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DPT 620: Neuro > PNF > Flashcards

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
Q

what is a quick way to increase stability?

A

weight bearing

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26
Q

what is the purpose of manual contacts in PNF?

A

placing hands on the skin stimulates pressure receptors overlying muscles and provides info about the desired direction of movt

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27
Q

how do we provide manual contacts in PNF?

A

lumbrical grip

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28
Q

what is the purpose of positioning in PNF?

A

muscle positioning at the optimal range of fxn allows for optimal muscles response

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29
Q

where in their range are muscles the strongest?

A

mid-range

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30
Q

how should the therapist be positioned for PNF?

A

directly in line with the desired movt

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31
Q

what is the purpose of verbal cues in PNF?

A

well timed words and appropriate volume directs the pt’s movt

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32
Q

what is the purpose of visual guidance in PNF?

A

pt instructed to look at the move as they are occuring to enhance muscles contraction

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33
Q

what is the timing for PNF?

A

smooth, coordinated mov’t patterns, from distal to proximal

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34
Q

___ parts move through its full range 1st, then holds the position while the more ___ movt is completed

A

distal, proximal

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35
Q

t/f: distal parts of movt are usually completed midway through the motion

A

true

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36
Q

what is the purpose of resistance in PNF?

A

resistance is applied to all types of contractions to aid muscles contraction and motor control

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37
Q

t/f: max and prolonged resistance allows for prolonged firing of muscles spindles and jt receptors

A

true

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38
Q

what is a stretch in quick stretch PNF?

A

muscles are placed in elongated position and a stretch reflex is elicited, going further into elongated range

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39
Q

what is a repeated stretch in quick stretch PNF?

A

the stretch reflex elicited from muscles under the tension of elongation

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40
Q

what is the neurophysiological basis of quick stretch in PNF?

A

lengthened muscles

engages muscles spindle

facilitates agonists and synergists

can be applied at the beginning of range or through the ROM

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41
Q

what are the indications for quick stretch in PNF?

A

initiation of motion

increased stability

applied through ROM

facilitation

superimposed on contraction

increased strength

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42
Q

what system controls intrafusal fibers?

A

gamma system

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43
Q

what system controls extrafusal fibers?

A

alpha system

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44
Q

what is the purpose of the gamma system?

A

it keeps the spindles stretch sensitive by keeping the intrafusal fibers on stretch when they would normally be slack

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45
Q

t/f: tapping/vibration are repetitive quick stretch

A

true

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46
Q

what is initial increase in strength due to during recovery?

A

increased input to the neuromuscular system, not hypertrophy

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47
Q

what is prolonged stretch in PNF?

A

sustained stretch, typically at end of available range

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48
Q

what is the neurophysiologic basis for prolonged stretch?

A

engages GTOs

autogenic inhibition, reciprocal facilitation

(inhibit agonists or facilitate antagonists)

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49
Q

what are the indications for prolonged stretch in PNF?

A

inhibition

increase ROM

basis for serial casting

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50
Q

which PNF principle is the basis for serial casting?

A

prolonged stretch

51
Q

what is the result of applying deep pressure to a tendon?

A

reduction in muscle tone

52
Q

what is resistance in PNF?

A

manual or gravity

applied with stretch

graded for appropriate contraction to ensure smooth and coordinated move

53
Q

what is the neuropysiologic basis for resistance in PNF?

A

autogenic inhibition (engages muscles spindles by engaging the gamma system)

increases resting tone

reciprocal inhibition

54
Q

t/f: PNF can help increase a muscle’s representation in the brain so that the body can use the muscle better

A

true

55
Q

when a muscle contracts, it is natural for the intrafusal fibers to go slack, what systems keeps them stretch sensitive?

A

gamma system

56
Q

t/f: tracking resistance keeps spindles stretch sensitive

A

true

57
Q

what are the indications for resistance in PNF?

A

when combined with stretch, can decrease tone (stimulation of GTO

facilitation

improved quality of movt

carryover to weaker muscles

use lumbrical grip

58
Q

what is approximation in PNF?

A

compression of the jts or extremity or spine

applied manually or finally via WB

59
Q

what is the neurophyiologic basis for approximation in PNF?

A

engages mechanoreceptors in the jt capsule and ligaments

stimulates co-contraction about the jt

60
Q

what are the indications for approximation in PNF?

A

facilitation of muscles responses in stabilizing activity or extensor pattern

enhance contraction of antigravity, stabilizing muscles

enhance fxn in WB postures for stabilization

61
Q

what is traction in PNF?

A

distraction force separating the jt surfaces used to facilitate muscle contraction and motion

applied throughout motion

particularly effective in anti-gravity motions

62
Q

when and how do we use traction in PNF?

A

it depends

63
Q

what is the neurophysiologic basis of traction in PNF?

A

engages mechanoreceptors

engage GTO

engage spindle to facilitate alpha motor neuron response

64
Q

what are the indications for traction in PNF?

A

diminish pain (mechanoreceptors)

inhibition (GTO)

facilitation (spindles)

65
Q

each pattern in PNF has 3 dimensions, ____/_____, ____/____, and ____/____

A

flex/ext

abd/add

IR/ER

66
Q

t/f: move in PNF occurs in a straight line in a diagonal direction with rotation

A

true

67
Q

PNF patterns are named according to the direction of the movt, the ___ position, not the ____ position

A

finishing, starting

68
Q

what are the 2 types of PNF patterns?

A

proximal

distal (unilateral/bilateral; symmetric/asymmetric)

69
Q

what is the functional relevance of scapular anterior elevation?

