PNF Flashcards
Mobility
- Rhythmic initiation RI
- Hold relax active movement HRAM
- Repeated contractions RC (repeated quick stretch)
Increase ROM
- Rhythmical rotation RR
- Hold-relax HR
- Contract-relax CR
Stability
- Alternating isometrics AI
* Rhythmic stabilization RS
Controlled mobility
- Slow reversals SR
* Agonistic reversals AR
Skill
- Resisted progression RP
- Normal timing NT
- Timing for emphasis TE
Rhythmic initiation
RI: Mobility technique to initiate movement
movement progresses from completely passive to active-assisted to slightly resisted as patient is capable of exerting increased control over the movement. Verbal commands need to be soothing and the movement slow, repetitive, and rhythmic.
* great for hypertonic patients (Parkinson’s), and can also be used for hypotonic patients
Hold relax active movement HRAM
HRAM: Mobility technique to initiate movement
performed with patients who present with certain weaknesses who cannot initiate rolling from the lengthened range, or cannot sustain contraction through full range. In sidelying (shortened range) isometric contraction “hold” of the abdominals gradually elicited by manual resistance until max contraction is achieved, patient then told to relax and is passively brought towards supine (the lengthened range) where quick stretch is applied to the abdominals coinciding with the quick stretch is the command to roll over. Subsequent contraction receives tracking assistance or resistance.
Repeated contractions
RC (repeated quick stretch): Mobility technique to initiate movement
Repeated use of stretch reflex to initiate a muscular response or reinforce or strengthen a pre-existing contraction. Used to reduce fatigue and improve endurance.
Rhythmical rotation
RR: to increase ROM
if ROM is limited but the patient does not have the ability to actively contract the muscle then the RR technique is appropriate. Extremity is slowly, rhythmically rotated around the long axis of the limb for approximately 10-15 seconds. Used in complete/healed/spinal cord injuries. Also used for patients with hypotonia.
Hold relax
HR: to increase ROM
an isometric technique effective with decreased ROM due to muscle tightness on one side of the joint, and is particularly effective when pain either accompanies the limitation or is the primary cause of the immobility. An isometric contraction of all components of the range limiting or antagonistic pattern (muscle group being stretched) is elicited usually at the point of limitation of the available range. The isometric contraction is slowly built up and slowly released. Once relaxation is achieved, the limb actively moves against minimal resistance through the newly gained range to the new point of limitation. If the agonist muscle are too weak to move the part into the gained range, PROM is an alternative. Hold-relax may be applied to the agonist pattern instead of the antagonist or range limiting pattern. During this variation the manual contacts are placed to resist the agonist musculature to the movement and slight resistance is applied into the nonpainful range to reduce the anxiety of the patient.
Contract-relax
CR: to increase ROM
a combo of both isotonic and isometric contractions, also is applicable when there is decreased ROM on one side of the joint. The difference btw CR and HR is in the verbal commands, the type of contraction, and because it is always applied to the antagonistic, range limiting pattern. With the joint at the point of limitation, the patient is asked for an isotonic contraction of the rotary component and isometric contraction of the other 2 components of the antagonistic pattern. As with HR , a change in joint angle of flexion-extension, abduction, adduction is not allowed to occur. Unlike HR, the rotation is allowed and the build up of tension is immediate, not gradual, and the release is abrupt- for this reason CR is not an appropriate choice in the presence of pain.
Alternating isometrics
AI: stability technique
isometric technique in which the manual contacts are changed from one surface to the other to promote isometric contraction of one side of the body at a time. Command tends to be “hold this position”
Rhythmic stabilization
RS: stability technique
isometric technique in which both the agonist and antagonist are simultaneously and then alternately elicited resulting in co-contraction. Relaxation is not allowed during alterations in manual contacts. Command tends to be “hold this position, don’t let me turn you”
Slow reversals
SR: controlled mobility technique
used to facilitate coordinated reciprocal contractions. The manual contacts are gradually changed from one surface to the other to facilitate a smooth change of direction. To promote increased controlled mobility the distance the patient goes on each direction may be gradually increased.
Agonistic reversals
AR: controlled mobility technique
emphasizes control of movement. Alternates between 3 types of contraction: concentric, isotonic hold, and eccentric- all of the agonist muscle- so there is no shifting of hand placement all of the contractions are performed without any relaxation to promote smooth coordinated movement.
