PNF techniques

Question 1

PNF principles: position

Answer 1

• therapist position is important for both techniques and patterns
• position yourself in line with the pt’s movements
• allows you to provide the best tactile feedback and resistance
• precise manual contacts on the working muscles helps
• guide and teach movements
• promote muscle contraction

Question 2

PNF principles: manual contacts

what to do/what it does

Answer 2

• precise manual contacts on the working muscles helps
• guide and teach movement
• promote muscle contraction and activation of synergists
• enhance kinesthetic awareness

Question 3

PNF principles: visual input

Answer 3

• encourage pt to watch movements helps with motor learning and motor control
• encourage pt to follow hand or arm movement with their eyes during UE patterns encourages incorporation of trunk and promotes functional movement

Question 4

PNF principles: resistance

Answer 4

resistance can improve

• kinesthetic awareness - using tracking (light resistance)
• improve strength: using more resistance to match pt’s abilities
• relax muscles: maximal resistance to promote autogenic inhibition and increase muscle length

Question 5

PNF principles: approximation

Answer 5

• approximation increases weight through weight-bearing structures
• encourages muscle contraction to maintain weight-bearing and uprigth position

Question 6

PNF principles: traction

Answer 6

• providing slight traction of the joint capsule can help facilitate muscle activity and movement
• note avoid using if patient has a subluxation of joint

Question 7

what do PNF techniques do?

Answer 7

• designed to facilitate the neuromuscular system
• promote/facilitate increased muscle activity using: tactile/kinesthetics/proprioceptive input
• some techniques used input to reduce muscle activity

Question 8

PNF techniques for mobility

Answer 8

• rhythmic initiation
• repeated contractions
• contract-relax
• hold-relax
• rhythmic rotation

Question 9

Rhythmic initiation

Answer 9

Used for early mobility:

• sidelying to supine/prone
• hooklying to sidelying

key principles:

• movements go from passive to active assisted to active
• move from a small range through progressively larger ROM
• using hands as proprioceptive feedback
• can be used when someone is trying to roll

Question 10

Repeated contractions

Answer 10

• tiny quick stretch to activiate muscle spindle
• used at a point of weakness to help promote muscle activity
• improves mobility by helping improve movement through ROM
• give muscle a series of short, quick stretches
• pressure will be in the opposite direction of patient movement
• provide a verbal cue with your quick stretch

Question 11

Contract-relax

Answer 11

• used to increase muscle length
• uses contraction of tight muscle and rotation to promote relaxation
• patient moves actively to point of tightness with limb in ER/IR
• contracts tight muscle including rotation, as therpaist provides maximal resistance
• patient actively moves into new range

Question 12

Hold-relax

Answer 12

• used to increase muscle length
• uses contraction of tight muscles to promote relaxation
• patient moves actively to point of tightness
• patient contracts tight muscle, as therapist provides maximal resistance
• therapist passively moves patient into new range

Question 13

Rhythmic rotation

Answer 13

• used to increase mobility due to increased muscle tone
• helpful to temporarily relax pt to allow them to participate in therapy eg: working on sitting, rolling, standing, reaching
• therapist gentle moves tight limb into IR and ER
• increase amount of rotation as pt relaxes
• move limb through range as pt relaxes

Question 14

PNF techniques for stability

Answer 14

• stabilizing reversals
• rhythmic stabilization
• prolonged holds
• replication
• used to increase stability in sitting, standing or stability through an extremity in weight bearing

Question 15

Stabilizing reversals

Answer 15

• therapist asks pt to resist contraction on one side of body, followed by resistance on other side of body
• pt reverses isometric contractions between sides of body

Question 16

What are some important principles of stabilizing reversals

Answer 16

• slowly build up the pressure for resistance, then slowly decrease as you prepare to switch sides
• cue to patient: hold it/hold still; dont let me move you
• increase your force as the patient increases their force

Question 17

Rhythmic Stabilization

Answer 17

• encourages isometric co-contraction of flexors and extensors
• uses isometric use of rotational/oblique ms to promote stability
• therapist places one hand on flexor surface and one hand on other side of body on extensor surface
• as with stabilizing reversals: slowly increase and decrease resistance use verbal cues

