PNF Flashcards

1
Q

what is the proprioceptive part of PNF?

A

having to do with any of the sensory receptors that give info concerning mover and position of the body

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2
Q

what is the neuromuscular part of PNF?

A

involving the CNS, nerves, and muscles

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3
Q

what is the facilitation part of PNF?

A

making movt easier

normalizing movt

strengthening/augmenting movt

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4
Q

who developed PNF first?

A

Dr. Herman Kabat and PT Maggie Knott

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5
Q

who later added the task emphasis to PNF?

A

Dorothy Voss

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6
Q

t/f: movts in PNF are patterns set up to be similar to normal movt

A

true

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7
Q

t/f: PNF movts are usually in a cardinal plane

A

false

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8
Q

PNF is directed at improving what?

A

functional performance and coordinated patterns of movt

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9
Q

PNF patterns emphasize move in ______ and _____ rather than straight planes

A

rotation, diagonals

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10
Q

t/f: neuro PNF emphasizes proximal trunk, functional activities, and “developmental” postures

A

true

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11
Q

what developmental postures are used in PNF?

A

rolling, prone on elbows, quadruped, kneeling, half kneeling, modified plantigrade, standing and gait

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12
Q

PNF patterns resemble what patterns?

A

patterns used in normal functional activities

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13
Q

describe the PNF patterns generally:

A

spiral and diagonal, combining motions in all 3 planes (flex/ext, add/abd, transverse rotation)

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14
Q

PNF techniques incorporate what motor learning principles?

A

practice, repetition, visual guidance, and verbal cues

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15
Q

what is the point of visual guidance in PNF?

A

it enhances pt awareness of where there limbs are in space

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16
Q

t/f: facilitation techniques are proprioceptive and used to facilitate movement when it’s absent or severely disordered

A

true

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17
Q

what are the hallmarks of PNF?

A

moving in diagonal planes

spindle activation

sensory input

max/graded resistance

timing

verbal cues

visual cues

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18
Q

what provides spindle activation in PNF?

A

quick and prolonged stretch

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19
Q

what provides sensory input in PNF?

A

lumbrical grip

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20
Q

what are the indications for PNF?

A

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

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21
Q

what disorders/injuries/diseases may result in instability?

A

SCI, down syndrome, CP, R CVA (lateropulsion), cerebellar injury, shoulder injury

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22
Q

what ataxia would result from injury to the central/spinal cerebellum?

A

trunk ataxia

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23
Q

what ataxia would result from injury to the outer lobes of the cerebellum?

A

limb ataxia

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24
Q

what ataxia would result from injury to the floculonodular lobe of the cerebellum?

