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Rood Outline

Normal Growth & Development According to Margaret Rood

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.
Created by: 1190550002