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Basic Principles of PNF
Patient’s Position Therapist’s Body Position Manual Contact Elongation, Spring Test, Stretch Stimulus Resistance Verbal Command Use of Visual Execution of Proper Pattern Facilitation of Optimal Timing
Motor responses that are affected by manual contact
Strength or power
Direction of movement
Effect of manual contact on direction of movement is that it decreased ______ _______ ____ created by multiple contacts, patients response is easier or more precise.
conflicting sensory input
Application of appropriate manual contact
Lumbrical Grip
Identify specific location for contact
Should follow Three C’s
Muscles used by lumbrical grip
Intrinsic muscles
Contact surfaces used by manual contact
Palm - especially thenar and hypothenar eminences
Finger pads, not finger tips.
Correct contact is the specific point which facilitates the ________ in the correct direction. General guideline is to choose a surface which faces directly into the ________ desired.
appropriate contraction, line of movement
Three C’s of Appropriate touch
Confidence
Control
Compassion
Learn to be invited in by the patient to the appropriate depth.
Two types of muscle contractions
Isotonic
Isometric
Types of Isotonic Contraction
Concentric - Shortening contraction
Eccentric - Lengthening contraction
Maintained Isotonic - No movement but with the intent to move.
Commands for isotonic contractions
Concentric: Push, Pull
Eccentric: Let go slowly, or Slowly let go
Maintained Isotonic: Keep it there, or Don’t let me move you.
Resistance of an isometric contraction:
Slow and Low
Commands for an Isometric Contraction
Hold It
Don’t let me move you. Don’t Push
Most effective use of an isometric contraction is facilitating and training the ______ contractions throughout the body. Used to facilitate a ______ response.
Core muscle, fiber specific
Resistance can be affected by:
Patient’s position Gravity Existing reflexes The diagonal pattern The position of the distal component.
Differences between use of traction and approximation. in the categories of joint pain, type of force, and postures used
Traction Used with painful joints Elongation of a segment Mostly used in NWB postures Approximation Carefully used with painful joints Compression of a segment Used in mostly WB postures.
The use of traction and approximation ads and additional ___________ to the directional resistance.
Force Vector
The therapist must be aware of the ___________ created by both the restaance and traction or approximation to ensure smooth and appropriate resistance.
Resultant force
The therapist must be sure to avoid using traction or approximation to ___________ the movement rather than _________ the resistance
Assist
Enhance
Traction is the elongation of a segment to __________ of the segment’s core muscles and promotes a _____________
Increase muscular response
CoreFirst movement strategy
The direction of traction is always applied ______________ and is ________ in force
Away from the apex of motion
consistent
Resistance must be ___________ to balance the force of the traction
Graduated
Approximation is the compression of a segment to _________
Promote stability
The desired response during approximation can be initiated or reinforced by a reflex producing ________ followed immediately by _____________
Quick Approximation
Maintained Approximation Pressure
Care must be used during approximation to avoid _______ and to consider underlying __________
Pain
Pathology
Elongation of a muscle increases its responsiveness to cortical stimulation is the definition of ____
Stretch Stimulus
A spinal reflex used in conjunction with the techniques and procedures of PNF to facilitate a reflex contraction is the definition of a _____
Stretch Reflex
How is the stretch reflex best facilitated?
Use of a quick stretch
This should always be applied before applying a stretch stimulus
Spring test
The stretch reflex is synchronized by a _____ to stimulate a volitional effort by the patient when possible
Verbal command
The stretch reflex is reinforced by the immediate application of ________. This resistance must occur within the first few degrees of movement by the patient or the effects of the stretch reflex will be diminished as the proper _________ will not be facilitated and resisted.
Appropriate resistance
Core response
The stretch stimulus can be applied in a midrange by applying it to _______ to generate tension
An existing isometric contraction
Contraindication to a quick stretch
Hyperactive stretch reflex not under voluntary control
Pain
Normal Timing allows for
Dynamic stability with controlled mobility
The normal timing of a response can be altered to emphasize an individual component. This utilization of timing is referred to as _____________ and is often used to make the other techniques _______ ______ and to ensure the appropriate ______ ______
Timing for emphasis, more effective, motor recruitment.
