Pnf Flashcards
PNF philosophy
Belief that all humans have potentials that have not been fully developed
Neuroplasticity princple: use it and improve it
PNF positive approach
Positive feedback for pts
Setting them up for success
Use of a stronger part to influence weaker
NP: salience, specificity
PNF functional approach
Movement must be specific, purposeful, and aimed towards functional goal
Optimal movement requires well integrated neuromuscular system
Goal has value to pt
NP: salience`
PNF maximal repsonse
PT is always trying to facilitate a maximum response from pt
NP: specificity, use it or lose it, use it and improve it
PNF repetition
Rep of maximal response
Increase awareness/enhance motor function
Different positions and environment
NP: specificity, transference and repetition matters
PNF continued activity
Intensive, goal driven, will be different at every stage
NP: intensity matters, time matters
PNF potential
NP: use it and improve it
PNF whole person
NP salience
PNF strong to influence weak
NP specificity
PNF optimum function
NP salience
PNF basic principles
Proprioceptive/tactile input
Visual input
Verbal input
PNF tactile input - patient position
Influence of gravity
Reflexes
Pain
Treatment goal
PNF tactile input - manual contacts
Consider direction of desired motion
Specific - use of lumbrical grip
PNF PT position/ body mechanics
Safety of therapist
Ability to feel pt response
Neutral posture
In line w/ desired motion
PNF appropriate resistance
Amount of resistance that facilitates smooth/coordinated movement
- facilitate contraction
- increase awareness or motion
- improve control and coordination
- use w/ all types of contractions
- can result in overflow/irradiation to desired target
What is the goal of traction and approximation in general?
Stimulates: joint receptors, muscle spindles, facial receptors
PNF traction
MOVEMENT
Elongation of a segment
Pulling, anti gravity movements
ex: reaching, swing pahse of gait
PNF approximation
STABILITY
Compression of a segment
Pushing, WB movements Ex: stance phase of gait
2 types
PNF quick stretch
High velocity, low amplitude elongation of a motion segment
Muscle spindles and GTO, joint receptors, facial receptors
Tissues need to have tension
Stimulate VOLUNTARY MOVEMENT
PNF normal timing
Sequence of muscle firing that results in strong, smooth, controlled, coordinated movement
PNF irradiation
Overflow principle -increase strength, ROM -decrease tone Directed toward functional goal Motor cortex activation w/ varying degrees of muscle contraction
- Places demand on one stronger body part to facilitate recruitment of another weaker part
PFN - patterns of facilitation
Optimal movement created by TRUNK and EXTREMITIES working together
Resisting a DIAGONAL allows for move muscle to participate in movement
Named for end position
PFN visual input
Integrated w/ muscle synergies, facilitates coordination of head and trunk movements
Cue movement direction
PNF verbal input
Tone and rhythm
Simple and precise
Preparatory command
Consider- stage of motor learning, needs of whole person
PNF techniques aim to:
-teach movement or stability
- increase ROM
- improve coordination
-increase strength
-increase endurance
promote relaxation
-decr pain
Rhythmic Initiation- indications/Goals
- difficulties in initiating motion
- movement is too slow or too fast
- uncoordinated or dysrhytmic motion
- general tension
GOALS: fix all the above and…help the patient relax
rhythmic initiation- description
- PT starts by moving the pt through PROM, using speed of verbal command to set rhytm
- the pt is asked to begin working actively in the desired direction. return motion is done by PT
- PT resists AROM, maintaining the rhythm with the verbal commands
Combination of isotonics - description
- PT resists the pts moving actively through a ROM (concentric)
- at the end of the motion the PR tells the pt to stay in that position (stabilizing contraction)
- when stability is attained the PT tells the pt to allow the part to be moved back slowly to starting position (eccentric)
Combination of isotonics- goals and indications
Indicated if pt has:
- decr eccentric control
- lack of coordination or ability to move in a desired direction
- decr AROM
- lack of active motion in the middle of the range
GOAL: fix all the above and … strengthen.
Dynamic reversals - description
- PT resists the pts moving in one direction
- as the end of desired ROM approaches, the PT reverse the grip on the distal portion of the moving segment
- as the pt reaches the end of his or her AROM, th PT gives the command to reverse direction, without relaxation, and resists the new motion at the distal part
- when the pt begins moving in the opposite direction the PT reverses the proximal grip so all resistance opposes the new direction
- reversals may be done as often as necessary
dynamic reversals indication/goals
Indicated in pt has:
- weakness of the agonistic muscles
- decr ability to change direction of motion
- exercised muscles begin to fatigue
GOAL: increase AROM, incr strength, develop coordination, reduce fatigue
stabilizing reversals- description
- PT gives resistance to the pt in one direction while asking the pt to oppose the force, no motion is allowed
- when the pt is fully resisting the force th ePT moves one hand and begins to give resistance in another direction
- after the pt responds to the new resistance the PT moves the other hand to resist the new direction
**alternating isotonic contractions opposed by enough resistance to prevent motion
stabilizing reversals- indication/goals
Indicated if pt has:
- decr stability
- weakness
- Pt unable to contract muscle isometrically
GOAL: incr stability and incr muscle strneth
Rhythmic stabilization- description
- PT resist an isometric contraction of the antagonistic muscle group. PT maintains the position of the part w/o trying to move
- resistance is incr slowly as the pt builds a matching force.
