Week 14

Question 0

Rood 4 principles of Treatment

Answer 0

1. Use reflexes to influence tone: reciprocal innervation, contraction of agonist as antagonist relaxes. Allows for mobility.
2. Sensory stimulation can produce desired results. Co-contraction allows stability. Simultaneous contraction of agonist & antagonist.
3. Heavy work: mobility on stability. Proximal muscles move while distal segments are fixed (rocking on all fours)
4. Skill: highest level of control. Combines efforts of mobility & stability (walking while transporting items)

Question 1

Rood Approach

Answer 1

Assumption that appropriate sensory stimulation can elicit specific motor responses. Developmental ontogenic pattern & sequence. Cephalo to caudal; proximal to distal

Question 2

Rood facilitation techniques (increase low tone)

Answer 2

• Tapping muscle belly 3-5x quickly before and during activity.
• Vibration over muscle belly w/ sweeping motion in direction of motion desired. Use light pressure, this adds strength to a contraction of weak muscle.
• Slow stroking facilitators withdrawal.
• Fast brushing. Icing quickly stimulates muscle and withdrawal response.
• Heavy joint compression (quadruped, prone on elbows).
• Quick stretch ( push forearm into flexion quickly)

Question 3

Weightbearing

Answer 3

Normalizes tone, good for high & low tone, both facilitory and inhibitory tech.

Question 4

Rood: Inhibitory techniques

Answer 4

• used for high tone muscles
• light jt compression
• maintained stretch: maintain lengthened position for several mins., can be done through splinting. Muscle spindles will reset to new length.
• neutral warmth: wrap in blanket or towel, used with children & serial casting
• deep pressure to tendon insertion to relax muscle

Question 5

Brunnstrom’s approach

Answer 5

Stages of recovery
Patterns of synergy(group of muscles acting as a unit & pt muscles cannot act alone)
Includes associated movements & associated reactions

Question 6

Brunnstrom’s 6 stages (arm)

Answer 6

1. Flaccidity, inability to perform any movement
2. Beginning development of spasticity; limb synergies begin to appear as associated reactions
3. Spasticity increasing; synergy patterns or some components can be performed voluntarily
4. Spasticity declining; movement combination deviating from synergies are now possible
5. Synergies no longer dominant; more movement combinations deviating from synergies performed with greater ease
6. Spasticity absent except when performing rapid movements; isolated jt movements performed with ease

Question 7

Use of synergies

Answer 7

Flexion more common in UE; extension more common in LE.

Synergies are reinforced by pt voluntary efforts through visual feedback and auditory stim.

Question 8

Associated movements

Answer 8

Normal: seen when first learning a new skill or with a challenging task ( I.e. Children using scissors often stick out their tongues )
Can stop associated movements at any time

Question 9

Associated reactions

Answer 9

Abnormal: involuntary movement of involved extremity. I.E. Affected arm flexes while unaffected arm performs an activity such as putting on a shoe.
Brunnstrom used associated reactions to elicit synergies in early stages of recovery

Question 10

CIMT (constraint induced movement therapy)

Answer 10

“Learned non-use” after stroke of upper extremity.

After a CVA, restraining unaffected side to force affected side to be used.

Question 11

CIMT Use

Answer 11

• use 3 months post stroke
• 10x10x10
• cannot have severe cog deficits or aphasia (difficulty speaking).
• pt must be able to understand instructions and safety during program
• restraint to unaffected arm 90 % of waking hours
• 2-3 week daily program
• repetitive training
• behavioral agreement & treatment diary involved