PNF Flashcards
what is the proprioceptive part of PNF?
having to do with any of the sensory receptors that give info concerning mover and position of the body
what is the neuromuscular part of PNF?
involving the CNS, nerves, and muscles
what is the facilitation part of PNF?
making movt easier
normalizing movt
strengthening/augmenting movt
who developed PNF first?
Dr. Herman Kabat and PT Maggie Knott
who later added the task emphasis to PNF?
Dorothy Voss
t/f: movts in PNF are patterns set up to be similar to normal movt
true
t/f: PNF movts are usually in a cardinal plane
false
PNF is directed at improving what?
functional performance and coordinated patterns of movt
PNF patterns emphasize move in ______ and _____ rather than straight planes
rotation, diagonals
t/f: neuro PNF emphasizes proximal trunk, functional activities, and “developmental” postures
true
what developmental postures are used in PNF?
rolling, prone on elbows, quadruped, kneeling, half kneeling, modified plantigrade, standing and gait
PNF patterns resemble what patterns?
patterns used in normal functional activities
describe the PNF patterns generally:
spiral and diagonal, combining motions in all 3 planes (flex/ext, add/abd, transverse rotation)
PNF techniques incorporate what motor learning principles?
practice, repetition, visual guidance, and verbal cues
what is the point of visual guidance in PNF?
it enhances pt awareness of where there limbs are in space
t/f: facilitation techniques are proprioceptive and used to facilitate movement when it’s absent or severely disordered
true
what are the hallmarks of PNF?
moving in diagonal planes
spindle activation
sensory input
max/graded resistance
timing
verbal cues
visual cues
what provides spindle activation in PNF?
quick and prolonged stretch
what provides sensory input in PNF?
lumbrical grip
what are the indications for PNF?
relaxation
initiation of movt
education/learning a motion
increased stability
applied throughout the ROM
facilitation-inhibition
superimposed on contraction
change rate of motion
increased strength
increased ROM
increased coordination and control
what disorders/injuries/diseases may result in instability?
SCI, down syndrome, CP, R CVA (lateropulsion), cerebellar injury, shoulder injury
what ataxia would result from injury to the central/spinal cerebellum?
trunk ataxia
what ataxia would result from injury to the outer lobes of the cerebellum?
limb ataxia
what ataxia would result from injury to the floculonodular lobe of the cerebellum?
visual ataxia
what is a quick way to increase stability?
weight bearing
what is the purpose of manual contacts in PNF?
placing hands on the skin stimulates pressure receptors overlying muscles and provides info about the desired direction of movt
how do we provide manual contacts in PNF?
lumbrical grip
what is the purpose of positioning in PNF?
muscle positioning at the optimal range of fxn allows for optimal muscles response
where in their range are muscles the strongest?
mid-range
how should the therapist be positioned for PNF?
directly in line with the desired movt
what is the purpose of verbal cues in PNF?
well timed words and appropriate volume directs the pt’s movt
what is the purpose of visual guidance in PNF?
pt instructed to look at the move as they are occuring to enhance muscles contraction
what is the timing for PNF?
smooth, coordinated mov’t patterns, from distal to proximal
___ parts move through its full range 1st, then holds the position while the more ___ movt is completed
distal, proximal
t/f: distal parts of movt are usually completed midway through the motion
true
what is the purpose of resistance in PNF?
resistance is applied to all types of contractions to aid muscles contraction and motor control
t/f: max and prolonged resistance allows for prolonged firing of muscles spindles and jt receptors
true
what is a stretch in quick stretch PNF?
muscles are placed in elongated position and a stretch reflex is elicited, going further into elongated range
what is a repeated stretch in quick stretch PNF?
the stretch reflex elicited from muscles under the tension of elongation
what is the neurophysiological basis of quick stretch in PNF?
lengthened muscles
engages muscles spindle
facilitates agonists and synergists
can be applied at the beginning of range or through the ROM
what are the indications for quick stretch in PNF?
initiation of motion
increased stability
applied through ROM
facilitation
superimposed on contraction
increased strength
what system controls intrafusal fibers?
gamma system
what system controls extrafusal fibers?
alpha system
what is the purpose of the gamma system?
it keeps the spindles stretch sensitive by keeping the intrafusal fibers on stretch when they would normally be slack
t/f: tapping/vibration are repetitive quick stretch
true
what is initial increase in strength due to during recovery?
increased input to the neuromuscular system, not hypertrophy
what is prolonged stretch in PNF?
