Rood’s technique, also known as multisensory stimulation, was developed in the 1950s by Margaret Rood, an American physical therapist and occupational therapist, whose main approach to treating brain-injured patients was to apply mild mechanical or superficial thermal stimulation to specific areas of the skin and to elicit purposeful responses through the application of certain motor actions in accordance with the individual’s developmental sequence. She applied the findings of neurophysiology and motor development to the rehabilitation of brain-injured patients, such as children with cerebral palsy, adults with hemiplegia, and other patients with motor control disorders.Rood devoted her life to clinical treatment and teaching, and rarely wrote books; therefore, the documentation of Rood’s techniques in the literature is mainly presented by some of her students.
I. Theoretical basis
Rood believed that muscles have different functions, and in most cases they contract synergistically, but some play a major role in “light work”, while others play a major role in “heavy work”.
(1) Proper sensory stimulation: Proper sensory stimulation can maintain normal muscle tone and induce the desired muscle response. The correct sensory input is necessary to produce the correct motor response. Controlled sensory input can reflexively evoke muscle activity, which is the earliest developmental stage of gaining motor control.
Sensory motor control builds on development and develops gradually. Therefore, treatment must progressively progress from lower to higher level sensorimotor control, depending on the individual patient’s developmental level.
The acquired reflex muscle responses can in turn be used to develop the control of these responses in the centers above the spinal cord.
(2) The completed movement should be purposeful: the purposeful response of the patient to the movement is used to induce the movement pattern of the subcortical centers. The active, antagonistic, and synergistic muscles are coordinated with each other according to the purpose of the treatment. For example, when the brain gives the command “pick up this book”, all the subcortical centers involved in this action are programmed to facilitate or inhibit the corresponding muscles, and the different muscle groups coordinate to complete the action. The cerebral cortex does not control a single muscle, and the patient’s attention is focused on the final goal: “picking up the book”, rather than on the movement of the muscles of the trunk and limbs. The sensations in the movement are the basis for mastering the movement and help to reflexively induce control of the movement. Although purposeful movement is not ideal for some patients with severe disease (it is difficult to induce this response), this approach is indeed a very effective treatment, especially for the trunk, upper extremities or proximal lower extremities.
(3) Focus on sensory-motor responses: Repeated sensory-motor responses are necessary for movement mastery, and the various activities used should not only be purposeful responses, but also repeatable.
2, the use of individual developmental laws to promote motor control Rood believes that, in terms of the laws of individual development, the development of motor control is generally flexion first, then extension; first adduction. Then abduction; first ulnar deviation, then radial deviation; and finally rotation.
3, using the 4 stages of motor control development Rood divided the developmental level of individual motor control into the following 4 stages.
(1) Repetitive motion of joints: accomplished by contraction of active muscles and inhibition of antagonistic muscles. For example, the movement of the limbs in newborns.
(2) Contraction of periarticular muscle groups together: this is the base help for fixation of proximal joints and development of distal joint skills.
(3) Distal fixation and proximal movement: for example, before an infant learns to crawl, the hands and feet touch the ground and the trunk swings back and forth.
(4) Skillful movements: proximal fixation and distal movement. For example, walking, crawling, hand use, etc.
4, using the 8 movement patterns of individual development Rood summarized 8 movement patterns according to the laws of individual development (Figure).
(1) Supine flexion pattern: manifested as trunk flexion in the supine position with bilateral symmetry and cross dominance (Figure 1).
(2) Turning or rolling mode: manifested by ipsilateral upper and lower limb flexion, turning or rolling the body (Figure 2)
(3) Prone extension mode: In prone position, the neck, trunk, shoulders, hips and knees are extended, and the center of the body is located at the level of chest 10. This posture is the most stable, but the application of this mode should be avoided in patients with high extensor muscle tone (Figure 3).
(4) Synergistic contraction mode of the cervical muscles; the head can be lifted against gravity in the prone position, which is the mode that promotes head control (Figure 4).
(5) Prone flexion elbow mode: prone position with anterior shoulder flexion and weight bearing with flexed elbow; this is the mode that extends the spine (Figure 5).
(6) Hand-knee position support mode: When the neck and upper limbs have been able to maintain stability, this position is available to facilitate the development of synergistic contraction of the lower limbs and trunk. The support progresses from static to dynamic and from more to less support points. For example, first bilateral hands and knees on the ground, then lift one or two support points (one hand or one knee), and finally develop to crawl (Figure 6).
(7) Standing: first standing still with both lower limbs, then, standing on one leg and then shifting the weight (Figure 7)
(8) Walking: the skillful stage of standing, including support, leg lifting, swinging, and foot following the ground (Figure 8).
Movement patterns in the order of individual development: supine flexion; turning or rolling; prone extension; concerted contraction of the cervical muscles; prone elbow flexion; support on hands and knees position; standing; walking.
II. Basic techniques and methods
(A) the use of sensory stimulation to induce muscle response
1. Tactile stimulation includes quick brushing and light touch. Rapid brushing refers to the use of soft bristle brush on the skin of the treatment area for 3-5 seconds of back and forth brushing, but also in the corresponding muscle groups of the spinal cord segment of the skin area stimulation, such as 30 seconds after no response, can be repeated 3 to 5 times. Light touch is to touch the dorsal skin between the fingers or toes, the palm of the hand or the bottom of the foot with a light touch to elicit a retracted response from the stimulated limb, and repeated stimulation of these areas can cause a cross-reflex extensor response.
