Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PHTH 551- Neurological Rehabilitation > PNF > Flashcards

PNF Flashcards

1
Q

What is PNF?

A

A motor learning approach used to improve motor function and facilitate maximal muscular contraction.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What does PNF stand for?

A

Proprioception: Knowing where your body and limbs are in space. Objective: make pt aware (and teach most efficient) of movement and posture.
PNF is based on proprioceptive(muscle spindles, GTO) and sensory inputs (cutaneous receptors).

Neuromuscular: Neurological and musculoskeletal system interaction: difficulties with posture and movement. Evaluate and treat problems w/ movement dysfunction and postural instability.

Facilitation: Assisting and/or promoting an improved patient movement response or posture.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the main goal of PNF?

A

Facilitate a patient in achieving a movement or posture.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the cycle of how PNF can be used?

A
  1. Assess movement or posture.
  2. Carry out PNF treatment.
  3. Reassess
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the background of PNF?

Types of PNF?

Possible mechanism?

A

1900: Concepts of neuromuscular facilitation and inhibition.
Kabat: Clinical PNF stretching techniques.

Types: contract relax, hold relax, agonist contraction, hold relax agonist contract….

Autogenic Inhibition 
Reciprocal Inhibition 
Passive properties of the musculoskeletal unit. Muscle properties
Stretch perception. 
Stretch Reflex
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the theoretical basis for PNF? 3 Mechanism?

A
  1. Proprioceptive stimulation: strengthening and relaxation.
  2. Voluntary muscle contractions performed with muscle stretching: reflexive components of muscular contraction, promote muscular relaxation, increase joint rom.
  3. Stretch Reflex:
    Autogenic inhibition, reciprocal inhibition, EMG activity.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Is there good evidence for PNF?

A

Not really. PNF compared to conventional PT does not show a significant effect because it is hard to isolate PNF from other techniques.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the basic principles of PNF? (Two cards about this)

A

Body position: PT and pt positioning for safety and comfort.

Manual contacts: Use of hands to guide movement and provide resistance

Body Mechanics: For safety and efficiency

Quick Stretch: Apply to exploit physiological properties of the ms to facilitate movement

Verbal command: To elicit a greater movement

Visual Stimuli: Reach towards a target

Appropriate resistance: Apply resistance to guide patient, apply resistance to the appropriate level of the patient you are treating.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the two PNF techniques we need to know for this course?
What are they used for?

A

Rhythmic initiation:

1) Passive, VC: Relax, let me move you
2) Active assisted, VC: Help me a little (MC need to be precise)
3) Resisted, VC: Push into my hand (MC need to be precise)

Used to:

  • Help the patient relax (passive)
  • Help initiate the movement
  • Help teach or make the patient aware of the direction of movement
  • Help achieve a better quality movement

Combination of Contractions:
Concentric contraction followed by isometric at the end then eccentric contraction back to starting position.

Used to:

  • Increase ROM
  • Achieve a more coordinated and fluid movement
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What functional rehab goals can PNF be used for?

A

Transfers and Mobility:

  • Rolling
  • Lying to sitting
  • Gain initiation

In neuro we have lower level patient for whom these functional mobility tasks are a primary goal.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the PNF patterns for this lab?

A 
Anterior Elevation of the Scapula
Posterior Depression of the scapula
Anterior Elevation of the Pelvis 
Posterior Depression of the Pelvis 
Anterior Depression of the Scapula
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are 4 key concepts of PNF?

A
  1. Coordination of mvmt between trunk and extremities.
  2. Resistance applied in a precise diagonal=stronger response and better coordination. Greatest arc of movement for the range that the patient has allows for activation of most of the muscles.
  3. To facilitate a better response by applying a quick stretch in the diagonal.
  4. Each pattern of movement is composed of 3 directions:
    Flexion or Extension+Abduction or Adduction+Internal or Extneral rotation

Patterns of movement can be used to assess and treat dysfunction.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are important anatomical feature to consider for PNF?

A

The concave structure of the scapula slides over the rib cage. With a diagonal arc of movement we are trying to achieve movement of the scapula over the shape of the rib cage.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

In what position should patients be placed for PNF techniques for AE and PD of scapula and pelvis?

A
  • Support limbs with a pillow
  • Neutral spine position
  • Head and neck position
  • Ensure pt comfort.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Anterior Elevation of the Scapula:

  1. UE Pattern.
  2. Why would we want to work on PNF for AE?
A
  1. Flexion-Adduction-External Rotation
  2. A. Stability: you need stability of the scapula in AE to carry out overhead activities.