Resisted progression
RP: skill technique
resistance to locomotion in either upright or prone postures for purposes of further increasing strength and endurance or enhancing normal timing of movement. The manual contacts given are determined by the part of the body to be emphasized.
Normal timing
NT: skill technique
used to develop coordination of the components of a movement pattern when there is adequate strength to control a pattern but the sequencing of the movements is not normal. NT should proceed from a distal to proximal direction. During treatment a movement pattern is initiated but all proximal motion is delayed until the distal component approaches full range. RC or TE to the lagging component may be used. When movement through distal range is satisfactory, the entire pattern is allowed to occur.
Timing for emphasis
TE: skill
effective technique when the weakness in a movement pattern is restricted to only one component of the movement pattern, such as the wrist, elbow, or shoulder. This technique is used to elicit a strong contraction of the more normal components of the pattern in order to produce an overflow effect into the weaker components. Overflow is produced by allowing the entire pattern to contract isotonically to a point in the range at which the stronger components can contract isometrically with the greatest efficiency (where patient can hold best), at that point the hold is sustained while the weaker musculature simultaneously performs an isotonic contraction with quick stretch superimposed.
D1FUE
Shoulder: (3) flex, add, ER
Forearm: (1) supinated
Wrist: (2) flexed, radially deviated
Fingers: (1) flexed
D2FUE
Shoulder: (3) flex, abd, ER
Forearm: (1) supinated
Wrist: (2) extended, radially deviated
Fingers: (1) extended
D1EUE
Shoulder: (3) ext, abd, IR
Forearm: (1) pronated
Wrist: (2) extended, ulnar deviation
Fingers: (1) extended
D2EUE
Shoulder: (3) ext, add, IR
Forearm: (1) pronated
Wrist: (2) flexed, ulnar deviation
Fingers: (1) flexed
D1FLE
Hip: (3) flexed, add, ER
Ankle: (2) DF, IN
Toes: (1) extended
D2FLE
Hip: (3) flexed, abd, ER
Ankle: (2) DF, EV
Toes: (1) extended
D1ELE
Hip: (3) ext, abd, IR
Ankle: (2) PF, EV
Toes: (1) flexed
D2ELE
Hip: (3) ext, add, ER
Ankle: (2) PF, IN
Toes: (1) flexed
If a pt was in D1EUE and is to move into D1FUE- where would the PTA’s hand be to facilitate the movement
- finger flexors in palm of hand
- radial styloid
- bicep
If a pt was in D1EUE and is to move into D1FUE- how would this movement be described? and what function could it promote?
- bring your hand to your opposite ear
* motion can be used to enhance supine towards side=lying or prone
If a patient was in D1FUE and is to move into D1EUE- where would the PTA’s hand be to facilitate movement?
- Ulnar finger extensors
- ulnar styloid process
- triceps
If a patient was in D1FUE and is to move into D1EUE-
what function could this movement promote?
•rolling back to supine
If a patient was in D2EUE and is to move into D2FUE- where would the PTA’s hand be to facilitate movement?
- Radial finger extensors
* radial styloid process, •biceps
If a patient was in D2EUE and is to move into D2FUE- how would this movement be described?
Pull a sword out of your opposite hip and bring it over your shoulder
If a patient was in D2FUE and is to move into D2EUE- where would the PTA’s hand be to facilitate movement?
- Ulnar finger flexors
- ulnar styloid process
- pronators
If a patient was in D2FUE and is to move into D2EUE- how would this movement be described?
Put the sword which you have over your shoulder back into your opposite hip
If a patient was in D1ELE and is to move into D1FLE- where would the PTA’s hand be to facilitate movement?
- Medial dorsiflexors
- toe extensors
- hip flexors/ adductors
If a patient was in D1ELE and is to move into D1FLE- what function could this movement promote?
• This motion can be used to enhance rolling supine towards sidelying or prone
If a patient was in D1FLE and is to move into D1ELE- where would the PTA’s hand be to facilitate movement?
- Lateral toe flexors/ plantarflexors
* hip extensors/ abductors
If a patient was in D1FLE and is to move into D1ELE- what function could this movement promote?
• This motion can be used to enhance return to supine position
If a patient was in D2FLE and is to move into D2ELE- where would the PTA’s hand be to facilitate movement?
- medial toe flexors/ plantarflexors
* hip adductors/ extensors