Question 18

Prolonged holds

Answer 18

• Use isometric contraction
• most commonly used for extensors, but can be used to elicit any muscle contraction
• therapist provides resistance, encouraging maximal/strong contraction
• as patient contracts should see: muscle shaking, irradiation of contraction to synergistic muscles
• commonly used with other techniques to encourage muscle contraction and stability

Question 19

PNF technique

Replication

Answer 19

• used to encourage upright posture in sitting or standing
• can be used to encourage any static position e.g maintaining sidelying or bridging
• assist patient into posture
• provide resistance to encourage extension
• ask pt to move back into posture, providing tracking resistance to guide pt

Question 20

PNF techniques for dynamic postural control or transitional movements

Answer 20

• dynamic reversals (skill)
• combination of isotonics
• repeated contractions
• rhythmic initiaion

Question 21

Dynamic reversals

Answer 21

• encourages concentric contraction on one side of the body followed by concentric contraction on other side
• contraction of agonist, followed by contraction of antagonist
• flexion/extension; abduction/adduction; IR/ER
• manual resistance by therapist on working muscles
• use tracking resistance to guide weigth shift
• use more resistance to encourage strengthening and weightshifting

Question 22

What are examples of dynamic reversals for dynamic postrual control and transition mobiltiy

Answer 22

• encouraging trunk flexion and extension in sitting
• encourage weight-shift side to side or diagonally in sitting or standing
• hooklying, moving legs side to side
• sidelying, rolling between supine and prone
• quadruped, kneeling, half-kneeling: weight shifts anterior/posterior, lateral diagnoals
• shifting toward heels and back up
• quadruped: side bends; cat-cow
• POE

Question 23

combination of isotonics

Answer 23

• encourages concentric contraction followed by eccentric contraction (or vice-versa)
• manual contacts remain in same location since the same muscles are working
• encourage pat to move into your hands during concentric movement
• encourage pt to maintain contact with your hands or to move slowly

Question 24

when to use combination of isotonics

Answer 24

• used in tranistional movements and weight-shifting to encourage controlled movements
• moving between squatting and standng, bridiging
• can be used for most movements described for use wtih dynamic reversals, eg flexion/extension

Question 25

repeated contractions | what does it improve

Answer 25

- improves dynamic postural control by engaging mucles to improve weight shifting - improves transitional mobility by engaging muscles to help pt move from one position to another

Question 26

Rhythmic initiation

Answer 26

- can be used to help pt transition between movements - keep in mind this technique is difficutly to use against gravity - as pt improves, transition to dynamic reversals or combination of isotonics - ex: in sitting - promote trunk flexion/extension

Question 27

PNF techniques for skills

Answer 27

- dynamic reversals - combination of isotonics - repeated contractions - resisted gait progression - timing for emphasis

Question 28

# how is repeated contractions used for skill

Answer 28

- used during a skill activity at a point of weakness to promote muscle activity - performed as described for mobility activities

Question 28

# how are dynamic reversals/combination of isotonics | used for skills

Answer 28

- used in skill activity with extremity out of weight bearing - examples: reaching activities, stepping activities - use dynamic reversals for concentric contractions on both sides - use combination of isotonics to improve eccentric control

Question 29

Resisted gait progression

Answer 29

- used to help initiate stepping - used to encourage initiation of step using pelvic rotation - can be performed with therapist standing in front of or behind pt - therpaist provides light quick stretch to pelvic to encourage forward rotation of pelvis then asks pt to step forward - as pt improves can modify manual contacts at shoulders, quads, lower leg - can be performed unilaterally or bilaterally

Question 30

resisted progression used

Answer 30

- to initiate any locomotor activity - crawling - knee walking etc

Question 31

timing for emphasis

Answer 31

- used to promote movement of the distal segment prior to movement of the proximal segment - to encourage ankle DF prior to hip flexion and knee extension during swing phase - to encourage hands opening during reaching - ETC

Question 32

# Timing for emphasis principles

Answer 32

- limit the proximal movement by providing resistance until the patient initiates the distal movement - use tactile cues on the distal segment on the anterior foot to encourage DF, dorsum of the hand to promote opening