Exam 3: PNF Flashcards
What does PNF stand for?
Proprioceptive Neuromuscular Facilitation
Describe what the term “proprioception” indicates in the definition of PNF?
Stimuli produced within an organism by movements of its own tissues that is stimulated by some aspect of muscle length or tension, joint angle, and head position
Describe what the term “neuromuscular” indicates in the definition of PNF?
Pertaining to nerves and muscles
Describe what the term “facilitation” indicates in the definition of PNF?
Promotion or quickening of natural processes, more specifically the effect produced in nerve tissue by the passage of an impulse that lowers the resistance to transmission so that a subsequent stimuli may be elicited more easily
What are the five main principles of the foundations of PNF?
- Target the whole person rather than a specific problem or body segment
- Mobilize reserves of untapped potential
- Positive approach to reinforce what a patient can do at a physical and physiological level
- Achieve highest level of function though most efficient movement combinations
- Integrate the principles of motor control and learning
What is the systems model of motor control, and what did it lead to the creation of with PNF?
Functional movement based on the interaction of many systems. Helped to created the stages of motor control
What are the stages of motor control?
- Mobility
- Stability
- Controlled mobility
- Static dynamic
- Skill
What is the general concept of direct PNF techniques?
Apply activities and techniques to the most impaired areas
What is the general concept of indirect PNF techniques?
Apply activities and techniques to less involved areas create movement and synergies that will develop movement in the more involved areas
What two things should be considered when determining the appropriate activity and technique for PNF?
The personal environment and context. What is the posture or movement that is functionally necessary for the patient
What are the three parameters for PNF intervention?
- Frequency
- Duration
- Intensity
What is the principle of “afterdischarge”?
The effect of the stimulus continues after the stimulus is removed. As the strength and duration of the stimulus increased, the afterdischarge will increase as well
What is the result of afterdischarge?
Feeling of increased power that comes after the maintained static contraction
What is temporal summation?
A succession of weak stimuli to cause excitation
What is spatial summation?
Weak stimuli is simultaneously applied to different areas of the body to reinforce each other and cause excitation
What is irradation?
Spreading and increased strength of a response that occurs when either the number of stimuli or the strength of the stimuli is increased
What is successive induction?
An increased excitation of the agonist muscles follows the stimulation of their antagonists
What is reciprocal innervation or reciprocal inhibition?
Contraction of the muscles is accompanied by the simultaneous inhibition of their agonists as a means of coordinating movement
What are the four categories within PFN treatment that the therapist has to consider?
- Learning sequence
- Diagonal pattern
- Elements
- Techniques
What is a learning sequence?
The organization of postures and movements based on normal and typical growth and development. Is not a linear approach, and will reflect the development of motor abilities
What are diagonal patterns of movement?
Highly sophisticated set of movement patterns for the extremities and trunk which are based on normal and typical patterns of movement observed in functional activities
True or False: Diagonal patterns of movement incorporates movement in multiple planes and are based on normal and typical muscle synergies
True
How are extremity patterns named?
By what is happening at the proximal joint
The Ulnar Thrust pattern is a combination of what two movements?
Proximal D1 flexion and distal D1 extension
The Ulnar Withdrawal patterns is a combination of what two movements?
Proximal D1 extension and distal D1 flexion
The Radial Thrust pattern is a combination of what two movements?
Proximal D2 extension and distal D2 flexion
The Radial Withdrawal pattern is a combination of what two movements?
Proximal D2 flexion and distal D2 extension
What are the four combinations of extremity patterns?
- Bilateral symmetrical
- Bilateral asymmetrical
- Symmetrical reciprocal
- Asymmetrical reciprocal
What is the bilateral symmetrical combination pattern?
Same diagonal and same direction
What is the bilateral asymmetrical combination pattern?
Different diagonals in the same direction
What is the symmetrical reciprocal combination pattern?
Same diagonal in different directions
What is the asymmetrical reciprocal combination pattern?
Different diagonals in different directions
What two patterns can address the upper trunk?
Chop/reverse and lift/reverse
What pattern is the lead arm doing for a chop/reverse?
D1
What pattern is the lead arm doing for a lift/reverse?
D2
What is the purpose of elements or procedures for facilitation?
Influence direction of movement, type of muscle contraction, and level of motor control the patient is capable of progressing to
What are the 7 elements or procedures for facilitation?
- Tactile stimulus
- Body positioning and mechanics
- Resistance
- Verbal stimulation
- Visual stimulus
- Approximation and compression
- Traction and distraction
Describe the element of tactile stimulus
Placement of hands in the direction of movement or on the actual muscles to activate and convey the direction and force that is required for the movement
Describe the element of body positioning and mechanics
Therapist aligned within the diagonal and is weight shifting with the patient to help the patient know what direction they should be moving in and allow for full ROM
Describe the element of resistance
Can be mechanical, manual, or gravitational. Enhanced concentric, eccentric, isometric, maintained isotonics, movement initiation, stability, relaxation, ROM, and sensory awareness
Describe the element of verbal stimulation
Define the type of muscle contraction, direction of motion, increase arousal and responsiveness, or promote relaxation
Describe the element of visual stimulus
Feedback for getting the idea of the activity, monitor progress, increase muscle activation and ROM. Have them watch their hands and body during the movement
Describe the element of approximation and compression
Used to facilitate extensor muscles and stability around the joint
Describe the element of traction and distraction
Used to increase ROM at a joint
Describe the technique Normal Timing
Used to develop normal coordination of the components of the movement pattern when there is adequate strength but sequencing is impaired. Proximal motion is delayed until the desired response is elicited in the distal components
What is the rationale for Normal Timing?