A

visual ataxia

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25
what is a quick way to increase stability?
weight bearing
26
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
27
how do we provide manual contacts in PNF?
lumbrical grip
28
what is the purpose of positioning in PNF?
muscle positioning at the optimal range of fxn allows for optimal muscles response
29
where in their range are muscles the strongest?
mid-range
30
how should the therapist be positioned for PNF?
directly in line with the desired movt
31
what is the purpose of verbal cues in PNF?
well timed words and appropriate volume directs the pt's movt
32
what is the purpose of visual guidance in PNF?
pt instructed to look at the move as they are occuring to enhance muscles contraction
33
what is the timing for PNF?
smooth, coordinated mov't patterns, from distal to proximal
34
___ parts move through its full range 1st, then holds the position while the more ___ movt is completed
distal, proximal
35
t/f: distal parts of movt are usually completed midway through the motion
true
36
what is the purpose of resistance in PNF?
resistance is applied to all types of contractions to aid muscles contraction and motor control
37
t/f: max and prolonged resistance allows for prolonged firing of muscles spindles and jt receptors
true
38
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
39
what is a repeated stretch in quick stretch PNF?
the stretch reflex elicited from muscles under the tension of elongation
40
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
41
what are the indications for quick stretch in PNF?
initiation of motion increased stability applied through ROM facilitation superimposed on contraction increased strength
42
what system controls intrafusal fibers?
gamma system
43
what system controls extrafusal fibers?
alpha system
44
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
45
t/f: tapping/vibration are repetitive quick stretch
true
46
what is initial increase in strength due to during recovery?
increased input to the neuromuscular system, not hypertrophy
47
what is prolonged stretch in PNF?
sustained stretch, typically at end of available range
48
what is the neurophysiologic basis for prolonged stretch?
engages GTOs autogenic inhibition, reciprocal facilitation (inhibit agonists or facilitate antagonists)
49
what are the indications for prolonged stretch in PNF?
inhibition increase ROM basis for serial casting
50
which PNF principle is the basis for serial casting?
prolonged stretch
51
what is the result of applying deep pressure to a tendon?
reduction in muscle tone
52
what is resistance in PNF?
manual or gravity applied with stretch graded for appropriate contraction to ensure smooth and coordinated move
53
what is the neuropysiologic basis for resistance in PNF?
autogenic inhibition (engages muscles spindles by engaging the gamma system) increases resting tone reciprocal inhibition
54
t/f: PNF can help increase a muscle's representation in the brain so that the body can use the muscle better
true
55
when a muscle contracts, it is natural for the intrafusal fibers to go slack, what systems keeps them stretch sensitive?
gamma system
56
t/f: tracking resistance keeps spindles stretch sensitive
true
57
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
58
what is approximation in PNF?
compression of the jts or extremity or spine applied manually or finally via WB
59
what is the neurophyiologic basis for approximation in PNF?
engages mechanoreceptors in the jt capsule and ligaments stimulates co-contraction about the jt
60
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
61
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
62
when and how do we use traction in PNF?
it depends
63
what is the neurophysiologic basis of traction in PNF?
engages mechanoreceptors engage GTO engage spindle to facilitate alpha motor neuron response
64
what are the indications for traction in PNF?
diminish pain (mechanoreceptors) inhibition (GTO) facilitation (spindles)
65
each pattern in PNF has 3 dimensions, ____/_____, ____/____, and ____/____
flex/ext abd/add IR/ER
66
t/f: move in PNF occurs in a straight line in a diagonal direction with rotation
true
67
PNF patterns are named according to the direction of the movt, the ___ position, not the ____ position
finishing, starting
68
what are the 2 types of PNF patterns?
proximal distal (unilateral/bilateral; symmetric/asymmetric)
69
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
70
what is the functional relevance of scapular posterior depression?
activates trunk extension, rolling backward, UE in transfers, or crutch gait
71
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
72
what is the functional relevance of scapular posterior elevation?
moving backward, reaching out b4 throwing something, and putting on a shirt
73
what is the functional relevance of anterior pelvic elevation?
rolling forward parts of swing phase in gait
74
what is the functional relevance of posterior pelvic depression?
terminal stance activities, walking stairs making high steps, in jumping
75
what is the functional relevance of anterior pelvic depression?
terminal swing, loading response (eccentric) going down stairs
76
what is the functional relevance of posterior pelvic elevation?
walking backward, preparing to kick a ball
77
what motions make up UE D1 flexion?
shoulder flexion, ER, add variable elbow forearm supination wrist flexion, radial deviation finger flexion
78
what motions make up UE D1 extension?
shoulder extension, IR, add variable elbow forearm pronation wrist extension, ulnar deviation finger extension
79
what motions make up UE D2 flexion?
shoulder flexion, ER, abd variable elbow forearm supination wrist extension, radiation deviation finger extension
80
what motions make up UE D2 extension?
shoulder extension, IR, abd variable elbow forearm pronation wrist flexion, ulnar deviation finger flexion
81
what motions make up LE D1 flexion?
hip flexion, add, ER variable knee ankle DF, inversion toe extension (DF)
82
what motions make up LE D1 extension?
hip extension, abd, IR variable knee ankle PF, eversion toe PF
83
what motions make up LE D2 flexion?
hip flexion, abd, IR variable knee ankle DF, eversion toe extension (DF)
84
what motions make up LE D2 extension?
hip extension, add, ER variable knee ankle PF, inversion toe PF
85
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
86
what are the symmetrical UE patterns in PNF?
BL UE flex-abd-ER with trunk ext
87
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
88
how can we use PNF with bed mobility?
hooklying to bridging rolling transitional mobility lower trunk rotation sidelying to sit stability and controlled mobility
89
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.
90
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)
91
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.
92
what can traction be used for?
relaxation increase ROM facilitation s/p joint replacement decrease joint pain
93
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.
94
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
95
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
96
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
97
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
98
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
99
what can repeated contractions or stretch be used for?
impaired strength initiation of movement fatigue limitation in active range of motion
100
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!!!
101
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
102
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
103
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
104
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
105
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)
106
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
107
what can timing for emphasis be used for?
weakness poor coordination of certain aspects of a diagonal
108
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
109
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
110
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
111
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
112
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
113
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
114
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
115
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
116
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
117
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
118
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
119
what can hold relax active contraction be used for?
restricted passive ROM marked weakness
120
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."
121
what can contract relax be used for?
limitations in ROM - facilitates a deeper stretch through dynamic stretching
122
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
123
what can contract relax, active contraction be used for?
resistance to PROM (usually of hamstrings)