PNF Flashcards
Proprioceptive
- Stimuli produced within an organism by movement of its tissues
- Sensory receptors which are stimulated by some aspect of muscle length, tension, joint angle, either stationary or moving, and by head position. Refers to all sensory receptors including exteroceptors and interceptors. (I.e. muscle spindles, G.T.O.s, joint connective tissue, skin receptors, eyes, ears, inner ear receptors)
Neuromuscular
Pertaining to nerves and muscles, specifically the ability for the muscles to properly initiate, have appropriate initiation, strength and endurance.
Facilitation
- The promotion or hastening of any nautral process, specifically the effect produced in nerve tissue by the passage of an impulse which lowers resistance to transmission so that a second stimuli or subsequent stimuli may more easily evoke a response.
- Increase ease of performance of any action, resulting from the lessening of nerve resistance by the continued successive application of the necessary stimulus.
- To make easier.
- Inhibition of abnormal tone and movement patterns are intricate components of facilitation.
PNF principles
- Patient position
- Therapist body position
- Manual contact
- Elongation, spring test, stretch stimulus
- Resistance
- Verbal command
- Use of visual
- Execution of proper pattern
- Facilitation of optimum timing
Motor responses affected by manual contact
- Strength or Power
- Direction of movement
Strength or Power
Proper contact to the segment being facilitated increases strength of contraction.
Proper placement should be either specific to
1. the surface which corresponds to the direction of movement (indirect) facilitation
2. Skin surface over the actual muscle of which a stronger contraction is desired (direct)
Direction of Movement
The active or resistive contraction of a segment or body part in a specific direction
-decrease conflicting sensory input created by multiple contacts or commonly used wrap-around grips to make patients response easier and more precise.
Application of Appropriate Manual Contact
- Lumbrical Grip
- Identify specific location for contact
- Confidence, Control, Compassion
LEARN TO BE INVITED IN BY THE PATIENT TO THE APPROPRIATE DEPTH
Lumbrical Grip
Provides efficient facilitation while imparting a feeling of security. Utilizes the intrinsic muscles of the hand which decreases the potential for grabbing the patient or touching too many surfaces.
Contact surfaces: palm (thenar and hypothenar) and finger pads. Grip should be comfortable (Pain inhibits appropriate response)
Amount of contact depends on body part being resisted and size of patient.
Specific location for contact
point of contact may vary between patients for many of the patterns. Correct direction/contact=specific point which facilitates the appropriate contraction
choose a surface which faces directly into the line of movement desired.
Therapist body position
At either end of the desired movement with therapists shoulders and hips facing the direction of that movement; forearms pointed in DOM. In the correct position, and imaginary line can be drawn through desired movement and therapist midline/COG. Slightest deviation can alter the desired effect of manual contact and resistance. ASIS headlights.
Therapist Body Mechanics
Therapists moves directly influence how pt moves. PT movements must mirror image of patient’s movement
Guidelines:
1. PT spine in neutral throughout with movement from legs, hips, and upper extremities
2. Weight shift/movement always in the direction desired of the pt
3. Weight shift/movement in direct proportion to pt movement
4. Movement of PT body is directly related to the arc of motion being performed by pt to ensure proper direction and strength of resistance throughout entire ROM
5. PT body position should always allow for the resistance to come from the therapists trunk, pelvis, and legs, not arms
Appropriate resistance
- used to evaluate and facilitate two different types of muscular contractions
- Varied to facilitate the appropriate response of the desired contraction depending on the functional component being treated.
- Resisted vs Passive ROM exercises
- Manual Vs Non-manual resistance
- Breathing
Types of resistance (muscular contractions)
- Isotonic Contraction
- Isometric Contraction
Isotonic Contraction
Contraction in which the internal force overcomes the external force allowing movement.
INTENSION is movement
Associated with joint motion or a change in position.
Includes Concentric, eccentric, Maintained Isotonic
Concentric
Shortening contraction; resistance applied desired or available ROM. Resistance varies throughout arc according to pt strength and coordination
COMMAND: “Push” “Pull”
Eccentric
Controlled lengthening contraction; Resistance can be applied to any part of ROM.
Promotes kinesthetic awareness and increase strength and ROM
COMMAND: “Let go slowly or slowly let go”
Maintained Isotonic
Concentric contraction with resistance by PT allows minimal to no motion to occur.
Facilitates appropriate strength, endurance, and irradiation.
Efficient MI initiates with appropriate core, immediately followed by the global response allowing for irradiation to the localized core muscle or other phasic or global groups.
PT attentive to motor recruitment pattern to ensure appropriate facilitation of temporal and spacial summation for irradiation.
*INTENSION OF THE PT IS MOVEMENT even when no movement is allowed, global muscles are facilitated with an efficient “CoreFirst” motor strategy.
COMMAND: “Keep it there” “Don’t let me move you”
Isometric Contraction
Intension is a stabilizing contraction in which minimal or no joint motion occurs. Patient intention is to maintain a position in space against external resistance. Contraction is built and released slowly with PT constantly attempting to match the force being generated by the patient. Most closely resembles the true stabilization contraction observed during functional postures and activities.
MOST EFFECTIVE FOR FACILITATING AND TRAINING THE CORE MUSCLE CONTRACTIONS THROUGHOUT THE BODY. FACILITATES FIBER SPECIFIC RESPONSE
Low and slow resistance
Command: “Hold it, don’t let me move you. Don’t push”
- give careful consideration to the overflow or irradiation which occurs during the course of the contraction; can give valuable input about the functional or structural integrity of the pts body.
UTILIZES temporal summation to increase the local response and slowly builds to facilitate an appropriate CoreFirst motor strategy. Irradiation is effective to facilitate a spreading of the controlled contraction.
Appropriate resistance can improve
- Coordination- less effort, more controlled
- ROM - resistance is varied throughout range
- Strength - resistance is gradually increased
- Initiation - resistance gradually increases at beginning of range
- Stabilization - resistance is slowly applied
- Relaxation - light resistance, emphasis on letting go
May be affected by
a. patients position
b. gravity
c. existing reflexes
d. the diagonal pattern
e. position of the distal component
Traction and Approximation Use
Adds additional force vector to directional resistance
*Avoid using to assist the movement rather than enhance the resistance
Traction
elongation of a segment to increase muscular response of the segment’s core muscles and promotes a “CoreFirst” movement strategy
Carefully applied may reduce pain.
Always applied away from the apex of the arc of motion and is consistent in force.
must be graduated to balance the force of the traction
*Think over the bowl
*Fingers should be extended to enhance the traction
Approximation
Compression of a segment to promote stability
used when facilitating weight bearing postures or positions.
desired response can be initiated or reinforced by a reflex-producing quick approximation then maintained approximation pressure.
Caution to avoid pain and consider underlying pathology.
Stretch Stimulus Definition
Elongation of a muscle increases its responsiveness to cortical stimulation