Home Free Lab ReportsBasic Assumptions “Normal muscle tone is a prerequisite to movement

Basic Assumptions “Normal muscle tone is a prerequisite to movement

Basic Assumptions
“Normal muscle tone is a prerequisite to movement.” (Early, Mary B, 2013, pg.410).
– Rood believed that patients who have CNS dysfunctions may experience changes in muscle tone from hypertonicity (more tone) to hypotonicity (less tone). Normal muscle tone is constantly changing due to the demands of motor actions resulting to rood’s assumption that some muscles are used for heavy work and others for light work. Rood described light work muscles as “mobilizers” which are primarily flexors and adductor muscles whereas heavy work muscles act as “stabilizers”, which consist of extensor and abductor muscles. Its main function is to maintain good posture and holding patterns of movement however both light work and heavy work muscles collaborate to allow coordinated movement to take place. For example, when a person is putting on a button up shirt, the heavy work muscles located proximally are responsible for maintain good posture at the trunk, stable shoulders, and forearm when putting on the shirt. While the light work muscles located distally are responsible for coordination and handiness needed to button the shirt.
“Treatment begins at the developmental level of functioning.” (Early, Mary B, 2013, pg.410)
– Rood believed that the development of movement occurs in sequences and that skills are built on one another. Patients continue to the next development stage until the degree of voluntary motor control is achieved. Furthermore, treatment follows the cephalocaudal rule which begins from proximal to distal, and proceeds to the sacral area.
“Motivation enhances purposeful movement.” (Early, Mary B, 2013, pg.410).
– Rood recognized that motivation plays a key role in rehabilitation. Meaningful activities for the patient will motivate practice of desired movement resulting in a high percentage of participation in treatment.
“Repetition is necessary for the re-education of muscular responses.” (Early, Mary B, 2013, pg.410).
– Rood understood that repetition will help improve coordination and assists the brain with memorizing specific motor activity. However, it can become tedious so the occupational therapist should provide numerous activities that resemble similar motor patterns.

Principles of treatment
“Reflexes can be used to assist or retard the effects of sensory stimulation.” (Early, Mary B, 2013, pg.410).
– Rood believed that reflexes are used to influence muscle tone. She believed that the alignment of the head and neck will determine the result of an increase or decrease in muscle tone.
“Sensory stimulation of receptors can produce predictable responses.” (Early, Mary B, 2013, pg.410).
– In Rood’s approach, certain desired stimulation can result in wanted outcome. For example, a slow rocking stimulus for a rocking chair can create a calming effect which can benefit patients who experience hypertonicity.
“Muscles have different duties” (Early, Mary B, 2013, pg.410).
– Similar to the discussion of normal muscle tone is a prerequisite to movement, each group of muscles (heavy work and light work muscles) have certain functions and characteristics.
“Heavy-work muscles should be integrated before light-work muscles”. (Early, Mary B, 2013, pg.410).
– Understanding that the use of proximal muscles first before distal. For example, fine finger coordination (light work muscles) is non-functional without the strength of the proximal muscles, such as the arms.
Occupational therapy application of treatment
Cutaneous stimulation
– Stimulation of external movement that is applied to the skin can facilitate movement or inhibit undesirable movement. Responses may be delayed or immediate.
– To facilitate movement, light moving touch of the skin can activate superficial muscle stimulation.
o Examples:
o Icing is unpredictable but it’s a powerful stimulus that can be used to facilitate muscle movement.
o Fast brushing however can have a delayed response and won’t reach maximal effect until after 30 minutes of the application
– To inhibit movement, slow warm strokes to the skin will help relax tight muscles
Proprioceptive stimulation
– Proprioceptive stimulation provides control and immediate outcome of the motor response. This will only happen if the stimulus is present. However, once the stimulus is removed, so will the motor response.
– Facilitates muscle contraction for spasticity:
– Heavy joint compression – approximation to help muscle contraction
– Quick stretch – stimulate muscle contraction
– Tapping – stimulates muscles
– Vibration – stimulates muscles and enables flaccid muscle to contraction
– Inhibits spasticity:
– Neutral warmth – to relax
– Manual pressure – tendon attached to the muscle
– Positioning – put in desirable position and cast for 2 weeks – move and recast
– Slow movement (rocking) – to calm down

