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CAFMT > PNF > Flashcards

PNF Flashcards

1
Q

Proprioceptive

A
  1. Stimuli produced within an organism by movement of its tissues
  2. 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)
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2
Q

Neuromuscular

A

Pertaining to nerves and muscles, specifically the ability for the muscles to properly initiate, have appropriate initiation, strength and endurance.

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3
Q

Facilitation

A
  1. 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.
  2. Increase ease of performance of any action, resulting from the lessening of nerve resistance by the continued successive application of the necessary stimulus.
  3. To make easier.
  4. Inhibition of abnormal tone and movement patterns are intricate components of facilitation.
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4
Q

PNF principles

A
  1. Patient position
  2. Therapist body position
  3. Manual contact
  4. Elongation, spring test, stretch stimulus
  5. Resistance
  6. Verbal command
  7. Use of visual
  8. Execution of proper pattern
  9. Facilitation of optimum timing
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5
Q

Motor responses affected by manual contact

A
  1. Strength or Power
  2. Direction of movement
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6
Q

Strength or Power

A

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)

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7
Q

Direction of Movement

A

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.

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8
Q

Application of Appropriate Manual Contact

A
  1. Lumbrical Grip
  2. Identify specific location for contact
  3. Confidence, Control, Compassion

LEARN TO BE INVITED IN BY THE PATIENT TO THE APPROPRIATE DEPTH

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9
Q

Lumbrical Grip

A

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.

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10
Q

Specific location for contact

A

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.

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11
Q

Therapist body position

A

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.

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12
Q

Therapist Body Mechanics

A

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

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13
Q

Appropriate resistance

A
  1. used to evaluate and facilitate two different types of muscular contractions
  2. Varied to facilitate the appropriate response of the desired contraction depending on the functional component being treated.
  3. Resisted vs Passive ROM exercises
  4. Manual Vs Non-manual resistance
  5. Breathing
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14
Q

Types of resistance (muscular contractions)

A
  1. Isotonic Contraction
  2. Isometric Contraction
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15
Q

Isotonic Contraction

A

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

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16
Q

Concentric

A

Shortening contraction; resistance applied desired or available ROM. Resistance varies throughout arc according to pt strength and coordination

COMMAND: “Push” “Pull”

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17
Q

Eccentric

A

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”

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18
Q

Maintained Isotonic

A

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”

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19
Q

Isometric Contraction

A

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.

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20
Q

Appropriate resistance can improve

A
  1. Coordination- less effort, more controlled
  2. ROM - resistance is varied throughout range
  3. Strength - resistance is gradually increased
  4. Initiation - resistance gradually increases at beginning of range
  5. Stabilization - resistance is slowly applied
  6. 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

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21
Q

Traction and Approximation Use

A

Adds additional force vector to directional resistance
*Avoid using to assist the movement rather than enhance the resistance

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22
Q

Traction

A

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

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23
Q

Approximation

A

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.

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24
Q

Stretch Stimulus Definition

A

Elongation of a muscle increases its responsiveness to cortical stimulation

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25
Q

Stretch reflex Definition

A

Spinal reflex used in conjunction with the techniques and procedures of PNF to facilitate a reflex contraction

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26
Q

Quick stretch technique

A

Stretch reflex is best facilitated through quick stretch by elongating a group of muscles in pattern to their lengthened or slightly taut range; applying traction and quickly/gently elongating the muscle further into the direction of pattern.
*Spring test before applying stretch stimulus
*reflex is synchronized with a verbal command to stimulate a volitional effort by pt
*Reflex response is reinforced by the immediate application of appropriate resistance in the first few degrees (or no proper core response)

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27
Q

If tension is maintained, the stretch stimulus…

A

can be superimposed on an existing contraction
-No recoil=cannot apply stretch stimulus. Begin with isometric to generate tension

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28
Q

Stretch reflex is used to achieve and enhance normal movement by:

A
  1. Facilitating initiation of motion
  2. increasing strength of muscle contraction
  3. increasing endurance by decreasing muscle fatigue and decreasing effort needed to produce movement
  4. influencing the direction of movement
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29
Q

Contraindications for quick stretch

A
  1. hyperactive stretch reflex not under voluntary control
  2. pain
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30
Q

Verbal commands should be

A

Simple
Concise
audible
specific to the desired contraction

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31
Q

Verbal commands used to

A
  • Coordinate volitional effort with reflex response
  • Define the type of muscular contraction desired
  • Define direction of motion
  • Signal timing of relaxation of contraction
  • Facilitate increased arousal and responsiveness
  • Stimulate generalized relaxation
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32
Q

Visual stimuli assists in

A
  1. Initial learning of activities
  2. Identifying direction of motion
  3. Identifying position in space
  4. Directing the motion of the head, trunk and extremities across midline and on the same side
  5. Increasing ROM
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33
Q

Three components of PNF Upper Extremity

A
  • Flexion or extension
  • Abduction or adduction
  • Rotation
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34
Q