Positioning not only refers to the issue of _________, but also the IPA’s unique concept of ________ a segment prior to elongating and finding the pattern
Support and mid-range alignment
Setting
The basic philosophy of PNF developed from the premise that __________
All human beings, including those with disabilities, have untapped existing potential
The effectiveness of any treatment program is dependent upon both the therapist and patient having well-defined ____ and the intention that those ____ will be achieved
goals, goals
Treatment is directed towards ________ and the improvement of the patient’s _________
Patient education
Performance of functional activities
The treatment approach is always _________, reinforcing and utilizing that which the patient can do on a _______ and ______ level
Positive
physical and emotional
The ability to _____ is an individual characteristic. Therefore, treatment is tailored to the individual with his ability to cooperate and _______ considered.
Learn, Learn
When treating a patient the therapist must remember that all problems, neurological and orthopedic affect the system as a _______. Therefore, the approach should be _______, addressing sensory, musculoskeletal, and psychological elements to ensure that each treatment is directed at a total human being not a specific problem.
Whole
Integrated
The purpose of treatment is to assist the patient to attain the _______ _____ of ______ possible through the development of the _______ ______ _______ system.
highest level of function
Most efficient neuromuscular
The process for _________ which is essential for the selection of appropriate techniques, is a _________ process throughout the entire treatment.
Evaluation
Continuing
Appropriate techniques are used to __________ normal spinal and subcortical reflexes in conjunction with voluntary activity to enhance the development of efficient ___________
Facilitate
Posture and Movement
To achieve optimal function Complex skills are broken into their _______ ______
Individual Components
Abnormal _______, ___________, and __________ are treated by direct or indirect inhibition, the emphasis is on training reciprocal motion
Tone, posture, and movement
Tapping a ___________ is the most effective means of increasing awareness, strength, and endurance. __________ of the response is used to promote retention of motor learning
Maximal response
Repetition
___________________ is essential to improve and maintain the strength, endurance, and coordination of the neuromuscular system. Therefor an _________ program provides for the greatest improvement.
Continued activity
Intense
The patterns of facilitation were developed by Dr. Kabat and Maggie in the ______ stages of the development of PNF
Final
It was through he utilization fo all the previous principles that they began to recognize the ________ that existed in all functional activities.
normal patterns of movement
Normal coordinated activities are accomplished by the extremities and trunk moving in _____ directions with ______ components
diagonal, spiral
The stretch reflex is most effectively elicited when the segment to be stretched is elongated in a ______ _____
Specific Diagonal
The muscular response is more coordinated and forceful when resistance is applied within a specific ______ ______
Diagonal Pattern
The _____ _______ is more coordinated and forceful when resistance is applied within a specific diagonal pattern
Muscular Response
Each extremity pattern is composed of
flexion/extension
abduction/adduction
rotation
Each Trunk/Scapula-Pelvis pattern is made up of
Flexion/extension/elevation/depression
Lateral/medial movement
Rotation/upward/downward rotation
The three components of patterns are ______ blended throughout the _______ ROM
equally, complete
The patterns are effective tools for evaluating the quality of a _________ __________ and the _______ of ______
Muscular contraction, range of motion
When dysfunctions are identified in a pattern, specific techniques are applied to ________ _________
facilitate improvement
The patterns are _______ diagonals and can be identified by placing the group of muscle or segment into an ________ position where all muscles feel equally on ________
narrow, elongated, stretch
The muscles of a pattern each work together with more ________ and ______ when in the pattern
power and efficiency
The muscles of a pattern each work together with more power and efficiency when in the _____
pattern
Working with patients in the pattern is a ________ not the ___________
means to the end, end of the means
The red zone of the stretch stimulus is the zone of ________
Minimal Recoil
The purple zone of the stretch stimulus is the _____ zone
Spring zone
The blue zone of the stretch stimulus is the zone of ________
good recoil
The green zone of the stretch stimulus is the zone of ______ or _____ recoil
Little or no
To achieve optimal function the interaction of ______ and _____ is taken into account
stability, mobility
To achieve optimal function the ability to perform the whole skill is facilitated through the _______ _______.
learning sequence
Proprioception is defined as the ________ produced within an organism by the movement of its __________
stimuli, tissues
Proprioception is defines as sensory receptors that are stimulated by some aspect of muscle ________ or ________, joint _______ either stationary or moving
muscle length or tension, angle
Proprioception is the sense of something that is either ______ or moving
stationary
Proprioception is the sense of something that is either stationary or _________
moving
Proprioception can be stimulated by head _______
position
Proprioception refers to all sensory receptors including ________ or ________
exteroreceptors and interoreceptors
Types of proprioceptive receptors include muscle spindles, _________, joint connective tissue, skin receptors, eyes, ears, ad the inner ear receptors
GTOs
Types of proprioceptive receptors include ________, GTOs, joint connective tissue, skin receptors, eyes, ears, ad the inner ear receptors
Muscle Spindles
Neuromuscular pertains to ______ and ______.
