PNF Flashcards
Basic principle of PNF
Motor learning is enhanced through skilled application of ten essential components of PNF
Ten essential components of PNF: MMMMVV JIBS
- Manual contacts
- Manual resistance
- MovementTiming
- Movement Patterns
- Verbal input
- Visual cues
- Joint facilitation
- Irradiation
- Body position and body mechanics
- Stretch
Manual contacts
Hand on skin
- stimulate pressure receptors
- provide pt.information about desired direction of movement- can be done passive, active and active with resisted
What type of grip should be used in manual contacts to control movement?
Lumbrical
Body position & mechanics
Dynamic clinician movement that mirrors the patient’s direction of movement . Essential in effective facilitation. The clinician’s pelvis, shoulders, arms, and hands should be placed in line with the movement. when this is not possible the arms and hands of the clinician should be in alignment with the movement. resistance is created through the use of the clinician’s body weight while the hands and arms remain relatively relaxed.
Stretch
Stretch reflex- utilized to facilitate muscle activity. If the muscle is placed in an elongated position, a stretch reflex could be elicited by producing slight movement further into the elongated range.
Contraindication for use of facilitator stretch- JFP
- Joint hypermobility
- Fracture
- Pain
T/F while quick stretch tend to increase motor response, prolonged stretch can potentially decrease muscle activity; therefore pt. response should be closely monitored
True
Manual Resistance
Manual, mechanical or gravitational forces utilized to apply external resistance to the body surface. Some PNF procedures focus on reducing internal resistance by altering neural firing patterns; other activities / techniques provide external resistance. Therefore in the context of PNF, resistance may be considered either a means of facilitation, through reduction of internal resistance, or a way to strenghten or train the target muscles, by an outside force. Through complex interactions among neural and contractile components,
Manual resistance may influence TEM3P
- Timing of functional movement patterns
- Endurance
- Movement initiation,
- Motor learning
- Muscle mass
- Postural stability
Lumbrical grip
MCP joints flexed & adducted while the fingers are in relaxed extension
Lumbrical grip
- Allows generation of flexion forces through the clinician’s hand without squeezing or exerting excessive pressure.
- Provides Optimal control of the three-dimentional movements that occur in PNF patterns
Irradiation (biggest principle in PNF)
A neurophysiologic phenomenon- spread of muscle activity in response to resistance, used synonymously with overflow and reinforcement.
In Irradiation the magnitude of the response increases as the
stimulus increases in duration and intensity
Why does PNF utilize the process of Irradiation?
To increase muscular activity in the agonist muscle or to inhibit opposing antagonist muscle groups.
With irradiation, resistance to trunk flexion produces
Overflow into the hip flexors and ankle DF
With irradiation, resistance to trunk extension produces
Overflow into the hip and knee extensors
With irradiation, resistance to UE extension & adduction produces
Overflow into trunk flexors
With irradiation, resistance to hip flexion, adduction, and ER produces
FADER
Overflow into the DFs
Joint facilitation
Traction & approximation stimulate receptors within the joint and periarticular structures.
Traction creates elongation of body segment in order to
facilitate motion and decrease pain
Approximation produces
Compression of body segments to promote stability and weight bearing
T/F - individual response to traction and approximation vary. These forces may be applied during performance of extremity patterns or superimposed body position
True
Timing of movement
Normal movements require smooth sequencing of muscle activation.Most functional movements occur in a distal to proximal direction, as in picking up a pencil. The pencil is grasped in the hand & then positioned for use by actions of the elbow and shoulder.
Patterns of movement
PNF is characterized by unique patterns of movement. Groups of muscles work together synergistically in functional contexts, they combine related movements to create PNF patterns. Because muscles are spiral and diagonal in both structure and function, most functional movements do not occur in cardinal planes. e.g reaching with an UE and walking are 2 common activities that occur as triplanar movements. PNF patterns therefore more closely simulate the demands incurred during functional movements.
Visual cues
Help a patient control and correct body position and motion. Eye movement influence both head and body position.
Feedback from visual system may be used to promote
Stronger muscle contraction & to facilitate proper alignment of body parts such as head & trunk through use of postural reactions
Verbal input
verbal command is utilized to provide info to the patient. Command should be concise and provide directional cue. Soft voice soothes, firmer to stimulate.
3 phases of verbal command - PAC
Preparation, Action, Correction
Preparatory phase
Readies patient for action
Action phase
Provides info about the desired action & signals the patient to initiate the movement
Correction phase
Tells pt. how to modify the action if necessary
T/F- PNF uses the knowledge of the effects of voice volume intonation to promote the desired response such as relaxation or greater effort
True
Extremity patterns are named for
The direction of movement occurring in the proximal joint & represent the movement that results from performing the pattern.
All PNF patterns consist of a combination of movements occurring in
3 planes
The rotation component is especially important and should be recruited during the beginning range of the pattern. Early rotation reinforces normal distal to prox timing of extremity movements while recruiting greater participation of trunk musculature.