Three components of PNF trunk/scapula-pelvis

A
  • Flexion or extension/Elevation or depression
  • Lateral or medial movement
  • Rotation/upward or downward rotation
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35
Q

Patient position during PNF

A

influences the success of PNF principles
Consider supports, influence of tone, comfort, and desired neuromuscular response

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36
Q

A. Normal coordinated activities are accomplished by the extremities and trunk moving in diagonal directions with spiral components
B. Stretch reflex is most effectively elicited when the segment to be stretched is elongated in a specific diagonal
C. muscular response is more coordinated and forceful when resistance is applied within a specific diagonal pattern
D. 3 components
E. Patterns are effective tools for evaluating the quality of muscular contraction and the range of motion. Specific techniques used to facilitate improvement with dysfunctions
F. Patterns are narrow diagonals, identified by groups of muscles or segments in an elongated position with all muscles feel equally on stretch. Muscles work together in pattern with more power and efficiency
G. Pattern is means to the end not end of the means

A

Patterns of facilitation

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37
Q

Timing: CoreFirst Motor Strategies

A

The sequencing of motor recruitment which takes place in a normal functional activity or movement.
NEED TO RECOGNIZE THE NORMAL TIMING OF AN ACTIVITY AND ADJUST THE RESISTANCE AND/OR VERBAL COMMANDS TO FACILITATE THE REINFORCEMENT OR RELEARNING OF THIS TIMING.

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38
Q

Normal timing progression

A

Proximal stability - distal mobility
Core stabilizers - prime movers

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39
Q

Normal timing allows for

A

Dynamic stability with controlled mobility

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40
Q

Most fundamental and critical principle in PNF

A

Positioning for success

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41
Q

Alignment has a direct influence on

A

Neuromuscular response
- essential for appropriate motor control

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42
Q

Basic Philosophy of PNF

A
  1. all human beings have untapped existing potential
  2. Treatment purpose to assist the patient attain highest level of function possible through development of most efficient neuromuscular system
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43
Q

Developmental sequence

A

Series of posture and movements which facilitates the activation of necessary neuromuscular function and motor control necessary for efficient daily activities and function

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44
Q

A breakdown in the body’s ability to effectively execute developmental postures and movements can be directly correlated…

A

To dysfunctions in an individual’s daily, recreational, and work activities.

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45
Q

Why can developmental skills be learned or lost?

A

Never effectively learned
Learned and lost due to injury or pathology

46
Q

What are developmental skills

A

Ability to roll, assume postures such as on elbows and hook lying or sit and ambulate with proper CoreFirst

47
Q

Goal of developmental foundations

A

Identify the missing Neuromuscular function or inefficient strategies and facilitate the function and control the developmental sequence is designed to obtain within our system

48
Q

Things to assess and train for efficient function with developmental sequence

A

Assumption of position
Stabilization within the position
Movement within the position over fixed distal extremity or BOS

49
Q

Building on the current knowledge of motor learning

A

Create functional learning environment
Identify whole activity then identify specific parts to assess and treat for mechanical capacity and neuromusclar function
Reintegration the restored functioning part to the motor control of the whole

50
Q

Progression of treatment

A
  1. Facilitate efficient NMN of interconnecting segment
  2. Utilize the interconnecting segment to facilitate Corefirst trunk control
  3. Utilize efficient trunk control and interconnecting segments to facilitate efficient extremity movement and function
  4. Progression to weight bearing activities with corefirst strategies in all ADL
51
Q

Anterior elevation shoulder girdle

A

11:30
Emphasize downward component during spring test and quick stretch
keep resistance down and back and emphasize the traction

52
Q

Anterior depression shoulder girdle

A

6:30
Emphasis downward rotation
avoid allowing PT hands to slide up into axilla
keep resistance up and back to facilitate the pattern and not just a forward roll
manual contact anterior lateral border of the scapula and inferior lateral border of pec minor

53
Q

Posterior elevation shoulder girdle

A

12:30
Emphasize upward rotation
Pain due to a elevated first or second rib
Be sure neck mid-cervical is well supported to avoid side bending during the pattern
*do not put pressure on pts neck with PT arm

54
Q

Posterior depression

A

5:30
a. isometric holds at EOR -> COI
b. work toward performing the pattern from the lengthened range
c. lock in stabilizers then superimpose movement on stable segment ROMBOIDS ARE PRIME STABILIZERS
d. lock in scapular adductors then resist segment to EOR
Emphasis is end ROM
Emphasize upward component of the resistance to facilitate the end range
Have a cushion of soft tissue between Therapist hand and the inferior angle of the scapula with no play
External rotation of humerus to assist in locking in the scapula stabilizers

55
Q

Scapular PNF set up checks

A

Check for side shear in the thoracolumbar and cervical regions
Appropriate support to head and neck, lumbar spine, and thighs.
BE SURE TRUNK DOES NOT ROTATE WHEN SETTING THE SCAPULA. KEEP THE MID-FRONTAL PLANE PERPENDICULAR TO THE MAT OR TABLE

