which are gradually modified by continuous use and sensory feedback to form harmonious motor control at the level of the cerebral cortex. If the correct stimulation is repeatedly applied to the skin receptors of paralyzed patients, it is possible to reconstruct the correct motor pattern.
1.Related neurophysiological basics
(1) The skin-saccade reflex associated with γ efference is shown in Figure 1.
As shown in Figure 1, stimulation of the skin covering the attachment points of tendons and muscle bellies, impulses are transmitted to the spinal cord and through γ efferent to the muscle shuttle, which can have a facilitative or inhibitory effect on the muscle depending on the nature and mode of stimulation. On the other hand, some skin-muscle reflexes are not related to γ efferent nerves.
(2) Skin-muscle shuttle reflexes unrelated to the γ efferent nerve.
As shown in Figure 2, stimulating the hair on the skin, through the hair or afferent nerve, the impulse is projected to the motor cortex via the dorsal root spinal cord-thalamic pathway, causing excitation of the thalamus at the beginning of the vertebral tract, and then out to the spinal cord via the corticospinal tract, and out to the muscle via α, which can also produce a facilitative or inhibitory response to the muscle by stimulating the skin.
2.Basic principle
(1) By applying different stimuli to the skin, the motor system can have a facilitative or inhibitory effect.
(2) Motor development proceeds in the order A→G in Figure 3.
(3) Motor control is divided into four stages from low to high level
①Activity.
②Stability.
③ Controlled activity, ③ Controlled activity
(4) Skill: Motor control is related to motor development, A, B and C in the above figure belong to !) In the diagram above, A, B, C belong to the level of !-, C, D, E, F belong to the level of 2), on the basis of D move from one side to the other, push the shoulder back and pull forward, unilateral weight-bearing, on the basis of E swing movement, unilateral weight-bearing, on the basis of F weight transfer and unilateral weight-bearing, etc. belong to the level of 3). On the basis of D, the head makes skillful movements, the free hand makes skillful movements, on the basis of E, the torso makes reciprocal activities diagonally, the free hand makes skillful movements and F and G are at the level of 4). The control of movement should be trained from low to high level.
Three, methods and techniques
(1) the promotion and inhibition of muscle
1, the method of promotion: applicable to flaccid paralysis, weak contraction, etc.
①Tactile.
A, fast brush finger, with a small electric brush, one end is equipped with bundles of soft hairs, electric brush rotation when the soft hairs open, stimulate the skin or hair on the surface of the muscle, 3 to 5 seconds, if 3 to 5 still no response, can repeat the stimulation 3 to 5 times, but also in the corresponding segment of the skin for 5 seconds. The method excites the high threshold C sensory fibers and promotes γ motor neurons. The effect peaks 30 to 40 minutes after stimulation.
B. Tapping the skin: Tapping the skin on the surface of the stimulated muscle can promote the response of the extra-saccadic muscle. Tapping the skin between the fingers on the back of the hand, the skin between the toes on the back of the foot or the palm and the sole of the foot can cause the retraction response of the limb. This method excites the low-threshold A fibers.
② of temperature: the main application of ice stimulation, local stimulation for 3 to 5 seconds, can promote muscle contraction, but also the result of excitation of C fibers, but about 30 seconds after ice stimulation often cause rebound phenomenon, that is, from excitation to inhibition, which should be noted.
③ proprioception, etc.
A. Quickly and gently tugging on the muscles.
B. Stretching the internal attachment muscles of the hand.
C. Stretching to the limit of ROM before further distraction.
D. Resisting contraction.
E. Putting pressure or pushing mo on the muscle belly.
F.Tap on the tendon or muscle belly.
G.Pressure on the bony prominence.
H.Forceful compression of the joint.
④Special sensory stimulation: suction adaptations ammonia, etc.
2.Methods of inhibition: for spasm or other cases of high muscle tone.
①Gently compress the joint.
②Pressure on the point of tendon attachment.
③push and moisten the skin surface of the posterior basal branch innervation (skin surface of the paraspinal muscles) with firm light pressure.
④Continuous traction.
⑤ slowly turning the patient from a supine or prone position to a lateral position.
⑥Medium-temperature stimulation, non-sensitive local baths, hot wet compresses, etc.
(7) distal fixation, proximal movement For conditions such as tardive dyskinesia, perform distal fixation, such as having the patient take the hands and knees position hands and knees position without moving, and in this position, make the trunk move anteriorly, posteriorly, left, right and diagonally, and if the spasticity is limited, slowly stroke or rub the skin of the muscle surface.
(2) For hypermobility applicable to conditions such as tardive dyskinesia, carry out the method of distal fixation and proximal movement, such as having the patient take the position of hands and knees hands and knees without moving, but in this position, make the trunk move anteriorly, posteriorly, left, right and diagonally, and if the range is more limited, slowly stroke or rub the skin on the surface of the muscles.
(3) The main principle of retraining of motor function is to proceed in the order of motor development.
1, from the overall consideration: according to the order in the former Figure 3-2-40. In terms of training motor control, the sequence of mobility → stability → controlled movement → skillful movement should be carried out.
2. From local consideration: flexion should be taken before extension, adduction before abduction, ulnar side before radial side, and finally rotation. In terms of which is first, the distal or proximal end, the first should be for for limb proximal fixation distal activity → distal fixation, proximal activity → proximal fixation, distal free learning skillful activity.
Fourth, the current evaluation of Rood therapy
(1) It is believed that there is a solid neurophysiological basis for facilitation through skin stimulation.
(2) The facilitation by freezing and brushing is effective only at the time of treatment and within 45-60 seconds of cessation, with brushing being more effective.
(3) To get the effect of attention, the duration of stimulation should be longer, but the effect is still not lasting after stopping.
(4) that this method further develops the traditional PNF.
(5) It is wrong to think that when skin stimulation is performed first, followed by muscle pulling for promotion, the interval between the two is 30 minutes. In fact, an interval of more than 5 minutes is no longer effective.