sustained stretch, typically at end of available range
what is the neurophysiologic basis for prolonged stretch?
engages GTOs
autogenic inhibition, reciprocal facilitation
(inhibit agonists or facilitate antagonists)
what are the indications for prolonged stretch in PNF?
inhibition
increase ROM
basis for serial casting
which PNF principle is the basis for serial casting?
prolonged stretch
what is the result of applying deep pressure to a tendon?
reduction in muscle tone
what is resistance in PNF?
manual or gravity
applied with stretch
graded for appropriate contraction to ensure smooth and coordinated move
what is the neuropysiologic basis for resistance in PNF?
autogenic inhibition (engages muscles spindles by engaging the gamma system)
increases resting tone
reciprocal inhibition
t/f: PNF can help increase a muscle’s representation in the brain so that the body can use the muscle better
true
when a muscle contracts, it is natural for the intrafusal fibers to go slack, what systems keeps them stretch sensitive?
gamma system
t/f: tracking resistance keeps spindles stretch sensitive
true
what are the indications for resistance in PNF?
when combined with stretch, can decrease tone (stimulation of GTO
facilitation
improved quality of movt
carryover to weaker muscles
use lumbrical grip
what is approximation in PNF?
compression of the jts or extremity or spine
applied manually or finally via WB
what is the neurophyiologic basis for approximation in PNF?
engages mechanoreceptors in the jt capsule and ligaments
stimulates co-contraction about the jt
what are the indications for approximation in PNF?
facilitation of muscles responses in stabilizing activity or extensor pattern
enhance contraction of antigravity, stabilizing muscles
enhance fxn in WB postures for stabilization
what is traction in PNF?
distraction force separating the jt surfaces used to facilitate muscle contraction and motion
applied throughout motion
particularly effective in anti-gravity motions
when and how do we use traction in PNF?
it depends
what is the neurophysiologic basis of traction in PNF?
engages mechanoreceptors
engage GTO
engage spindle to facilitate alpha motor neuron response
what are the indications for traction in PNF?
diminish pain (mechanoreceptors)
inhibition (GTO)
facilitation (spindles)
each pattern in PNF has 3 dimensions, ____/_____, ____/____, and ____/____
flex/ext
abd/add
IR/ER
t/f: move in PNF occurs in a straight line in a diagonal direction with rotation
true
PNF patterns are named according to the direction of the movt, the ___ position, not the ____ position
finishing, starting
what are the 2 types of PNF patterns?
proximal
distal (unilateral/bilateral; symmetric/asymmetric)
what is the functional relevance of scapular anterior elevation?
facilitates rolling forward, reaching in front of body
terminal stance on ipsi side and swing phase on contra side are related to this pattern
what is the functional relevance of scapular posterior depression?
activates trunk extension, rolling backward, UE in transfers, or crutch gait
what is the functional relevance of scapular anterior depression?
rolling forward, reaching forward, reaching down to the feet to take off socks and shoes, throwing a ball in sports activities
what is the functional relevance of scapular posterior elevation?
moving backward, reaching out b4 throwing something, and putting on a shirt
what is the functional relevance of anterior pelvic elevation?
rolling forward
parts of swing phase in gait
what is the functional relevance of posterior pelvic depression?
terminal stance activities, walking stairs
making high steps, in jumping
what is the functional relevance of anterior pelvic depression?
terminal swing, loading response
(eccentric) going down stairs
what is the functional relevance of posterior pelvic elevation?
walking backward, preparing to kick a ball
what motions make up UE D1 flexion?
shoulder flexion, ER, add
variable elbow
forearm supination
wrist flexion, radial deviation
finger flexion
what motions make up UE D1 extension?
shoulder extension, IR, add
variable elbow
forearm pronation
wrist extension, ulnar deviation
finger extension
what motions make up UE D2 flexion?
shoulder flexion, ER, abd
variable elbow
forearm supination
wrist extension, radiation deviation
finger extension
what motions make up UE D2 extension?
shoulder extension, IR, abd
variable elbow
forearm pronation
wrist flexion, ulnar deviation
finger flexion
what motions make up LE D1 flexion?
hip flexion, add, ER
variable knee
ankle DF, inversion
toe extension (DF)
what motions make up LE D1 extension?
hip extension, abd, IR
variable knee
ankle PF, eversion
toe PF
what motions make up LE D2 flexion?
hip flexion, abd, IR
variable knee
ankle DF, eversion
toe extension (DF)
what motions make up LE D2 extension?
hip extension, add, ER
variable knee
ankle PF, inversion
toe PF
what are the asymmetrical UE patterns in PNF?