56
Q

Scapular pnf set up

A
  1. Positioned in stable side lying position
  2. Therapist in line of diagonal motion
  3. Position scapula (if out of midline). Scapula should be in the mid-frontal plane
  4. Shoulder girdle to elongated position (maintained in the groove) “OVER THE BOWL”
  5. spring test end range
  6. Determine proper manual contact
  7. Apply gentle quick stretch same direction of spring test with appropriate verbal command and appropriate resistance/traction
  8. Emphasize tx to facilitate arc of motion with FINGERS EXTENDED TO AVOID GRIPPING
  9. Maintain body mechanics to stay in pattern
57
Q

Spring test results

A

Springy=efficient
Hard=inability to lengthen
Boggy=inability to fold
*test in the spin and skid motions

58
Q

Monitoring effective pattern

A
  • Efficient, balanced tension at lengthened ROM without cervical or thoracic strain
  • Movement is scapula on thoracic
  • Keep movement in straight diagonal with arc (not circular motion)
  • Movement from superior/inferior; anterior/posterior
  • Head of humerus should approximate and potentially cross midline
59
Q

Scapula moves as a

A

Wheel

60
Q

Skid

A

Pure anterior elevation

61
Q

Spin

A

Pure rotation

62
Q

Roll

A

Appropriate combination of AE and rotation

63
Q

Pelvic AE

A
  1. Set the pelvis and properly elongate to ensure the proper motor response
  2. Pelvis positioned in midline, vertical position in relation to mid-frontal plane
  3. PD = L/S neutral lordosis with side bending allowing for gapping on the up side facets
  4. AE = L/S side bend into closure of the upside facets and slightly flex
  5. Palpate for EOR restrictions I.e. joints or soft tissue. Correlate end feel to spring test
  6. Different hand grip female vs male
64
Q

Pelvic PD

A
  1. Be attentive to beginning position *be sure pelvis is in true AE
  2. No trunk rotation or extension present
  3. Emphasize traction component of resistance to facilitate the arc of Lumbar movement and downward rotation of pelvis esp. end range
  4. Avoid pelvic retraction
  5. Ischial tuberosity grip *ensure good tissue lock to avoid stretching anal tissues
65
Q

Pelvic AD

A
  1. Grip: ischium and pelvis or patient in S/L with upper leg extended and grip on Greater Trochanter and ischium
  2. Pattern emphasis: reciprocal elongation of the quadratus and re-educator into the new range
66
Q

Pelvic PE

A
  1. Grip: Take up slack of the soft tissues and cup hands around posterior/superior aspect of ilium
  2. Be very attentive to spine position and setting of the pelvis and note that the excursion is much more controlled and smaller than AE
  3. Careful not to cause compression/rotation in lumbar spine
  4. Emphasis on coordinated contraction of the core, especially multifidi and the quadratus
  5. Key assessment: the lengthened range of PE for mechanical restrictions and ability to facilitate isometric/eccentric contractions
67
Q

Pelvis in Gait: mid stance to just before toe off

A

Pelvis PD couples with strong core response of trunk

68
Q

Pelvis in Gait: pre toe off/heel strike opposite leg

A

Passive PE toe off side

69
Q

Pelvis in Gait: Toe off

A

AE

70
Q

Heel strike

A

AD

71
Q

Hip motions required/ LE patterns:
Mid stance to toe off

A

Extension
Abduction
Internal rotation

72
Q

Hip motions required/ LE patterns:
Toe off to heel strike

A

Flexion
Adduction
External rotation

73
Q

Reciprocal effect

A

Ex. R hip AE-L shoulder AE
L hip PD-R shoulder PD

74
Q

Execution of pattern in sidelying

A
  1. position patient in sidelying, trunk supported to prevent rotation or lateral shear
  2. Position hips in appropriate flexion to allow for lumbo/pelvic mobility
  3. Support under leg for initial training of pattern
  4. Note position of head/neck and upper body
  5. Evaluate passive mobility, noting coupled motion of lumbar spine/pelvis
  6. Observe for end feel of soft tissues and joints
75
Q

Gait observation

A
  1. Gait look efficient
  2. movement of pelvis
  3. movement of scapula
  4. Movement of spine
  5. Connectivity between upper and lower trunk
  6. effort and symmetry in the swing phase
  7. Stability on the stance leg
76
Q

Rolling observation

A
  1. Extension rolling
  2. Flexion rolling
  3. Upper or lower trunk rolling
  4. Log rolling
  5. Segmental rolling
  6. Functional purpose of rolling
    a. improves strength in and coordination between body parts
    - mass and independent movement
    - control of free extremity movement
    b. Develops neuromuscular patterns utilized in more complex activities
    - Vestibular stimulation
    - Develop control of abnormal reflexes and tone
77
Q

Irradiation to facilitate Pelvic AE with hip flexion/adduction/ER

A
78
Q

COI for elongation into AD

A
79
Q

Irradiation and COI for efficient coupling of pelvic PD and hip Ext/Abd/ER facilitation
*Gold star- needed for function

A
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CAFMT (8 decks)

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