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NMR II > Exam 3: PNF > Flashcards

Exam 3: PNF Flashcards

1
Q

What does PNF stand for?

A

Proprioceptive Neuromuscular Facilitation

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2
Q

Describe what the term “proprioception” indicates in the definition of PNF?

A

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

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3
Q

Describe what the term “neuromuscular” indicates in the definition of PNF?

A

Pertaining to nerves and muscles

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4
Q

Describe what the term “facilitation” indicates in the definition of PNF?

A

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

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5
Q

What are the five main principles of the foundations of PNF?

A
  1. Target the whole person rather than a specific problem or body segment
  2. Mobilize reserves of untapped potential
  3. Positive approach to reinforce what a patient can do at a physical and physiological level
  4. Achieve highest level of function though most efficient movement combinations
  5. Integrate the principles of motor control and learning
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6
Q

What is the systems model of motor control, and what did it lead to the creation of with PNF?

A

Functional movement based on the interaction of many systems. Helped to created the stages of motor control

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7
Q

What are the stages of motor control?

A
  1. Mobility
  2. Stability
  3. Controlled mobility
  4. Static dynamic
  5. Skill
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8
Q

What is the general concept of direct PNF techniques?

A

Apply activities and techniques to the most impaired areas

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9
Q

What is the general concept of indirect PNF techniques?

A

Apply activities and techniques to less involved areas create movement and synergies that will develop movement in the more involved areas

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10
Q

What two things should be considered when determining the appropriate activity and technique for PNF?

A

The personal environment and context. What is the posture or movement that is functionally necessary for the patient

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11
Q

What are the three parameters for PNF intervention?

A
  1. Frequency
  2. Duration
  3. Intensity
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12
Q

What is the principle of “afterdischarge”?

A

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

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13
Q

What is the result of afterdischarge?

A

Feeling of increased power that comes after the maintained static contraction

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14
Q

What is temporal summation?

A

A succession of weak stimuli to cause excitation

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15
Q

What is spatial summation?

A

Weak stimuli is simultaneously applied to different areas of the body to reinforce each other and cause excitation

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16
Q

What is irradation?

A

Spreading and increased strength of a response that occurs when either the number of stimuli or the strength of the stimuli is increased

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17
Q

What is successive induction?

A

An increased excitation of the agonist muscles follows the stimulation of their antagonists

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18
Q

What is reciprocal innervation or reciprocal inhibition?

A

Contraction of the muscles is accompanied by the simultaneous inhibition of their agonists as a means of coordinating movement

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19
Q

What are the four categories within PFN treatment that the therapist has to consider?

A
  1. Learning sequence
  2. Diagonal pattern
  3. Elements
  4. Techniques
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20
Q

What is a learning sequence?

A

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

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21
Q

What are diagonal patterns of movement?

A

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

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22
Q

True or False: Diagonal patterns of movement incorporates movement in multiple planes and are based on normal and typical muscle synergies

A

True

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23
Q

How are extremity patterns named?

A

By what is happening at the proximal joint

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24
Q

The Ulnar Thrust pattern is a combination of what two movements?

A

Proximal D1 flexion and distal D1 extension

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25
Q

The Ulnar Withdrawal patterns is a combination of what two movements?

A

Proximal D1 extension and distal D1 flexion

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26
Q

The Radial Thrust pattern is a combination of what two movements?

A

Proximal D2 extension and distal D2 flexion

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27
Q

The Radial Withdrawal pattern is a combination of what two movements?

A

Proximal D2 flexion and distal D2 extension

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28
Q

What are the four combinations of extremity patterns?

A
  1. Bilateral symmetrical
  2. Bilateral asymmetrical
  3. Symmetrical reciprocal
  4. Asymmetrical reciprocal
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29
Q

What is the bilateral symmetrical combination pattern?

A

Same diagonal and same direction

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30
Q

What is the bilateral asymmetrical combination pattern?

A

Different diagonals in the same direction

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31
Q

What is the symmetrical reciprocal combination pattern?

A

Same diagonal in different directions

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32
Q

What is the asymmetrical reciprocal combination pattern?

A

Different diagonals in different directions

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33
Q

What two patterns can address the upper trunk?

A

Chop/reverse and lift/reverse

34
Q

What pattern is the lead arm doing for a chop/reverse?

A

D1

35
Q

What pattern is the lead arm doing for a lift/reverse?

A

D2

36
Q

What is the purpose of elements or procedures for facilitation?

A

Influence direction of movement, type of muscle contraction, and level of motor control the patient is capable of progressing to

37
Q

What are the 7 elements or procedures for facilitation?

A
  1. Tactile stimulus
  2. Body positioning and mechanics
  3. Resistance
  4. Verbal stimulation
  5. Visual stimulus
  6. Approximation and compression
  7. Traction and distraction
38
Q

Describe the element of tactile stimulus

A

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

39
Q

Describe the element of body positioning and mechanics

A

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

40
Q

Describe the element of resistance

A

Can be mechanical, manual, or gravitational. Enhanced concentric, eccentric, isometric, maintained isotonics, movement initiation, stability, relaxation, ROM, and sensory awareness

41
Q

Describe the element of verbal stimulation

A

Define the type of muscle contraction, direction of motion, increase arousal and responsiveness, or promote relaxation

42
Q

Describe the element of visual stimulus

A

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

43
Q

Describe the element of approximation and compression

A

Used to facilitate extensor muscles and stability around the joint

44
Q

Describe the element of traction and distraction

A

Used to increase ROM at a joint

45
Q

Describe the technique Normal Timing

A

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

46
Q

What is the rationale for Normal Timing?

