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Rood Outline
Normal Growth & Development According to Margaret Rood
| Question | Answer |
|---|---|
| What is central state? | Overal mental & physical status of an individual at any given point in time |
| Three Basic Components that comprise central state? | Autonomic, Somatic, Cortical |
| Ergotropic | Sympathetic: more alert, tone relatively increased, cortex desynchronized; More wide awake, higher arousal level |
| Trophotropic | Parasympathetic; Less arousal, relatively lower mm tone (opposite of ergotropic) |
| Why is the central state concept useful? | Framework for assessing pt's overall state of readiness for fxnal activities; Preparation for fxnal activity & Maintenance of appropriate state |
| Is preparation or maintenance of activity more challenging? | Maintenance |
| Skill & precision of PT eval enhanced by careful attention to? | Central state & its components; Response to techniques geared toward state alteration; Subsequent input needed to maintain appropriate state |
| What 2 components comprise the developmental sequence? | Vital & Skeletal |
| What are vital components? | Breathing, Articulation, B&B, etc. |
| What are skeletal components? | Stages of motor control (what PT is concerned with!) |
| 2 Primary Motor Functions developed in sequence of skeletal functions? | Mobility & Stability |
| Mobilizing Functions | Elongation, Concentric, Elongate before you activate |
| Stabilizing Functions | Co-contractions |
| What 2 additional responses develop from combining mobility & stability? | Mobility superimposed on stability & Skill |
| Mobility Superimposed on Stability | Distal fixed, can still move & do different actions |
| Skill | Good speech (very distal), fine motor, skill can't really be taught- if you have a normal system, you acquire it; Ex: head still so tongue can move & produce speech |
| Development of Functional Mobility | Key patterns of supine flxion & prone extension can be viewed as laying the groundwork for further motor developments |
| Reciprocal innervation | Supine flexion & pivot prone are 2 patterns that exemplify phenomenon |
| Rolling | Uses parts of supine flexion & prone extension |
| Withdrawal Supine (Supine Flexion) | Reciprocal innervation; Integrates TLR; ATNR also integrated so unilateral & contralateral motions that were predominant are giving way to bilateral actions; This pattern: flexors activated, extensors elongated |
| Withdrawal Supine also useful for? | ROM measurements; Increasing symmetry, breaking up tone; Respiratory |
| How would you assess supine flexion? | Place child in supine, sidelying, or semi-reclined position |
| What part of the body provides passive stability? | Trunk |
| Ribs/Respiration | Age appropriate rates; Babies are shallow breathers |
| UEs | Learn anti-gravity flexion; Scapular & humerus begin to dissociate at age-appropriate times |
| LEs | Newborns: flex/abd/ER hips/knees; by end of 6 months should be able to get legs fairly straight |
| What pattern is associated with efficient sucking movement, coordinated with swallowing & respiration? | Skeletal Flexion; first functional integration of autonomic & somatic functions with trophotropic bias |
| What reflex is used to roll at this point? | ATNR- no RALBA, should practice rolling over to increase RALBA |
| Pivot Prone aka? | Prone extension (reciprocal innervation pattern); Considered a mobilizing pattern, bilateral reciprocal pattern; extensors activated & flexors elongated; Helps prepare for stability |
| How to assess pivot prone? | Pt in antigravity position (prone) |
| Eyes & Head | Relatively midline looking relatively horizontally; maintain head in midline with mouth parallel to floor |
| Spine, UEs, LEs | Spine: extended UEs: Relatively more extended LEs: PF & Legs extended |
| Characteristics of mm active in patterns of fxnal mobility | a. Fibers parallel to long axis of mm b. Mm cross 2+ joint c. Distal attachment/both attachments small & tendinous d. Located more laterally/distally e. More superficial than stabilizing mm f. Move distal point of attachment toward proximal point |
| Characteristics of mm active in patterns of fxnal mobility | g. Flexor mm/mm associated with flexor patterns h. Active when distal lever free & NWB i. Initiate mvmt to perform brief bursts j. Shorten/concentric contractions k. Major role in distal actions during skill |
| Receptor functions associated with mobility patterns | Activating quick protective response; Distal mvmt for skill |
| Development of Stability | Co-contraction; occurs sequentially in key patterns of PoE, PoH, all 4's, semi-squat, standing |
| Stability | Motor funciton that fixes portions of the body so WB can be done |
| Pivot Prone | First stability-developing pattern; Exxential pre-req for all WB patterns; Dependent on labyrinthine righting reflex |
| Pivot Prone | Major postural mm activated: Deep tonic extensors of neck/trunk; scapular adductors; downward rotators of scapula; GH extensors, ERs; Le extensors |
| What 2 things does pivot prone/inverted position do? | Extensors max contracted & mm spindles slack; Normal tonic gamma stim allows polar ends to contract; This biases mm spindle to shorten & any mvmt into flexion stimulates Ia's in extensors; Flexors in max range (stretch), 2ndary endings are most stimulated |
| Co-contraction easier from what position | If you starts from total extension; mvmt into flexion stimulate Ia's in extensors which facilitates extensors & inhibits flexors; & max stretch on flexors from total ext stimulates 2ndary endings that facilitates flexion |
| Once in co-contraction, both groups of mm are in sub-max range, which leads to? | Extensors: facilitates extensors & inhibits flexors; Flexors: facilitates flexors & inhibits extensors |
