PNF Lower Trunk and LE Flashcards
1
Q
Why PNF
A
- Can improve performance of functional tasks by increasing strength, flexibility, ROM, & overall motor control
- Uses the developmental sequence as a guide to promote achievement of progressively higher levels of proficiency and functional independence in bed mobility, transitional movements, sitting, standing and walking
2
Q
Essential elements of PNF
A
- Manual contacts
- Body position and body mechanics
- Stretch
- Manual resistance
- Joint facilitation
- Timing of movement
- Patterns of movement
- Cues: visual cues and verbal input
- Irradiation/reinforcement
3
Q
Describe pelvic patterns
A
- More limited ROM vs scapular patterns
- Utilize same clock as with scapular patterns
- Diagonals: 11-5 o’clock = posterior elevation to anterior depression; 1-7 o’clock = anterior elevation to posterior depression
4
Q
Functionally relevant pelvic patterns during gait
A
- Anterior elevation: pull your pelvis up & forward; promotes pelvis protraction during preswing
- Posterior depression: sit back into my hands; promotes trailing limb posture
5
Q
Describe D1 hip flexion
A
- Hip flexion, adduction, & ER
- “Pull your foot up & in and pull your leg across”
- Works against spastic patterns, promotes swing phase
- Functionally: cross leg while sitting, take off shoes
- No knee/ankle movements
- Think dog & fire hydrant
- Not frequently used functionally but a good exercise to break abnormal synergy by combining ankle eversion with DF (difficult for stroke pts)
6
Q
Describe D1 hip extension
A
- Hip extension, abduction, & IR
- “Push your foot down & out”
- Promotes stance phase and sit to stand
- In standing think soccer kick
7
Q
PNF Facilitation Techniques for LE
A
- Each technique promotes a few stages of motor control: mobility, stability, controlled mobility
- Rhythmic Initiation
- Rhythmic Rotation
- Hold Relax Active Movement
- Hold Relax
- Contract Relax
- Alternating Isometrics
- Rhythmic Stabilization
- Slow Reversal
- Slow Reversal Hold
- Agonistic Reversals
8
Q
Describe rhythmic initiation
A
- Improves mobility: movement initiation or relaxation; helps with lower level functional tasks where there is a lack of initiation due to weakness or hypertonicity
9
Q
Sequence of rhythmic initiation
A
- Initially PROM to encourage relaxation & teach movement of task
- Ask patient to assist while slowly removing assistance & maintaining manual contacts
- Resistance as tolerated
- Think initiate mobility; momentum strategy, or teach movement pattern
10
Q
Describe rhythmic rotation
A
- Improve mobility
- PROM in a rotational pattern
- Slow rhythmical movement about longitudinal axis: relaxation & tone reduction to reduce spasticity/rigidity
11
Q
Describe hold relax active movement/contraction (Replication)
A
- Improves mobility/ROM towards end range of agonist pattern by improving muscle recruitment
12
Q
Sequence of hold relax active movement/contraction (Replication)
A
- Position near end range of restricted movement
- Perform resisted isometric contraction of agonist muscle group
- Have pt relax & move passively into lengthened position
- Have pt perform active movement into the agonist pattern.
- Do this with increasing increments into lengthened position as the pt gains greater agonist range
- Can also apply quick stretch at lengthened position to recruit muscle spindles
- Apply slight resistance
13
Q
Describe hold relax
A
- Increases passive joint ROM & decreases movement related pain
14
Q
Sequence of hold relax
A
- Patient or PT moves the joint to the limit of pain free ROM
- Verbal cue of ‘hold’ as the patient maintains this position while the PT resists an isometric contraction of the antagonist (the muscles restricting the motion) - 5-8 secs
- Verbal cue of ‘relax’ as the PT gradually eliminates resistance to isometric contraction and
- The joint ROM is increased passively by PT or preferably actively by patient to tolerance
- Alternative method: can also be done with isometric contraction of ‘agonist’
15
Q
Describe contract relax
A
- Increases passive joint ROM & soft tissue length
- Most effective with 2 joint muscles contractures involving rotary component & when pain is not a significant factor
16
Q
Sequence of contract relax
A
- PT or patient moves joint to end ROM, a VC to “turn and push or pull” is given to generate contraction of short muscles
- Resistance overcomes all motions except for rotation resulting in isometric contraction of all muscles components except for the concentric rotary component
- Held for 5 seconds, then pt relaxes and the joint is lengthened actively or passively to the new limit ROM
17
Q
Describe alternating isometrics (isotonic stabilizing reversals/alternating holds)
A
- Promotes stability, strength, & endurance for postural control in specific postures
- Isometric contractions of agonist/antagonist promote alternating pattern
- Verbal cues: don’t let me push you or push against my hand (external perturbations
- Trunks ability is often the focus
- One hand on patient at all times, manual contacts can shift
- Often applied in various postures to improve postural control
- Can also be applied to extremities
18
Q
Describe rhythmic stabilization (isometric stabilizing reversals)
A
- Promotes stability through co-contraction of muscles surrounding target joints
- Rotary force is emphasized to encourage simultaneous contraction of primary stabilizers around joint
- Pt is asked to hold the position
- Force increased slowly matching pt’s effort