2, temperature stimulation commonly used to stimulate ice, because ice has the same effect as a quick brush and touch. The specific method is to put ice on the local 3 to 5 seconds, and then wipe dry, can cause the same effect as a quick brush. Since ice can cause a protective sympathetic response (vasoconstriction), stimulation of the posterior branch of the spinal nerve in the back should be avoided. When using ice to quickly stimulate the palms of the hands and soles or fingers and toes between the dorsal skin, can cause the same effect as light touch – reflex retraction, when the retraction response should be appropriate to add resistance for the movement of the limb to improve the stimulation effect.
3, pulling the muscle quickly and slightly pulling the muscle can cause muscle retraction now this effect is immediately visible. Pulling the adductor muscle group or flexor muscle group, can promote the group of muscles and inhibit its antagonist muscle group; pulling the internal muscles of the hand or foot can cause the adjacent fixed muscle synergistic contraction. For example, a strong grip can pull the intrinsic muscles of the hand, and if this action is performed in a weight-bearing position (elbow and knee position), it can promote the contraction of the fixed elbow and knee muscles.
4, lightly tapping the tendon or muscle belly can produce the same effect as a quick pull.
5, squeezing squeezing the muscle belly can cause the pulling response served with the pulling muscle shuttle; squeezing the joint hard can cause the muscles around the joint to contract. Therefore, a variety of support positions, for example, supine flexion of the hip, flexion of the knee bridge position, flexion of the elbow prone position, hands and knees 4-point kneeling position, standing position when picking up one or two limbs and make the affected limb weight bearing, etc.. All of them can produce similar effects. For example, pressure on the lateral aspect of the heel bone can promote the ankle dorsiflexors and inhibit the calf triceps, producing ankle dorsiflexion; pressure on the medial aspect of the heel bone is the opposite.
6, special sensory stimulation Rood often choose some special sensory stimulation to promote or inhibit muscle Ran. For example, auditory and visual stimuli can be used to promote or inhibit the central nervous system; fast-paced music has a facilitating effect, while soothing music has an inhibiting effect; the tone and tenor of the therapist’s speech can influence the patient’s behavior; brightly lit, brightly colored environment can produce a facilitating effect.
(B) the use of sensory stimulation to inhibit muscle response
1.Squeezing slight squeezing joints can relieve muscle spasm.
(a) squeeze the shoulder b, c pressurize the tendon
(1) Squeeze the shoulder: When treating a hemiplegic patient’s painful shoulder, the therapist can hold his elbow, make the upper limb abduct, and then push the upper arm gently toward the scapular glenoid so that the humeral head enters the joint fossa and hold it for a moment, which can relax the muscles and relieve pain (Figure a).
(2) Light pressure on the back. In the treatment of childhood cerebral palsy, squeezing the sacrospinous muscle in the back relaxes the muscles throughout the body. For example, with the patient in prone position, the therapist alternates hands to lightly compress the muscles on both sides of the spine from the back of the neck down to the sacrococcygeal area, and the relaxation effect of the muscles can usually occur after 3-5 minutes.
(3) Pressure on the tendon: When the flexor tendon of the hand is spastic or contracted, continuous pressure on the flexor tendon of the hand can cause relaxation of this muscle (Figure b, e).
2, pulling sustained pulling or holding an already lengthened muscle in that position for minutes, days or even weeks can inhibit or reduce spasticity. For example, in patients with significant flexor spasm, a series of splints or plaster rests can be used to keep the spastic flexor muscle in the lengthened position for several weeks of continuous tension, followed by a new splint or rest to keep the tendon in a longer state.
(C) Clinical application of Rood technique should be based on the nature and degree of the patient’s motor disorder and the developmental stage of motor control, from low to high level.
1.Delayed paralysis For delayed paralysis, rapid and stronger stimulation should be adopted to induce muscle movement, and the following methods are commonly used.
(1) Rapid brushing: rapid brushing on the skin area of key muscles or active muscle groups.
(2) Overall movement: The overall movement of the limb is used to promote contraction of muscle weak areas.
(3) Stimulation of the bony end: appropriate tapping, rapid icing and vibration at the bony end.
(4) Inducing muscle contraction: immobilize the transport end of the limb and apply pressure and resistance at the proximal end of the limb to induce deep muscle activity.
2.Spastic paralysis For spastic paralysis, slow and light stimulation should be taken to inhibit abnormal muscle movements, and the following methods are commonly used.
(1) Light brushing; gently brushing the antagonistic muscles of the spastic paralysis muscle group as a way to induce the response of the key muscles.
(2) Slow pulling: slow pulling is used to lower the tone of the extensor muscles of the neck and lumbar region, the scapular girdle retractor, and the quadriceps.
(3) Repetitive contraction: reduce spasm in the shoulder and hip muscle groups by non-resistant repetitive contraction (Fig.)
(4) Limb weight-bearing. The patient can be placed in a weight-bearing position to stimulate the mechanoreceptors of the joint and promote postural stability through compression and pressure during weight-bearing. For example, to reduce upper extremity spasticity and promote weight-bearing capacity in the forearm and hand, the humeral head must be correctly positioned within the articular glenoid without inversion and internal rotation; similarly, for lower extremity weight-bearing, the hip joint must be in a neutral position without flexion and inversion.
(5) Individual pattern: the appropriate pattern can be selected according to the developmental pattern introduced earlier and according to the needs of the individual. For example, it should be avoided if the extensor muscle tone is increased.
3. Swallowing and articulation disorders are mainly induced by muscle response, and stronger stimulation can be taken locally by the following methods.
① Lightly brush the upper lip, face and throat, avoiding stimulation of the lower jaw. lower part of the oral cavity.
②Stimulate the lips and face with ice and rub the front of the lower jaw with ice.
③ Resist blocking sucking.