UE chop/reverse chop
UE lift/reverse lift
LE ext w/lower trunk ext and rotation
LE flexion w/lower trunk flex and rotation
what are the symmetrical UE patterns in PNF?
BL UE flex-abd-ER with trunk ext
what are the lower trunk BL asymmetrical patterns in PNF?
LE flexion w/lower trunk flexion and rotation (often on a swiss ball)
LE extension w/lower trunk extension and rotation
how can we use PNF with bed mobility?
hooklying to bridging
rolling
transitional mobility
lower trunk rotation
sidelying to sit
stability and controlled mobility
what is the technique for approximation?
approximation provides a compression on a joint surface through manual force or weight bearing, causing a cocontraction of muscles around a joint. The force is applied to the longitudinal axis of the bone. Activates the mechanoreceptors.
what can approximation be used for?
can be used for either facilitation or inhibition, increase stability.
good for limited joint stability, instability of extensor muscles, poor static control, weakness (hypotonia)
what is the technique for traction?
elongation of a segment and separation of joint surfaces which facilitates an enhanced muscular response to promote movement or enhance stability.
traction is used to facilitate motion (especially pulling & antigravity motions), aid in elongation of muscle tissue when using the stretch reflex, and resist some part of the motion.
what can traction be used for?
relaxation
increase ROM
facilitation
s/p joint replacement
decrease joint pain
what is the technique for rhythmic initiation?
begin moving the patient through the desired motion passively, then using AAROM, active ROM, and finally active-resisted ROM
verbal cues are used throughout to set the pace and rhythm for the patient if needed
helps facilitate muscle agonists to initiate motion.
what is the technique for rhythmic initiation, active hold?
same as rhythmic initiation but with added holds during the motion
when the patient is going through active ROM the PT instructs them to hold the position they are in
what can rhythmic initiation, active hold be used for?
decreased eccentric control
lack of coordination or ability to move in a certain direction
decreased active ROM
what is the technique for quick stretch?
provides a short-lived contraction of the agonist muscle and inhibition of the antagonist muscle which facilitates a muscle contraction of the agonist
can be done in a weak part of the range to strengthen too
main thing behind repeated contractions
what can quick stretch be used for?
can be applied anywhere within a motion; superimposed on a contraction
change the rate of motion
facilitation or increased motor output
ability to contract a muscle how it’s supposed to
impaired strength
initiation of movement
fatigue
limitation in active ROM
what is the technique for repeated contractions or stretch?
repeated isotonic contractions from the lengthened range, induced by quick stretches and enhanced resistance
performed through the range or part of range at a point of weakness
what can repeated contractions or stretch be used for?
impaired strength
initiation of movement
fatigue
limitation in active range of motion
what is the technique for combination of isotonics?
use of PNF techniques on isotonic contractions with movement aimed at agonist to control muscle contractions
it combines different muslce contractions such as concentric and eccentric
hand position does not change!!!
what can combination of isotonics be used for?
relaxation
education/learning a motion
applied throughout the ROM
facilitation
change in rate of a motion
increase strength (see below)
to gain functional movements, improve power and endurance
your hand position DOES NOT CHANGE
it is good for gait initiation
you can combine many other PNF tecniques with this motion
what is the technique for graded manual resistance –>max resistance
graded manual resistance PNF exercise utilizes the physical therapist as a source of resistance
trains muscle strength, coordination, and control throughout the various muscle lengths in a range of motion
graded resistance involves applying varying levels of resistance during muscle contractions to improve strength, flexibility, and motor control in the desired movement pattern
what can graded manual resistance–>max resistance be used for?
increase strength
applied throughout the range. Indications
muscle weakness
ROM limitations
functional mobility impairments
sports performance
enhancement
neurological conditions
what is the technique for irradiation/overflow?
performed when a stimulus is applied to one limb, causing a muscle contraction in the opposite extremity; allowing weaker muscles to activate by stimulating the muscles of the contralateral limb
this overflow happens due to an associated reaction
uses eccentric lowering of the weaker limb
what can overflow/irradiation be used for?
strengthening of weaker segments using stronger segments
increased stability
facilitation
superimposed on a contraction
can be used in persons with decreased motor output, using what movements they do have to facilitate those they do not (either on the opposite side, or proximal to distal)
can be used to facilitate core/abdominal contractions (distal overflow to proximal)
what is the technique for timing for emphasis?