nerves and muscles
Neuromuscular’s definition applies specifically to the ability for the muscles to ________, have appropriate _________, ________ and ________
Initiate, Initiation, strength, endurance
Facilitation is the ________ or _______ of any natural process
Promotion or hastening
Facilitation is specifically the effect produced in _______ tissue by the passage of an impulse which lowers the resistance to _________ so that a second stimuli or subsequent stimuli may more_______ provoke the response
nerve, transmission, easily
Facilitation is to increase the ______ of performance of any action, resulting from the lessening of nerve ______ by the continued successive application of the necessary ________
ease, resistance, stimulus
Facilitation is to make ________
easier
The inhibition of abnormal _______ and _______ are intricate components of faciliation
tone and movement patterns
_______ is the type of manual contact in which the surface corresponds to the direction of movement
indirect facilitation
_______ is the type fo manual contact where the skin surface over the actual muscle of which a stronger contraction is desired is contacted
direct facilitation
The stretch reflex is used to achieve and enhance normal movement by facilitating ________ of motion
initiation
The stretch reflex can increase the ________ of a muscle contraction
strength
The stretch reflex increased the ________ by decreasing muscle fatigue and decreasing the effort needed to produce movement
endurance
The stretch reflex increased the endurance by decreasing muscle ________ and decreasing the _______ needed to produce movement
fatigue, effort
The stretch reflex can influence the ________ of movement
direction
To accomplish a quick stretch you ________ a group of muscles in pattern to their ______ or _______ ______ range
Elongate, lengthened, slightly taught.
Once muscles are lengthened for a quick stretch into their taught range you apply _______ and quickly but gently _________ the muscle further in the direction of the pattern
traction, lengthen
You should always _______ before applying a stretch stimulus
spring test
When applying a quick stretch you always want to stay in the _____ zone
purple
Verbal commands are used to coordinate ________ effort with reflex response
volitional
Verbal commands are used to define the _______ of muscle contraction desired
type
Verbal commands are used to define the ________ of motion
direction
Verbal commands are used to signal the _______ of relaxation of contractions
timing
Verbal cues are used to facilitate increased _______ and ________
arousal, responsiveness
Verbal cues are used to stimulate generalized ________
relaxation
Verbal commands are used to define the type of _______ _______ desired
muscle contraction
Verbal commands are used to coordinate volitional effort with ______ response
reflex
Verbal commands are used to _______ increased arousal and responsiveness
facilitate
Visual stimuli are used to assist in the initial ______ of an activity
learning
Visual stimuli are used to identify the ________ of motion
direction
Visual stimuli are used to identify _______ in space
position
Visual stimuli are used to direct the motion of the ______, ______, and _______ across midline and on the same side
head, trunk, extremities
Visual stimuli are used to increase
ROM
Visual stimuli are used to assist in the _______ learning of an activity
initial
Visual stimuli are used to identify the direction of _______
motion
visual stimuli are used to identify position in _____
space
Visual stimuli are used to direct the motion of the head, trunk, and extremities across _____ and on the same ______
midline, side
Resistance is varied to improve ________ using less effort but more controlled movement
coordination
Resistance is varied to improve _________ when resistance is varied throughout the range
range of motion
Resistance is varied to improve ________ when resistance is gradually increased
strength
Resistance is varied to improve ________ when resistance is gradually increased at the beginning of the range
initiation
Resistance is varied to improve _________ when resistance is slowly applied
stabilization
Resistance is varied to improve ________ when light resistance is used with an emphasis on letting go
relaxation
Resistance is varied by the therapist to facilitate the ________ response of the desired contraction depending on the functional component being treated
appropriate
Functionally an isometric contraction is one in which the ______ is a stabilizing contraction in which minimal or no joint motion occurs
intention
This type of contraction is most effective for facilitating and training core muscle contractions throughout the body
isometric
When applying resistance to promote an isometric contraction, one should give careful consideration to the _________ or ________ which occurs during the course of contraction. An analysis of this overflow can give valuable input about the functional or structural integrity of the patient’s body
overflow or irradiation
Manual contact improves the direction of movement by enhancing a specific manual contact, it does this by decreasing conflicting sensory input created by ______ _____ or commonly used _____ ______ grips
multiple contacts, wrap around