- Mostly used for trunk stabilizers to improve postural control/balance
- Often used in various postures
19
Q
Describe slow reversal (dynamic reversals)
A
- Promotes controlled mobility
- Used to address weakness, joint stiffness, or impaired coordination
- Concentric agonist contraction promoted with manual contacts & verbal cues (push or pull against me)
- At end range manual contacts switch smoothly to facilitate antagonist concentric contraction
- Resistance from slight to maximal
- Can be performed to improve control of diagonal limb patterns or trunk movements in different postures
20
Q
Describe slow reversal hold
A
- Variation of slow reversal technique in which resisted isometric is held at completion of ROM in each direction of pattern
- Helps in building stability at end ROM
- Verbal cues of “push against my resistance and hold”, “pull against my resistance and hold”
21
Q
Describe agonistic reversals (combination of isotonics)
A
- Improves functional movement throughout a pattern or task by promoting controlled mobility, also promotes strength & endurance
- Both concentric & eccentric contractions of the agonist musculature are promoted
22
Q
Sequence of agonistic reversals
A
- Concentric contraction of the agonist group is resisted through a specific direction and range of the chosen pattern or task
- At desired endpoint, the pt holds with isometric contraction against resistance (briefly),
- Then the clinician resists slow controlled return toward beginning of movement emphasizing eccentric control
- At the other end, another isometric hold
23
Q
PNF techniques to improve bridging, postural control in bridging
A
- Once in hook lying
- Rhythmic rotation in hook-lying to improve trunk rotation for rolling: reduce tone in trunk ms and improve mobility
- Alternating isometrics for stability
- Rhythmic initiation through the knees by stabilizing feet – to improve mobility for assuming bridging position
- Hold-relax active movement to improve mobility for assuming bridge posture
- Alternating isometrics: stability with bridge posture by resisting sideways pushes
- Rhythmic stabilization: stability
- Agonistic reversals: controlled mobility/skill
24
Q
PNF techniques to improve rolling
A
- Rhythmic initiation w/ or w/o prepositioning of LE into flexion/adduction - mobility
- Hold relax active movement: mobility to enhance ability to roll through greater range
- Slow reversal, slow reversal hold: controlled mobility
- Agonistic reversals: controlled mobility
- Combine with D1F of UE or LE to encourage rolling from supine<>sidelying
- And, D1E of UE or LE sidelying<>supine
- Chops and Lifts during rolling
25
Q
PNF techniques to improve prone positions
A
- In prone on elbows or prone on hands position (specifically useful in SCI patients)
- Alternating isometrics: stability
Rhythmic stabilization: stability - Slow reversal: controlled mobility through lateral or diagonal wt shits
- Slow reversal hold: controlled mobility
26
Q
PNF techniques for prone on elbows to quadruped
A
- Manual contact at the ischial tuberosity to assume quadruped: mobility
- Once in quadruped (or for working in reverse)
- Alternating isometrics and rhythmic stabilization for stability
- Slow reversals for lateral weight shifts/rocking for controlled mobility
- D1/D2 flexion patterns in quadruped for controlled mobility
- Agonistic reversals forward<>backward to promote rocking: controlled mobility in preparation for kneeling
27
Q
PNF techniques for quadruped to kneeling
A
- Manual contact on ischial tuberosity, verbal cue of ‘push back into my hands’
- As patient unloads UEs shift manual contact to iliac crest & posterior pelvis, verbal cue ‘straighten your hips & trunk’
- Hold relax active movement/agonistic reversals for kneel-sitting to kneeling
- Once in kneeling: alternating isometrics & rhythmic stabilization on upper trunk & pelvis for stability in kneeling posture
- May need to work in reverse from kneeling to kneel-sitting
28
Q
PNF techniques to improve sitting
A
- Improve ant./post. pelvic tilts: rhythmic initiation, hold relax active movement for training to assume upright sitting posture (mobility); slow reversals for controlled mobility while sitting
- Improve trunk stability: alternating isometric, rhythmic stabilization
29
Q
PNF techniques for sit to stand
A
- Improve flexion momentum of trunk (mobility): hold relax active movement
- Improve controlled trunk movement forward during momentum transfer or during triple extension: Slow reversals, agonistic reversals (may need to adjust manual contacts on upper trunk/pelvis during sit<>stand task depending on pt’s abilities and weakness), approximation on pelvis may help
- Also need to train stand to sit (work in reverse)
30
Q
PNF techniques to improve stability in symmetrical or mid-stance standing
A
- Approximation on pelvis: downward & posteriorly or downward & anteriorly
- Approximation on trunk: downward
- Techniques on trunk/pelvis: alternating isometrics, rhythmic stabilization (can do in various stance phases)
- Can also apply techniques on stance knee: alternating isometrics
31
Q
PNF techniques to improve swing phase of gait
A
- Manual contacts on weaker pelvis
- Apply quick stretch to facilitate muscle recruitment for pelvic anterior elevation/protraction to initiate swing
- May need assistance on posterior pelvis to promote swing
- Can also train gait swing/stance phases in sidelying: remember quick stretch & irradiation to pelvis to promote anterior elevation or posterior depression to promote swing or push off