redirects the energy of a strong contraction into weaker muscles
prevent all motions of a pattern except the one being emphasized
resist an isometric or maintained contraction of the strong motions in a pattern while exercising the weaker muscles
what can timing for emphasis be used for?
weakness
poor coordination of certain aspects of a diagonal
what is the technique for rhythmic rotation?
rotation of the extremity at the joint through the PNF pattern - relaxation is achieved with slow, repeated rotation of a limb at a point of limitation - as muscles relax the extremity is slowly and gentely moved into the range - as new tension is felt this technique is repeated
what can rhythmic rotation be used for?
inhibilition (particularly useful with rigidity or significant spasticity)
relaxation in muscles of excess tension / hypertonicity or in muscles with limited ROM, trunk rotation used for rigitity and tone
what is the technique of reversal of antagonist: dynamic or slow reversal?
the patient will move into their stronger direction with therapist resistence
as the end range of the motion appraches, the therapist will reverse their grip on the distal portion of the moving extremity and directing pateint to change direction. at the end of the movement, the therpaist will change the direction without any relaxation and immediately give resistence to the new diretction
these reversals can be done at any time
this is done to facilitate both the agonist and the antagonist without pause
what can reversal of antagonist: dynamic or slow reversal be used for?
decreased active range of motion
weakness of the agonistic muscles
decreased ability to change direction of motion
exercised muscles begin to fatigue
relaxation of hypertonic muscle groups
what is the technique for reversal of antagonist: stabilizing reversals (alternating isometrics)?
the therapist provides resistance to the paint starting in the strongest direction, while asking the patient to move against them. (allow very little movement)
to increase stability, approximation or traction may be used
when there is complete resitance from the patient, the therpist will move one of their hands and begin to resist in the oppostie direciton
once the patient responds to the new resistance, the therapists adjusts and moves to a new position
this is alternating isotonic contractions
what can reversal of antagonist: stabilizing reversals (alternating isometrics) be used for?
increase stability
facilitation
increased strength
resistance in cardinal plane.
used in cases of decreased stability, weakness, patient is unable to contract muscle isometrically and still needs resistance in one-way direction
can be performed directly on the patient trunk/extremity OR on an external tool the patient is holding
what is the technique for reversal of antagonist: rhythmic stabilization?
utilizes alternating isometric contractions of the agonist and then antagonists against resistance
the patient should not move and cue them as such
if the patient is struggling to maintain their position then slow down and lower resistance accordingly
what can reversal of antagonist: rhythmic stabilization be used for?
increase stability
facilitation
increased strength
resistance in rotational plane impaired strength and cordination
limitations in ROM
impaired stabilization control and balance
can be performed directly on the patient trunk/extremity OR on an external tool the patient is holding
what is the technique for hold relax (autogenic inhibition)
patient moves to end of pain-free ROM and holds the stretch for 10-20 seconds
the PT then resists the antagonist to create an isometric contraction
the patient then relaxes as the PT passively moves the patient through their available ROM
isometric contraction of the antagonist causes autogenic inhibition which decreases the restriction of the antagonist and allows for increased ROM
what can hold relax (autogenic inhibition) be used for?
indications: resitricted passive ROM
contraindications: recent surgery, inflammation, or swelling
population
example: a runner with tight hamstrings
what is the technique for hold relax: active contraction?
patient moves to end of pain-free ROM and holds the stretch for 10-20 seconds
the PT then resists the same muscle being stretched causing an isometric contraction and hold it for 10-15 seconds
the patient then moves actively into the newly gained range of the agonist pattern
concentric
active contraction serves to maintain inhibitory effects through reciprocal inhibitions
what can hold relax active contraction be used for?
restricted passive ROM
marked weakness
what is the technique for contract relax?
Pt moves to end of ROM for a given muscle
the PT then resists motion as the pt contracts the agonist muscle isotonically for approximately 10 seconds, allowing the patient to slowly move through the range of motion
then the PT gradually increases the stretch and the process is repeated
facilitates reciprocal inhibition. “Push against me.”
what can contract relax be used for?
limitations in ROM - facilitates a deeper stretch through dynamic stretching
what is the technique for contract relax, active contraction?
the PT first passively stretches the agonist muscle
the pt will then hold an isometric contraction against PT resistance of the same muscle for 6-15 seconds
this is then followed by a 6-15 second contraction of the antagonist muscle
the patient is then given a short rest break and the procedure is repeated
resist to point then have Pt actively go through rest of motion
what can contract relax, active contraction be used for?
resistance to PROM (usually of hamstrings)