- when the pt is responding fully, the PT moves one hand to begin resisting the antagonistic motion at the distal part
- the new resistance is built up slowly. as the pt responds the PT moves the other hand to resist the antagonistic motion also
- reversals are repeated as often as needed
Rhytmic stabilization- indication / goals
Indicated if pt has:
- limited ROM
- pain, particularly when motion is attempted
- Jt stability
- weakness of the antagonistic muscle groups
- decr balance
CONTRAINDICATIONS of rhythmic stabilization
- cerebellar involvement
- Pt unable to follow instructions due to age, language difficulty, cerebral dysfunction
Repeated stretch (quick stretch at beginning of range) - description
- PT gives a prepatory command while elongating fully all the muscles in t hepattern. particular attention is paid to rotation
- a quick “tap” is given to lengthen the muscles further and evoke the stretch reflex
- at the ame time as the stretch the PT gives a command to link the pts voluntary efforts to contract the stretchd muscles with the reflex response
- the resulting muscle contraction, reflec and voluntary , is resisted
repeated stretch (quick stretch at beginning of range -indication/goals
Indicated if a pt has:
- weakness
- inability to initiate motion due to weakness or rigidity
- fatigue
- decr awareness of motion
GOAL:facilitate initiation, incr AROM, incr strength, reduce fatigue, guide motion in desired direction
Repeated stretch (quick stretch at beginning of range) -CONTRAINDICATION
- joint stability
-pain
unstable bones due to fracture or Osteoporosis
-damaged muscle or tendon
repeated stretch (QS through Range)- description
- PT resists a pattern of motion so all the muscles are contracting and tense
- PT gives a prepatory command to coordinate the stretch reflex with a new, incr effort by the pt
- at the same time the PT slightly elongates the muscles by momentarily giving too much resistance.
- a new stronger muscle contraction is asked for and resisted
- the stretch may be repeated to strengthen or redirect the motion as the pt moves through the range
- pt must be allowed to move before the next stretch reflex is given
- pt must not relax or reverse direction during the stretch
repeated stretch ( QS through range) - indication/goals
Indicated if pt has:
- weakness
- fatigue
- decr awareness of desired motion
Goals: incr AROM and strength, reduce fatigue, guide motion in the desired direction
repeated stretch (QS through range)- CONTRAINDICATIONS
- joint stability
- pain
unstable bones due to fracture or osteoporosis-damaged muscle or tendon
-insufficient strength to maintain contraction of the muscles
Contract relax - description
- PT or the pt moves the joint or body segment to the end of the PROM. Active motion is preferred and the PT may resist it
- PT asks the pt for a strong contraction of the restricting muscle 3or pattern (antagonist)
- enough motion is allowed to happen for the PT to be certain that all the desired muscles, particularly rotators, are contracting,
- after sufficient time , PT tells the pt to relac
- both the pt and the PT relax
- the joint or body part is repositioned, wither actively by the pt or passively by the PT, to the new limit of PROM. active motion is preferred and may be resisted
- the technique is repeated until no more range is gained
- active resisted ex of the agonistic and antagonistic muscles is done in the new range of motion
contract relax - indications/ goals
indicated if pt has:
- decr ROM
hold relax- description for incr ROM
- PT or pt moves the joint or body segment to the end of the passive or pain-free ROM. active motion is preferred. the therapist may resist if it does not cause pain
-PT asks for an isometric contraction of the restricting muscles ir pattern with emphasis on rotation
-resistance is incr slowly - no motion is intended by either pt or PT
- after holding the contraction for enough time the PT asks the pt to relax
-both the PT and the pt relax gradually
-joint of body pattern is repositioned either actively or passively to the new limit of range. active motion is preferred if it is pain free. the motion may be resisted if that does not cause pain.
repeat all steps in the new limit of range
hold relax description for decr pain
Direct tx-
- pt is comfortable position
- PT resists isometric contraction of musclews affecting painful segment
Indirect tx-
- pt in comfortable position
- PT resist isometric contractions of muscles distant from the painful segment
- resistance is built up slowly and remains at a level below that which causes pain
- during the relaxation the resistance decr slowly
Hold relax - indication/goals
Indicated if pt has:
- decr PROM
- pts isotonis contrcations are too strong for the therapist to control
- pain
hold relax- CONTRAINDICATION
-pt is unable to do an isometric contrcation
replication- description
- place the pt in the end position where all the agonist muscles are shortened
- pt holds that position while the PT resist all the components
- ask the pt to relax. move pt passively a short distance back in the opposite direction, then ask pt to return to end position
- for each replication of the movement start further toward the beginning of the movement to challenge pt through an incr ROM
replication- Indictaion/goals
- to teach the pt the end position of the movement
- to assess the pts ability to sustain a contraction when the agonist muscles are shortened