B. Mobility: You need mobility in the direction of scapular AE to bring the arm overhead towards Flex-Add-ER.

C. Functional Actives: You need the combination of mobility and stability to effectively carry our functional activities: Reach for objects overhead, place objects on shelf, comb hair, put seat belt, to roll form sidelying to prone.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How do you carry out AE of the scapula?

  • MC
  • Direction of Elongation (DE)
  • Verbal Command
A

MC: Anterior and superior aspect of the shoulder.
DE: Towards PD of the scapula
VC: Pull Up

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What muscles are working during AE?

A
  • Scalenes
  • Upper fibers of Serrates Anterior
  • Upper traps
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Posterior Depression of the Scapula:

  1. UE Pattern
  2. Why would we want to work on PNF for PD?
A
  1. Extension, Abduction, Internal Rotation
  2. Posture: more efficient posture, more stable upper trunk, contributes to better neck and UE ROM.

Stability: More stable lower trunk (b/c Upper trunk is more stable in scapular PD), less stress in lower back when doing certain activities (lifting) b/c of more stable trunk.

Mobility: You need to have good ROM in the direction of PD of the scapula to be able to do activities that require the UE to be in Ext-Abd-IR.

Function: Need a combination of mobility and stability to efficiently carry out functional activities: Transfers, walking w/ assistive devices, got from sit-to-stand using an armrest.

Reduction of Tone: Scapular PD may help to decrease UE tone

Ambulation: Scapular AE and PD contribute to good trunk movement and efficient arm swing during gait.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How do you carry out PD of the scapula?

  • MC
  • Direction of Elongation (DE)
  • Verbal Command
A

MC: 1 hand Inf. Angle of the Scapula. Other hand: posterior surface of the scapula and humerus.

DE: Towards AE of the scapula.

VC: Push Down

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What muscles are working during PD?

A
  • Lat Dorsi
  • Rhomboids
  • Inf. Fibers of Serrates Anterior.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Why would we want to work on pelvic PNF patterns?

A

Mobility: Pelvic movement can be limited by restrictions in hip and vertebral column.

Stability: Need to stabilize the pelvis in order to properly hip hinge when doing certain movements like sit to stand and picking up objects from the floor.

Lumbar Spine: to achieve max elongation of the trunk we need mobility in the direction of PD of the pelvis

Ambulation: Good pelvis mobility is required during gait.
Swing phase: AE
Heel strike: AD
Heel Strike to Toe Off: PD
Initiation of Toe Off: PE

Reduction of Tone: Pelvic PD may help reduce tone in LE.

22
Q

How do you carry out AE of the pelvis?

  • MC
  • Direction of Elongation (DE)
  • Verbal Command
A

MC: Superior and anterior aspect of the Iliac Crest.
DE: Towards PD of Pelvis
VC: Pull Up

23
Q

How do you carry out PD of the pelvis?

  • MC
  • Direction of Elongation (DE)
  • Verbal Command
A

MC: Under Ischial Tuberosity
DE: Towards AE of the Pelvis
VC: Push Down

24
Q

What are the main muscles being worked in PD of the pelvis?

A

Transverse Abdominus

Internal Obliques

25
Q

Anterior Depression of the Scapula:

  1. UE Pattern.
  2. Why would we want to work on PNF for AD?
A
  1. Extension-Adduction-Internal Rotation
  2. Stability: Need to stabilize scapula in AD to reach for an object in front and below.
    Mobility: need scapular AD mobility to reach in the direction of Ext-Add-IR
    Functional Activities: Put on pants, socks, remove brakes
    Scapular AD can be used indirectly to facilitate abdominals.
26
Q

How do you carry out AD of the scapula?

  • MC
  • Direction of Elongation (DE)
  • Verbal Command
A

MC: On either side of the axilla
One hand: partially covering pectorals
One hand: Partially covering the scapula

DE: Towards posterior elevation of the scapula

VC: Pull Down

27
Q

What are the major muscle being targeted during AD of the scapula?

A

Pec Major and Minor

28
Q

What is the philosophy of PNF?

What are 5 basic consideration w/ PNF?

A

All human beings have untapped existing potential.