Based on the concept of irradiation and the fact that quick stretch is superimposed on the contracting muscle and will enhance the motor response. Repetition will enhance motor learning
What is the application for Normal Timing?
Appropriate for patient who is having difficulty recruiting distal components of the movement pattern because of impaired coordination
Describe the technique of Rhythmic Rotation (RR)
Therapist passively moves the extremity and trunk through increments of range while slow rotating about the axis
What is the rationale for Rhythmic Rotation?
Inhibit the reticular activation system and stimulate the parasympathetic nervous system to induce relaxation
What is the application for Rhythmic Rotation?
Increase mobility, particularly effective with hypertonia
Describe the technique of Rhythmic Initiating
Slow rhythmic movement that starts passive, the progressed to active assisted, then progressed to active motions through increments of range
What is the rationale for Rhythmic Initiation?
Inhibit the arousal of the reticular activating system and calm the patient by reflexive autonomic changes
What is the application for Rhythmic Initiation?
Mobility and controlled mobility stages of motor control. Useful for patients who have difficulty initiating active movement or lacks PROM
What patient population would benefit from Rhythmic Initiation?
Spasticity or rigidity
Describe the technique of Repeated Contractions (RC)
Patient isotonically contracts within the weak pattern in one direction. At the point of weakness, pt holds position, and the quick stretch is applied at the end of the range. Isometric contraction is held at the end of the range prior to quick stretch
What is the application for Repeated Contraction?
Weakness through any part of the range to increase mobility, stability, and controlled mobility
What is the rationale for Repeated Contraction?
Repeated use of the stretch reflex to elicit active muscle recruitment for the muscles under the tension of elongation
Describe the technique Timing for Emphasis
Weak or desired component is emphasized. Resist the strong component (likely proximal) while applying quick stretch to weak distal component
What is the rational for Timing for Emphasis?
Irradiation and the fact that quick stretch is superimposed on the contracting muscle will enhance firing
Describe the technique of Hold Relax Active Movement (HRAM)
Therapist resists an isometric contraction of the agonist in shortened range. Therapist passively moves limb to it is in the lengthened range and applies a quick stretch
What is the rationale for Hold Relax Active Movement (HRAM)?
Recruit more muscle activity
What is the application for Hold Relax Active Movement (HRAM)?
Weakness through range and facilitate active movement in and out of posture
Describe the technique of Slow Reversal (SR)
Isotonic contraction is followed by an isotonic contraction of the opposite muscle group
What is the rationale for Slow Reversal (SR)?
Successive induction, quick stretch stimulates the lengthened muscle
What is the application for Slow Reversal (SR)?
Development of normal timing and balanced activity between the agonist and antagonist to facilitate controlled mobility and skill stages of motor control
Describe the technique of Agonist Reversals (AR)
Enhance eccentric muscle control. Patient performs concentric contraction of muscle group and then performs eccentric contraction of same group
What is the rationale for Agonist Reversals (AR)?
Muscle fibers are stretched during the eccentric contraction to enhance muscle activity
What is the application for Agonist Reversal (AR)?
Graded eccentric control through pattern or functional transition
Describe the technique of Shortened Held Resisted Contractions (SHRC)
Low intensity isometrics in shortened ranges for at least 10 seconds. Promotes slow twitch recruitment of postural muscles and improve endurance
What is the rationale for Shortened Held Resisted Contractions (SHRC)?
Isometrics improves muscle response when body weight resistance is added later. Recruit slow twitch muscles necessary for postural control, endurance, and accuracy of movement
What is the application for Shortened Held Resisted Contractions (SHRC)?
Promote stability in safe positions
Describe the technique of Alternating Isometrics (AI)
Resist isometric in one pattern immediate followed by isometric in the antagonist pattern for postural endurance. Make sure to complete in optimal alignment
What is the rationale for Alternating Isometrics (AI)?
Resistance increases motor recruitment so stability is reinforced. Joint receptors that respond to approximation contribute to stability and controlled mobility
What is the application for Alternative Isometrics (AI)?
Reinforcement of stability and controlled mobility
Describe the technique of Rhythmic Stabilization (RS)
Simultaneous recruitment isometrically of all muscles that surround a joint. Resistance gradually increased with repetition and ultimately results in co-contraction
What is the application for Rhythmic Stabilization (RS)?
Stability and strength to maintain a given posture of the extremity or trunk. Increase mobility in the presence of pain
Describe the technique of Hold Relax (HR)
Therapist resists isometric of the range limiting muscle or the opposite muscle. Hold for 7-9 seconds and then relax. Once relaxed, pt actively moves into new range
What is the application for Hold Relax (HR)?
Increase ROM or mobility
Describe the the technique of Contract Relax (CR)
Therapist resists the range limiting pattern, but allows for rotation to occur. Hold for 7-9 seconds, and then actively move into new range
What is the application for Contract Relax (CR)?
Increase ROM and assist with mobility stage of motor control
Describe the technique of Resisted Progression
Appropriate resistance of functional movement sequence to reinforce combination and coordination of sub-components of the functional task
What is the rationale for Resisted Progression?
Sensory input via manual contacts, stretch, resistance, and verbal commands to reinforce movement