A

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
Q

what is the functional relevance of scapular posterior depression?

A

activates trunk extension, rolling backward, UE in transfers, or crutch gait

71
Q

what is the functional relevance of scapular anterior depression?

A

rolling forward, reaching forward, reaching down to the feet to take off socks and shoes, throwing a ball in sports activities

72
Q

what is the functional relevance of scapular posterior elevation?

A

moving backward, reaching out b4 throwing something, and putting on a shirt

73
Q

what is the functional relevance of anterior pelvic elevation?

A

rolling forward

parts of swing phase in gait

74
Q

what is the functional relevance of posterior pelvic depression?

A

terminal stance activities, walking stairs

making high steps, in jumping

75
Q

what is the functional relevance of anterior pelvic depression?

A

terminal swing, loading response

(eccentric) going down stairs

76
Q

what is the functional relevance of posterior pelvic elevation?

A

walking backward, preparing to kick a ball

77
Q

what motions make up UE D1 flexion?

A

shoulder flexion, ER, add

variable elbow

forearm supination

wrist flexion, radial deviation

finger flexion

78
Q

what motions make up UE D1 extension?

A

shoulder extension, IR, add

variable elbow

forearm pronation

wrist extension, ulnar deviation

finger extension

79
Q

what motions make up UE D2 flexion?

A

shoulder flexion, ER, abd

variable elbow

forearm supination

wrist extension, radiation deviation

finger extension

80
Q

what motions make up UE D2 extension?

A

shoulder extension, IR, abd

variable elbow

forearm pronation

wrist flexion, ulnar deviation

finger flexion

81
Q

what motions make up LE D1 flexion?

A

hip flexion, add, ER

variable knee

ankle DF, inversion

toe extension (DF)

82
Q

what motions make up LE D1 extension?

A

hip extension, abd, IR

variable knee

ankle PF, eversion

toe PF

83
Q

what motions make up LE D2 flexion?

A

hip flexion, abd, IR

variable knee

ankle DF, eversion

toe extension (DF)

84
Q

what motions make up LE D2 extension?

A

hip extension, add, ER

variable knee

ankle PF, inversion

toe PF

85
Q

what are the asymmetrical UE patterns in PNF?

A

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
Q

what are the symmetrical UE patterns in PNF?

A

BL UE flex-abd-ER with trunk ext

87
Q

what are the lower trunk BL asymmetrical patterns in PNF?

A

LE flexion w/lower trunk flexion and rotation (often on a swiss ball)

LE extension w/lower trunk extension and rotation

88
Q

how can we use PNF with bed mobility?

A

hooklying to bridging

rolling

transitional mobility

lower trunk rotation

sidelying to sit

stability and controlled mobility

89
Q

what is the technique for approximation?

A

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
Q

what can approximation be used for?

A

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
Q

what is the technique for traction?

A

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
Q

what can traction be used for?

A

relaxation

increase ROM

facilitation

s/p joint replacement

decrease joint pain

93
Q

what is the technique for rhythmic initiation?

A

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
Q

what is the technique for rhythmic initiation, active hold?

A

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
Q

what can rhythmic initiation, active hold be used for?

A

decreased eccentric control

lack of coordination or ability to move in a certain direction

decreased active ROM

96
Q

what is the technique for quick stretch?

A

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
Q

what can quick stretch be used for?

A

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
Q

what is the technique for repeated contractions or stretch?

A

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
Q

what can repeated contractions or stretch be used for?

A

impaired strength

initiation of movement

fatigue

limitation in active range of motion

100
Q

what is the technique for combination of isotonics?

A

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
Q

what can combination of isotonics be used for?

A

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
Q

what is the technique for graded manual resistance –>max resistance

A

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
Q

what can graded manual resistance–>max resistance be used for?

A

increase strength

applied throughout the range. Indications

muscle weakness

ROM limitations

functional mobility impairments

sports performance

enhancement

neurological conditions

104
Q

what is the technique for irradiation/overflow?

A

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
Q

what can overflow/irradiation be used for?

A

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
Q

what is the technique for timing for emphasis?

A

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
Q

what can timing for emphasis be used for?

A

weakness

poor coordination of certain aspects of a diagonal

108
Q

what is the technique for rhythmic rotation?

A

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
Q

what can rhythmic rotation be used for?

A

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
Q

what is the technique of reversal of antagonist: dynamic or slow reversal?

A

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
Q

what can reversal of antagonist: dynamic or slow reversal be used for?

A

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
Q

what is the technique for reversal of antagonist: stabilizing reversals (alternating isometrics)?

A

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
Q

what can reversal of antagonist: stabilizing reversals (alternating isometrics) be used for?

A

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
Q

what is the technique for reversal of antagonist: rhythmic stabilization?

A

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
Q

what can reversal of antagonist: rhythmic stabilization be used for?

A

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
Q

what is the technique for hold relax (autogenic inhibition)

A

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
Q

what can hold relax (autogenic inhibition) be used for?

A

indications: resitricted passive ROM
contraindications: recent surgery, inflammation, or swelling

population

example: a runner with tight hamstrings

118
Q

what is the technique for hold relax: active contraction?

A

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
Q

what can hold relax active contraction be used for?

A

restricted passive ROM

marked weakness

120
Q

what is the technique for contract relax?

A

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
Q

what can contract relax be used for?

A

limitations in ROM - facilitates a deeper stretch through dynamic stretching

122
Q

what is the technique for contract relax, active contraction?

A

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
Q

what can contract relax, active contraction be used for?

A

resistance to PROM (usually of hamstrings)

DPT 620: Neuro (10 decks)

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