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.