| Most important Rood Principle? | Using strong extensors from the inverted position or pivot prone to drive the flexors in co-contraction to provide stability for all subsequent activity |
| Neck Co-Contraction | Sub-occipital mm stretched as head brought from the face vertical position to face horizontal position |
| PoE | From pivot prone to PoE, certain mm groups stretched to cause co-contraction; helps develop unilateral stability |
| PoH | Arms fully extended at elbow & weight supported on open hands |
| Quadruped | Upper trunk & UEs at peak of stability-developing stages & assume full WB of UEs with trunk in a horizontal position; This reflects cephalocaudal & proximodistal trends in WB |
| Semisquat | After child is ambulatory; Co-contraction of leg mm in midrange position |
| Baby standing on balance board with only heels supported, what happens as they stand up? | If they go into PF all the way, this is new; if no PF occurs, they have more experience in this position |
| Standing & Walking | Is first static & bilateral, then become unilateral when WS occurs; Upright standing represents highest level of co-contraction sequence |
| Characteristics of mm of fxnal stability | a. Fibers run obliquely b. 1+ attachments seem broad & aponeurotic c. Medial/proximal than mobility mm acting on same joint d. Deeper e. Cross 1 major joint f. Move point of proximal attachment toward point of distal attachment |
| Characteristics of mm of fxnal stability | g. Perform heavy work h. Endurance muscles i. Work primarily in a stretched position j. Major role in proximal fxn during skill |
| Purpose of stability patterns? | Provide a steady background of neuromm activity that will be regulatory for mobility patterns; respond to basic tonic rhythms in body |
| Sensitivity to stretch in deep extensors thought to be developed in what position? | Pivot prone; important in stability development is the stretch that WB in prone positions puts on tonic intrinsic mm of hands & feet |
| After gaining ability to stabilize body parts in midrange WB position, what does the child begin? | Experimenting with mvmt out of midranges |
| Development of mobility superimposed on stability | Concerned with WB patterns, extremity action that occurs when distal parts involved are fixed on supporting surface & with trunk & neck mvmts that occurs in a horizontal position |
| Neck Co-Contraciton | Once deep tonic neck extensors elongated (supine flexion) & activated (pivot prone), child can reorient head to face vertical position, rotate & hold new position |
| WS in PoE begins in what direction? | Lateral |
| PoE | pushing backward first then pulls forward and shifts side to side; forearm/elbow held in place while mvmt occurs in thoracic region, SGs & shoulder joints |
| Quadruped | Rocking forward, back, side to side; allows dendrite growth ; Large ranges of rocking |
| Standing | WS; side to side & repeated bouncing; when child stands, frees UEs to perform skills |
| Characteristics of mm active at level 3 | a. Mvmt of body in WB position that services body for unilateral WB b. WS in stable extended position begins with large range of rocking mvmts c. Range of walking gradually decreases until perfect 90/90 in quadruped |
| Characteristics of mm active at level 3 | d. Increase in demand on stabilizer on WB extremity leading to increased co-contraction of mm on that extremity e. Extremity away from which weight is shifted is free to execute skill |
| Receptor fxns associated with level 3 | Most important additions are speculated to be from the high threshold spindle & joint receptors |
| Skilled Movements | Rapid, varied, well dissociated |
| What is the hallmark of skilled mvmt? | ROTATION |
| Development of Skill | Distal part of extremity is free & mvmts are superimposed on stability |
| PoE & PoH | Neck has begun level of skilled fxn. more rostral activities of speech articulatoin & eye control make significant gains |
| Quadruped | One UE will assume weight while other reaches forward to grasp & explore |
| Standing & Walking | Erect posture is skill position for upper trunk b/c it frees UEs for manipulation even more than WS in all 4's |
| Characteristics of Muscle | Stabilizers- provide more refined regulation of mobility than at any previous stage; Most distal & most rostral mobilizers are essential for skilled mvmt of the highest order |
| T/F: Unilateral WB is part of stability? | TRUE: PoE: pivot prone-> PoE, certain mm groups are stretched to cause co-contraction. Child starts to develop unilateral stability |
| T/F: In pivot prone &/or co-contraction patterns, the extensors are at max length to stimulate secondary endings in those muscles? | FALSE: max stretch on flexors from total extension will stimulate secondary endings; Always results in facilitation of flexors |
| T/F: WB in standing allows UEs to engage in skilled activity? | TRUE: When child stands, UEs freed to perform skills |
| T/F: Adequate ROM needed even as functional stability develops? | TRUE: Key pattern series identifies, in sequence, crucial constellation of motor competencies leading to ambulation. Need all components; |
| T/F: The central state of each person moves along a continuum? | TRUE: Must develop one stage to move on to the next |
| T/F: Stimulation to areas of the body with large representations in the sensory cortex elicits stability pattern responses? | FALSE: Areas with large representation in sensory cortex are for SKILL. Most distal & most rostral mobilizers are the essential ones for skilled mvmt of the highest order. |
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