  1. Establish functional goals.
  2. Find balance btwn pt education and making them as independent as possible.
  3. Focus on what the pt can do, rather then what they can’t do.
  4. Modify approach based on individual needs.
  5. Pt as a whole, not just specific body part.
29
Q

How are the characteristics of neuromuscular control related to PNF?

A

Must evaluate what characteristics of neuromuscular control are functional and which are problematic. Then treat accordingly.

Characteristics include: tone, initiation of met, balance, quality of contraction, control and reversal of direction, speed and strength of contractions. ROM, endurance.

30
Q

What are the types of muscle contractions?

A

Isometric:
Slow: evaluates the ability to stabilize the trunk during and activity and maintain contraction during an extended period of time.
Quick Evaluates the ability to stabilize against a sudden force.

Isotonic:
Eccentric
Concentric

31
Q

Why are the basic principles of PNF important (PP, MC, QS)?

A
  • Facilitate a better or more efficient response from pt.
  • Establish a standard for treatment and evaluation.
  • Used in combination w/ each other or specific techniques.
32
Q 
What are the essential elements of the following PNF principles? 
PP
MC
TP
BM 
AR
QS
AP
VC
VS
A

Patient Position: Can affect pt response, so be consistent w/ pp. Ensure: comfort, limbs supported w/ a pillow, proper head and neck position, neural spine.

Manual Contacts: Hand position that PT uses. Can affect pt response, so be consistent w/ mc. Influence the direction pt will move. Lumbrical grip.

Therapist Position: PT relative to the pt. Influence direction pt will move. Better position easier to apply resistance.

Body Mechanics: Avoid back injuries.

Appropriate resistance: Min, mod or max depending on level of pt. (Goal, pathology and physical condition pt)

Quick Stretch: Gentle tap at the beginning of range. Helps initiate movement. Do not use if increases pain or if joint instability.

AP: Used in combination w/ appropriate resistance. Facilitate ability to maintain a position, sense of stability, teach or increase awareness of good posture.
Contraindicated: Increases pain, #, RA, irritable joints.

VC: Can influence pt response. Simple and cons. Give VC at the same time as QS. Volume is important (like soft tone if pt in pain)

VS: Can help increase rom and facilitate learning (mirror)

33
Q

What are the 5 principles of good body mechanics for PNF?

A

BoS
Efficient alignment of the sine (neutral)
Bracing: may need to contract trunk to help maintain neutral spine.
Weight shift/ acceptance: stay close to patient
Axis of motion: not at the spine. Axis: hip, knees, and or ankle.

34
Q

What can resistance be used for in PNF?

A
  • Initiate mvmt
  • Increase motor recruitment
  • help pt relax
  • teach or make pt aware of a movement or position
  • Obtain more coordinated or controlled movement
35
Q
  1. What is the first thing to assess for PNF?

2. What are the parameters for PNF?

A
  1. Always assess the mvmt you are trying to work on first to see where there is difficulty.
    (ie mass trunk flexion or rolling, does the scapula or the pelvis need to be worked or both?)
  2. Reps and sets are based on the level of the pt and assessment after treatment to see if pt is picking up technique. <5reps for low level pts. More for higher level pts.
36
Q

Recall of Key Points:

  1. PNF promotes a stronger neuromuscular response and better coordination using?
  2. Steps?
A
  1. Appropriate resistance (proprioceptive guide and cue for pt to move in a specific direction), precise diagonal, quick stretch in the diagonal (QS makes use of the elastic properties of ms to initiate mvmt).
  2. Evaluate, treatment, re-evaluation, integration
37
Q

Why is Mass Trunk Flexion (Rolling) of clinical importance?

A
  • Teach a pt that can roll w/ effort, how to roll in a more efficient manner (better strength and coordination)
  • Teach a pt that cannot roll how to roll
  • May also be in preparation to teach a pt to eventually sit up.
38
Q

How is PNF for Mass Trunk Flexion done?

A

MC: Combines AD of the scapula w/ AE of the pelvis.
One hand: On the axilla partially covering the pecs. Other hand: On the superior and anterior aspect of the pelvis.

DE: Towards PE of the scapula. Towards PD of the pelves.

VC: Curl
-Can also add extremities (arms and legs)

39
Q

What are the different components of lying to sitting that a PT can assist a pt w/?

A
  • Teach pt to push off the bed using arms.
  • Teach pt to bring up trunk allowing the pt to come up onto elbow and hand
  • AE of scapula and PD of pelvic to get trunk elongation..
  • Assits both upper trunk and legs or just one component of the movement.
40
Q

How do you assist with 1. Trunk 2. Legs during lying to sitting?