PNF APPROACH
Basic Assumption
PNF is based on motor development and normal movement. The brain does not register individual muscle actions but total movement through normal motor activity. This approach uses mass movement patterns that resembles every day functional activities and ADLs. PNF encourages normal functional movement and
Principles of Treatment
“Normal motor development proceeds in a Cervicocaudal and Proximodistal direction.” (Early, Mary B, 2013, pg.417).
– Cervicocaudal is a known direction from head to tailbone and Proximodistal is from body center to extremities. These directions are followed in order to facilitate fine motor coordination in the upper extremities. Without the control of the head, neck, and trunk region, fine motor coordination cannot develop efficiently.
“Early motor behaviour is dominated by reflex activity.” (Early, Mary B, 2013, pg.417).
– When a person matures, primitive reflexes are introduced and available to allow progressive development to occur such as rolling, crawling, and sitting. Tone and movement in the extremities can be affected by reflexes. For example, reaching for a coffee mug can be reinforced by having the head positioned toward the object.
“Motor behavior is expressed in an orderly sequence of total patterns of movements and posture.” (Early, Mary B, 2013, pg.417).
– Motor movements are developed progressively. Through ontogenetic rule, an infant must obtain the prerequisite skill to stand before it walks, afterwards the development of coordination occurs as a result.
“The growth of motor behavior has a rhythmic and cyclical trend, as evidenced by shifts between flexor and extensor dominance”. (Early, Mary B, 2013, pg.417).
– Muscle balance and control is important in the goals of PNF treatment. Establishing balance by first recognizing the imbalances and facilitating the weak components. For example, a who patient shows a flexor synergy, should facilitate extension.
“Normal motor development has an orderly sequence but lacks a step-by-step quality.” (Early, Mary B, 2013, pg.417).
– When an overlap occurs during development, a patient cannot perform an advanced activity until it has perfected one before it. For example, a patient who experiences with ataxia cannot handwrite while sitting may feel better writing prone on their elbows.
“Establishing a balance between antagonists is a main objective of PNF.” (Early, Mary B, 2013, pg.417).
– Adjustments in balance are implemented as movement and posture change. To improve the changes, limiting the agonist and going against the synergies will improve the development of stable posture.
“Improvements in motor ability depends on motor learning.” (Early, Mary B, 2013, pg.417).
– Auditory, visual and tactile are multisensory inputs that is used for motor learning in the PNF treatment approach.
o Auditory
– The tone of voice used will influence a client’s response. Using concise and clear verbal tone is recommended. Assertive and sharp tone will cause maximal stimulation response. Soft and calm tone will encourage smooth movement
o Visual
– Helps to coordinate and initiate movements.
o Tactile
– Where therapist or patient’s hand is guiding and reinforcing the correct movements.

