PNF Flashcards
Neuromuscular definition
pertaining to the nerves and muscles
Facilitation definition
promoting or hastening of any natural process
Neuromuscular facilitation
promoting or encouraging normal activity of the neuromuscular system
proprioceptive
pertaining to the proprioceptors/ sensory inputs
Therapeutic Exercise
- movement with a purpose
- focuses on optimal afferent input
-promotes optimal neuromuscular activity
Continuous sensory input is provides by
1) manual contacts to assist, resist, block or guide
2) verbal guidance to cue, coach, enforce
3) visual feedback
who are the originators of PNF
Dr. Kabat, Maggie Knott and Dorothy Voss (used on polio patients)
what is PNF utilized for (5 things)
- improve strength
- neuromuscular control
- increase flexibility
- ROM
- stability
General indicators for PNF
1) abnormal muscle tone
2) promote optimal and coordinated movement
3) to increase strength and endurance
4) to stretch tight muscles
Agonist
the muscle that produces the movement
Antagonist
the muscle that needs to relax to allow for movement
Supporters
muscles that stabilize the trunk and extremities
Fixators
muscles that hold bones steady
PNF goal
to strengthen the gross motor patterns instead of specific muscle actions
PNF Facilitation
creates an increase in excitability of motor neurons (weak muscles)
PNF Inhibition
creates a decrease in excitability of motor neurons (spasticity or tight muscles)
Sensory facilitation used by therapist
hand contact, voice, breathing, and encourage patients to use their eyes
what does normal movement require?
the balance of strength and co-ordination between muscle groups and being able to work in combined diagonal motions
neuro-irradiation (overflow)
activating weak muscles by using surrounding strong ones; produces an overflow of electrical impulses surrounding the muscle. Done by successive induction and reciprocal inhibition
PNF application steps
1) know the movement pattern from start to finish
2) have the patient look at limb for visual cues
3) use verbal cues for coordination
4) provide hands on contact with appropriate pressure
5) PT should maintain proper body mechanics
6) PT gives an appropriate resistance
7) Allow for rotational movement
8) have appropriate timing
9) give a quick stretch to facilitate in muscle activation
Upper D1 Flexion
Shoulder: flexion, adduction, and external rot.
Forearm: supination
Wrist: Flexion and radial deviation
Hand: Flexion and Adduction
Upper D1 Extension
Shoulder: Extension, Abduction, and internal rot.
Forearm: pronation
Wrist: extension and ulnar deviation
Hand: extension and abduction
Upper D2 Flexion
Shoulder: flexion, abduction, external rot.
Forearm: supination
Wrist: Extension and radial deviation
Hand: Extension and abduction
Upper D2 Extension
Shoulder: extension, adduction, internal rot.
Forearm: pronated
Wrist: flexion and ulnar deviation
Hands: flexion and adduction
Lower D1 Flexion
Hip: flexion, adduction, external rot.
Knee: flexion
Ankle: dorsiflexion and inversion
Toes: extension
LE D1 Extension
Hip: Extension, Abduction, and internal rot.
Knee: extension
Ankle: planter flexion and eversion
Toes: flexion
Lower D2 Flexion
Hip: Flexion, Abduction, internal rot.
Knee: flexion
Ankle: dorsiflexion and eversion
Toes: extension
Lower D2 Extension
Hip: extension, Adduction, external rot.
Knee: extension
Ankle: plantarflexion and inversion
Toes: Flexion
Hold - Relax (stretching)
-Affected body part is moved until resistance is felt.
-PT provides resistance for an Isometric hold (5-10 secs)
-Autogenic Inhibition (agonist muscle)
-Finish with PROM into new range
Contract - Relax (stretching)
- affected body part is moved until resistance is felt
- Reciprocal inhibition. (concentric contraction of antagonist)
- PT applies resistance for 5-10 seconds then move into new range.
- Voluntary relaxation
Hold - Relax - Antagonist - Contract (stretching)
the same steps/ methods as hold-relax besides patient uses AROM to move into new range (concentric contraction of antagonist)
Rhythmic Initiation (strengthening)
-Used with patients who are unable to initiate movement or very limited ROM.
-Directed at agonist movers
- teaches patient movement pattern
-Do the ROM first passive (4-6), then active assisted (4-6), then active (4-6)
- movement is slow and goes through available range.
Repeated Contraction (strengthening)
-directed toward agonist muscles
-repeated dynamic contractions concentrically against max resistance until fatigue
Slow Reversal (strengthening)
-Isotonic contraction of agonist muscle followed by isotonic contraction of antagonist muscle
- develops normal reciprocal timing of agonist and antagonist muscles
-reversal of agonists
Slow reversal hold (strengthening)
same as slow reversal but an isometric contraction is added at the end of each range.
Rhythmic stabilization (strengthening)
-helps promote stability through co-contractions of trunk, pelvic girdle or shoulder
-provide gentle perturbations for 5-10 secs
- reversal of agonists
when to use muscle activation techniques
-non-optimal motor control
-strength
-endurance
-co-ordination
when to use relaxation (stretching) techniques
muscular tension or tightness
reciprocal inhibition
-muscle spindle
-senses muscles strength
-facilitate agonist by turning off the agonist
autogenic inhibition
-GTO
-sense tendon stretch
-cause agonist inhibition
Historical principles of PNF
1) developmental activities are useful bases for treatment
2) Sensory reflex influences movement and posture
3)Co-ordinated, alternating movement between agonist and antagonist muscles groups are important for normal function.
4) use known principles of motor learning activities
5) Movement occurs in diagonal activity not planar motions