2 major extremity diagonal patterns
Diagonal 1 (D1) Diagonal 2 (D2) each divided into flexion & extension
UE D1 Flexor final position Pattern
E FADDER
Scapula Anterior elevation
Shoulder flexion / ADD/ ER
Elbow Extension
Forearm- Supination
Wrist- Flex / radial dev
Finger flex
UE D1 Extension final position pattern
DEXTABIR EPEE
Scapula posterior depression
Shoulder Ext/AB/IR
Elbow Ext
Forearm Pronation
Wrist EXT / UD
Finger Ext
UE D1 flexion pattern functional movement for
feeding
UE D1 Extension pattern functional for
Performing protective reaction with a sitting position
UE D2 flexion final position
E FABER
Scapular Posterior elevation
Shoulder F /Ab /ER
Elbow Ext
Forearm supination
Wrist Ext / RD
Finger Ext
UE D2 Extenison final position
D EXTADDIR
Scapular anterior depression
Shoulder ext /add/ IR
Elbow ext
Forearm pronation
Wrist flex / UD
Finger flex
LE D1 Flexion pattern End positon
FADER DIE-
- Pelvis Anterior elevation
- Hip F/Ad/ER
- Knee flex
- Ankle DF / inversion
LE D1 Extension final pattern
EXABIR PEF-
- Pelvis- post. Depression
- Hip -Ext /Ab/IR
- Knee- ext
- Ankle PF /eversion
LE D2 Flexion end pattern
FABIR
- Pelvis- Anterior depression
- Hip- F/Ab/IR
- Knee- flex
- Ankle- DF/eversion
LE D2 Extension pattern
EXTADER
- Pelvis- Post. elevation
- Hip- Ext/Ad/ER
- Knee- Ext
- Ankle PF/inversion
UE pattern encompasses
Scapular, shoulder, elbow, wrist and fingers. SEWF
LE pattern encompasses
Pelvis, hip, knee, ankle and toes. HKAT
What exercise is commonly used in functional training that utilizes both D1 and D2 PNF patterns for the upper extremity.
The chop exercise,
Muscle recruitment is enhanced through the use of
appropriate reflex and proprioceptive stimuli.
The efficient recruitment of motor patterns involves the use of the following PNF techniques SMARTI
- Stretch reflexes
- Manual pressure
- Approximation
- Resistance
- Traction
- Irradiation
Resistance applied to a muscle contraction will
Facilitate a smooth motor response through optimal muscle contraction and relearning. The type and degree of resistance varies to achieve the appropriate motor response.
Irradiation
Overflow of neuronal excitation from stronger motor units to weaker ones, or units that may be inhibited by injury. Done by applying graded resistance to larger muscle groups to enhance contraction in the weaker groups.
Traction -
Application of traction perpendicular to the arc of motion is used to facilitate an enhanced motor response .
Manual pressure
Neuromuscular responses are influenced by contact with the skin and deeper pressure receptors.
Stretch reflex
A stimulus that increases the state of responsiveness of a motor unit to cortical stimulation. Reflex is stimulated by the quick elongation of muscle. The stretch stimulates extrafusal and intrafusal muscle spindles to create a contraction. The muscle spindle and its reflex constitute a feedback device that operates to maintain muscle length. The reflex produces a brief isolated contraction; however, with resistance can facilitate a muscular response.
Approximation
A compressive force to approximate joint surfaces can facilitate a motor response and promote stability.
Rhythmic rotation
For pt. with spasticity and no active movement
Scapula anterior elevation
Start- clinician’s R hand on pt. acromial region. L hand on top of and reinforces R hand. Pt asked to shrug shoulder forward towards ear.
End- pt. completes motion while clinician shifts body weight onto her foreward foot mirroring pt. movement.
Scapula Posterior depression
Start- clinician’s R hand placed on pt. right acromion with her left hand contacting the inferior & medial border of the scapula. the pattern begins upon command to pull the shoulder blade down and back
End- As pt. continues through the ROM the clinician shifts her body weight onto her back leg to counter pt. effort.
Scapular Posterior elivation
Start- clinician hand placed slightly posterior to pt. right acromion - her R habd covers her L. The pt. is asked to shrug her shoulder up and back
End- As the pt. elevates and adducts her scapula the clinician shifts her body weight backwards
Scapular anterior depression
Start- Manual contacts are positioned slightly anterior to pt. R acromion wih L hand under the R . Verbal command to push shoulder blade down and forward is given
End- The clinician shifts her weight forward as the pt. depresses & adducts the scapula.
Goal of PNF technique FIReS
To promote functional movement through
- Facilitation,
- Inhibition,
- Relaxation of muscle groups
- Strenghtening
What are PNF techniques designed to do?
To promote or enhance specific types of muscle activity associated with a target pattern, posture or task.
Some techniques focus on isometric contractions to increase stability in a chosen position, others enhance movement initiation
Rhytmic initiation
Improve mobility- impaired by deficits in movement initiation, coordination or relaxation.
Technique involves
- Sequential application of first passive, then active assist, then active or slightly resisted motion.
- Passive used to encourage relaxation & teach movement of a task.
- Once relaxation is achieved, the pt. is asked to assist
- Cinician monitors pt. movement strategies….
Hold relax active movement
Enhances functional mobility by facilitating recruitment of muscle contraction in the lenghtened range of the agonist . Only one direction of a movement pattern is emphasised.
Resisted isometric contraction of the agonist pattern in a shortened range is used to increase muscle spindle sensitivity. Once an optimal contraction is achieved the pt. relaxes and the clinician then passively moves the part towards the lenghtened position in increments according to pt. response. A quick stretch may be applied concurrently with a command for the pt to move into the agonist pattern. Light resistance is often applied as a facilitatory element although resistance is not mandatory
Example of hold relax active movement
Scapular anterior elevation- pt is in side lying, clinician kneels behind. Pt. scapula is passively placed in anterior elevation & asked to hold this position. Clinician provides resistance to the isometric contraction. Pt. then relaxes and is moved slightly back towards posterior depression. then pt. pulls back up into ant. elevation
Hold relax
T