A

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

47
Q

What is the application for Normal Timing?

A

Appropriate for patient who is having difficulty recruiting distal components of the movement pattern because of impaired coordination

48
Q

Describe the technique of Rhythmic Rotation (RR)

A

Therapist passively moves the extremity and trunk through increments of range while slow rotating about the axis

49
Q

What is the rationale for Rhythmic Rotation?

A

Inhibit the reticular activation system and stimulate the parasympathetic nervous system to induce relaxation

50
Q

What is the application for Rhythmic Rotation?

A

Increase mobility, particularly effective with hypertonia

51
Q

Describe the technique of Rhythmic Initiating

A

Slow rhythmic movement that starts passive, the progressed to active assisted, then progressed to active motions through increments of range

52
Q

What is the rationale for Rhythmic Initiation?

A

Inhibit the arousal of the reticular activating system and calm the patient by reflexive autonomic changes

53
Q

What is the application for Rhythmic Initiation?

A

Mobility and controlled mobility stages of motor control. Useful for patients who have difficulty initiating active movement or lacks PROM

54
Q

What patient population would benefit from Rhythmic Initiation?

A

Spasticity or rigidity

55
Q

Describe the technique of Repeated Contractions (RC)

A

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

56
Q

What is the application for Repeated Contraction?

A

Weakness through any part of the range to increase mobility, stability, and controlled mobility

57
Q

What is the rationale for Repeated Contraction?

A

Repeated use of the stretch reflex to elicit active muscle recruitment for the muscles under the tension of elongation

58
Q

Describe the technique Timing for Emphasis

A

Weak or desired component is emphasized. Resist the strong component (likely proximal) while applying quick stretch to weak distal component

59
Q

What is the rational for Timing for Emphasis?

A

Irradiation and the fact that quick stretch is superimposed on the contracting muscle will enhance firing

60
Q

Describe the technique of Hold Relax Active Movement (HRAM)

A

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

61
Q

What is the rationale for Hold Relax Active Movement (HRAM)?

A

Recruit more muscle activity

62
Q

What is the application for Hold Relax Active Movement (HRAM)?

A

Weakness through range and facilitate active movement in and out of posture

63
Q

Describe the technique of Slow Reversal (SR)

A

Isotonic contraction is followed by an isotonic contraction of the opposite muscle group

64
Q

What is the rationale for Slow Reversal (SR)?

A

Successive induction, quick stretch stimulates the lengthened muscle

65
Q

What is the application for Slow Reversal (SR)?

A

Development of normal timing and balanced activity between the agonist and antagonist to facilitate controlled mobility and skill stages of motor control

66
Q

Describe the technique of Agonist Reversals (AR)

A

Enhance eccentric muscle control. Patient performs concentric contraction of muscle group and then performs eccentric contraction of same group

67
Q

What is the rationale for Agonist Reversals (AR)?

A

Muscle fibers are stretched during the eccentric contraction to enhance muscle activity

68
Q

What is the application for Agonist Reversal (AR)?

A

Graded eccentric control through pattern or functional transition

69
Q

Describe the technique of Shortened Held Resisted Contractions (SHRC)

A

Low intensity isometrics in shortened ranges for at least 10 seconds. Promotes slow twitch recruitment of postural muscles and improve endurance

70
Q

What is the rationale for Shortened Held Resisted Contractions (SHRC)?

A

Isometrics improves muscle response when body weight resistance is added later. Recruit slow twitch muscles necessary for postural control, endurance, and accuracy of movement

71
Q

What is the application for Shortened Held Resisted Contractions (SHRC)?

A

Promote stability in safe positions

72
Q

Describe the technique of Alternating Isometrics (AI)

A

Resist isometric in one pattern immediate followed by isometric in the antagonist pattern for postural endurance. Make sure to complete in optimal alignment

73
Q

What is the rationale for Alternating Isometrics (AI)?

A

Resistance increases motor recruitment so stability is reinforced. Joint receptors that respond to approximation contribute to stability and controlled mobility

74
Q

What is the application for Alternative Isometrics (AI)?

A

Reinforcement of stability and controlled mobility

75
Q

Describe the technique of Rhythmic Stabilization (RS)

A

Simultaneous recruitment isometrically of all muscles that surround a joint. Resistance gradually increased with repetition and ultimately results in co-contraction

76
Q

What is the application for Rhythmic Stabilization (RS)?

A

Stability and strength to maintain a given posture of the extremity or trunk. Increase mobility in the presence of pain

77
Q

Describe the technique of Hold Relax (HR)

A

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

78
Q

What is the application for Hold Relax (HR)?

A

Increase ROM or mobility

79
Q

Describe the the technique of Contract Relax (CR)

A

Therapist resists the range limiting pattern, but allows for rotation to occur. Hold for 7-9 seconds, and then actively move into new range

80
Q

What is the application for Contract Relax (CR)?

A

Increase ROM and assist with mobility stage of motor control

81
Q

Describe the technique of Resisted Progression

A

Appropriate resistance of functional movement sequence to reinforce combination and coordination of sub-components of the functional task

82
Q

What is the rationale for Resisted Progression?

A

Sensory input via manual contacts, stretch, resistance, and verbal commands to reinforce movement

NMR II (27 decks)

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