“Goal directed activities and functional approaches.” (Early, Mary B, 2013, pg.417). By
– Using PNF technique to redevelop normal muscle tone and re-educate muscles for functional activities and ADLs.
Occupational therapy application of treatment
– PNF focuses on diagonal and spiral movement patterns (supination and pronation). Additionally, manual contact, use of multi-sensory approach, approximation, traction and stretching
– Diagonal movement patterns are important when performing purposeful movement and functional activities.
BRUNNSTROM APPROACH
Basic Assumption
– The Brunnstrom approach utilizes synergy patterns to acquire full function by using only the affected side of the body. Brunnstrom based her intervention on a concept that when there’s a damaged CNS, it undergoes an “evolution in reverse”. Limb synergies are gross patterns of limb extension and flexion that originate in primitive reflexes and spinal cord patterns. Brunnstrom believed that patients progress with synergies and that motor learning will be acquire new skills.
Principles of Treatment
Motor Recovery after Cerebrovascular Accident
Stage 1: Flaccidity
– The goal is to apply regular stimulation to the muscles to cause spasticity
Stage 2: Spasticity
– Once spasticity is reached, the client is taught to control synergy patterns and achieve voluntary control even if it’s minimal.
Stage 3: Voluntary control over synergies
– When hypertonicity increases or peaks, patients develop control over tone by using opposite reflex pattern resulting growing voluntary muscle control. The goal is to achieve voluntary control with extensor synergy.
Stage 4: Spasticity decreases
– Spasticity begins to decrease, patient starts developing control over limb and spastic pattern. Patient’s later acquire the ability to control experiences of spasticity.
Stage 5: Basic limb synergies lose dominance
– Synergies become less dominant and voluntary muscle control is heightened. Movement combinations enables the patient to engage in ADL that require flexion and extension regularly.
Stage 6: Individual joint movements
– Synergies become absent and the patient is close to independence in occupation. Coordination beginning to normalize.
Stage 7: Normal function is restored
– Synergies are absent, patient is able to perform normal functioning.
Occupational therapy application of treatment
– Balance and trunk control is obtained through alternating sitting positions by moving in various positions and external devices such as pillows and cushions.
– Bed positioning – helps normalize muscle tone and prevent contractures by placing the patient in opposite synergy pattern.
– Bed mobility – turning toward the affected side is often easier than turning onto the unaffected side during transfer.
NDT (BOBATH) APPROACH
Basic Assumption
– NDT also known as neurodevelopmental approach or Bobaths which believed in relearning normal movement. This approach encourages the use of both sides of the body, with the development of alignment and symmetry of the pelvis and the trunk. This approach tries to avoid compensatory techniques because it may lead to overuse.
Principles of Treatment
– The goal of NDT is to normalize tone
Occupational therapy application of treatment
– Weight bearing
o Weight bearing on the affected side is effective to normalize tone
– Trunk Rotation
o Rotation of the trunk while standing or sitting will encourage shifting to the affected side. It also increases awareness to the affected side via sensory input.
– Slow controlled movement
o Slow controlled movement are encouraged because it reduces the likeness of abnormal movement.
– Proper position
o Proper alignment will help normalize tone and sensory input.
– Incorporating the UE into activity
o Incorporation of the affected side into purposeful activities.
DIFFERENCES AND SIMILARITIES BETWEEN THE 4 APPROACHES
BOLD = Similarities
Rood Approach
– Sensation stimulation via thermal and touch
– Ontogenetic
– Utilize primitive reflex
– Cephalocaudal, proximal to distal
– Stability is necessary before mobility
– Functional activity
– Facilitation and inhibition (BRUNNSTROM)
– Reduce abnormal tone

PNF Approach
– Diagonal and twisting movement pattern
– Overlap may occur
– Functional movement
– Limiting the agonist
– Going against synergy
– Rhythmic initiation
– Mass movement to enable movement
– Multi-sensory approach: auditory, visual and tactile
– Utilize primitive reflex
– Ontogenetic
– Cervicocaudal, proximal to distal
– Stability is necessary before mobility
– Functional activity

Brunnstrom Approach
– Utilize primitive reflex
– Progress with synergies
– Focuses on gaining control over individual muscles
– Only used the affected side
– 7 stages of motor recovery
– Functional activity
– Stability before mobility
– Reduce abnormal tone (ROOD)

NDT/Bobath Approach
– Quality of movement is important
– Alignment / symmetry
– Bilateral, unilateral approach
– Rotational movement occurs
– Avoid abnormal movement
– Avoid synergy movement and primitive reflex
– Avoid compensatory movement
– Stability before mobility
– Functional activity
– Functional movement
– Facilitation and inhibition

Discuss the relevancy of the sensorimotor approaches to your work as a rehab assistant.
– Sensorimotor approaches are important to understand because having a good knowledge of the four sensorimotor approaches will help differentiate which approach to use when working in the field as a rehab assistant. Exposure to clients who experience hypertonicity, hypotonicity and/or CVA can benefit rehab assistants in understanding the use of each approach. Most of the four approaches have common ideas, mainly focusing on stability before mobility. The common goal for each approach is to reduce abnormal movement, normalize tone, increase symmetrical posture, balance and regain independence to perform for purposeful activities. The use of the approaches will vary depending on the therapist, patient and their condition.