A
  1. 1 hand on each shoulder, just putting a manual contact to guide the pt. Pt uses 1 hand to push off the bed and the elbow of the other arm (can have pt push down on your hand to facilitate these movements).
  2. PD of the pelvis while bringing the legs off the bed. 1 hand on ischial tuberosity doing PD of the pelvis and 1 hand cuping the legs bringing the off the bed as the pt goes into posterior depression.
41
Q

What are the 2 components of PNF for gait?

A
  1. Weight shift/acceptance

2. Taking a step

42
Q

What position should the PT be in for PNF during gait?

A
  • PT positioned in appropriate diagonal.
  • As pt weight shifts forward, PT weight shifts back.
  • As pt takes a step forward, the PT takes a step back.
43
Q

What is the PNF technique for the weight shift/acceptance of gait?

A

MC: On the superior and anterior aspect of the iliac crest at 45 degree angle down and backwards.
VC: (Pt standing in tandem, ask to shift weight from back to forward foot) Shift forward
-Use approximation (push down and back towards heals) and appropriate resistance
-RI or CC

44
Q

What is the PNF technique for the Stepping forward component of gait?

A

MC: Superior and anterior aspect of the iliac crest at a 45 degree angle down and back.
VC: Take a step.
-Use QS, RI, CC
-Pt is standing tandem. PT applies QS to trailing leg. Approximate on the other leg by applying downwards pressure from hip to heel.

45
Q

What are the 2 variations for the stepping forward component of gait?

A

Variation 1:
MC: 1 hand: superior and medial aspect of the thigh and 1 hand on the superior and anterior aspect of the iliac crest, down and back at a 45 degree angle.
-PT provides resistance down and back to help guide the movement.

Variation 2:
MC: One hand on the anterior and superior aspect of the thigh and 1 hand on the foot.
-Use if pt has weak DF, use to facilitate foot clearance.

46
Q

How do you use PNF to take consecutive steps?

A

MC: Superior and anterior aspect of the iliac crest, 45 degree angle down an back.

VC: Shift-Step-Shift-Step

47
Q

How can PNF be used in a sitting position?

A

Goal: Teach pt good posture.

  • PD of the scapula
  • Bring pelvis into a neutral position

MC: Superior and anterior aspect of the iliac crest for the pelvis, apply pressure down and back at a 45 degree angle.

48
Q

How can you use PNF to teach a pt to come to stand or sit-to-stand?

  1. Foot Placement
  2. Arm placement
  3. Cross blocking
  4. Once pt is standing
A
  1. In parallel or in stride. In stride the least involved foot can be forward or back.
  2. Depends on pt’s ability. Choose position that will facilitate learning and achieve the desired goal. Can push on armrest of a chair or parallel bars.
  3. May feel need to block pt’s weak leg.

Mc: Superior and anterior aspect of the iliac crest to facilitate hip hinging at the pelvis.
-Have pt lean trunk forward.
-Use a weight shift to gain momentum to get the pt up and standing.
VC: 1, 2, 3, Up.

  1. MC: Superior and anterior aspect of the iliac crest at 45 degrees down and back.
    Approximate w/ appropriate resistance, down and back at 45 degree angle towards heels to reinforce stability once the pt is standing.

-make sure pelvis is up and forward to prevent hyperextension of the knee.

49
Q

What PNF techniques can be used to teach a pt to hip hinge in sitting?

A

MC: 1 hand on superior and anterior aspect of the iliac crest for the pelvis and either: A. 1 hand on the sternum or B. 1 hand on the opposite shoulder.

VC: Reach/come forward.

50
Q

How can you teach a pt to come to the edge of a chair (scoot forward)?
What are the two phases?

A

-Important for preparation for sit-to-stand.
-Initially move one side at a time.
-Smaller mvmts
-2 Components:
1. Weight shift/weight acceptance
MC: Both hands on superior and anterior aspect of the iliac crest at 45 degrees down and back. (or 1 hand on sternum).
VC: Shift.

  1. Bring leg and pelvis forward.
    MC: Superior and anterior aspect of the iliac crest at 45 degrees down and back.
    VC: Bring Your Leg forward.

Put it together: Repetition
-Shift then bring your leg forward or step.

PHTH 551- Neurological Rehabilitation (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions