PRELIMS: PNF TECHNIQUES

Question 1

Use of pressure as a facilitating mechanism and sensory cue to guide the direction of movement.

Answer 1

Manual Contact (MC)

Question 2

The spread of a response to stimulation, used to recruit weaker muscle groups.

Answer 2

Irradiation

Question 2

Opposing force to the patient’s movement, used to facilitate muscle contraction, increase motor control, and build strength.

Answer 2

Resistance

Question 2

Strengthening a response by adding more stimuli or force.

Answer 2

Reinforcement

Question 2

A quick stretch used to initiate movement and increase the force of muscle contractions via the stretch reflex.

Answer 2

Stretch (STR)

Question 3

Joint separation that promotes movement, facilitates muscle contraction, and enhances strength.

Answer 3

Traction

Question 3

Coordination of movements starting distally and progressing proximally to promote neuromuscular control.

Answer 3

Normal Timing

Question 3

Adjusting the sequence of movements to emphasize specific muscle groups or desired activities.

Answer 3

Timing for Emphasis

Question 4

Sensory receptors in joints that are stimulated by traction or approximation, aiding in movement and stability.

Answer 4

Joint Receptors

Question 4

Therapist’s Role in PNF

Answer 4

The therapist actively participates as part of the patient’s movement effort, guiding and supporting.

Question 4

A reflexive muscle contraction in response to a quick stretch, enhancing the force of muscle contractions.

Answer 4

Stretch Reflex

Question 4

Joint compression that promotes stabilization, postural control, and weight-bearing activities.

Answer 4

Approximation

Question 4

Proximal Pivot in PNF

Answer 4

in PNF patterns, shoulder flexion is always combined with external rotation (ER), and hip adduction occurs with external rotation, contributing to the proximal pivot movements.

Question 5

Treatment follows the natural sequence of motor development, from head to toe (cervicocaudal) and from central to peripheral (proximodistal).

Answer 5

Developmental Sequence

Question 5

Early motor behavior dominated by reflexes, with mature behavior supported by postural reflex mechanisms.

Answer 5

Reflex Activity

Question 5

Activities combined with facilitation techniques to accelerate learning of movement patterns, such as walking and self-care.

Answer 5

Goal-Directed Activities

Question 5

Movements such as supination and wrist radial deviation occur with shoulder ER. Similarly, foot inversion occurs with hip adduction and external rotation, demonstrating intermediate pivots.

Answer 5

Intermediate Pivot in PNF

Question 6

Finger flexion and adduction align with wrist flexion and shoulder adduction. Thumb adduction coincides with shoulder ER. These patterns show how digital pivots correspond to proximal and distal pivots.

Answer 6

Digital Pivot in PNF

Question 6

involve diagonal and spiral movements that mimic functional activities of daily life. These patterns help in improving strength, flexibility, and coordination through sequential movements from starting to ending positions.

Answer 6

Proprioceptive Neuromuscular Facilitation (PNF) patterns

Question 6

Both extremities perform identical movements simultaneously. This pattern is crucial for trunk flexion and extension, aiding in the development of reciprocal flexor and extensor dominance.

Answer 6

Bilateral Symmetrical Patterns (BS)

Question 6

Unilateral Patterns for LE: D2 Extension

Answer 6

Involves hip extension, adduction, and external rotation (ER), with knee extension, ankle plantarflexion, and foot eversion. This pattern simulates movements like stepping back.

Question 7

Extremities perform opposing movements simultaneously, such as D1 Flexion in one arm and D1 Extension in the opposite arm. This pattern helps stabilize the head, neck, and trunk by balancing movement across the body.

Answer 7

Reciprocal Patterns (RS)

Question 7

Paired extremities move toward one side of the body simultaneously, either with or without contact. These patterns facilitate trunk rotation and are used in activities like chopping or lifting.

Answer 7

Bilateral Asymmetrical Patterns (BA)

Question 7

Unilateral Patterns for LE: D1 Extension

Answer 7

Involves hip extension, abduction, and internal rotation (IR), with knee extension, ankle plantarflexion, and foot eversion. This pattern simulates movements like kicking.

Question 8

Unilateral Patterns for LE: D1 Flexion

Answer 8

Involves hip flexion, adduction, and external rotation (ER), with knee flexion, ankle dorsiflexion, and foot inversion. This pattern mimics movements like crossing one leg over the other.

Question 8

Unilateral Patterns for UE: D2 Extension

Answer 8

Involves shoulder extension, adduction, and internal rotation (IR), with wrist flexion and ulnar deviation, and finger flexion. This pattern simulates movements like pulling down.

Question 8

Unilateral Patterns for LE: D2 Flexion

Answer 8

Involves hip flexion, abduction, and internal rotation (IR), with knee flexion, ankle dorsiflexion, and foot inversion. This pattern mimics movements like lifting the leg out to the side.

Question 9

Unilateral Patterns for UE: D2 Flexion

Answer 9

Involves shoulder flexion, abduction, and external rotation (ER), with wrist extension and radial deviation, and finger extension. This pattern mimics overhead reaching.

Question 9

Unilateral Patterns for UE: D1 Extension

Answer 9

Involves shoulder extension, abduction, and internal rotation (IR), with wrist extension and ulnar deviation, and finger extension. This pattern simulates movements like pushing away.

Question 9

Back: Involves isometric and isotonic contractions with manual resistance, performed until fatigue is evident. Used to emphasize a weak component of a pattern, typically performed at any point in the range of motion.
Indication: Weakness and incoordination, correction of imbalance.
Contraindication: Acute orthopedic conditions, recent post-operative conditions.

Answer 9

Directed to Agonist - Repeated Contractions (RC)

Question 9

Unilateral Patterns for UE: D1 Flexion

Answer 9

Involves shoulder flexion, adduction, and external rotation (ER), with wrist flexion and radial deviation, and finger flexion. This pattern mimics reaching and grasping actions.

Question 10

Combines isometric hold, relaxation, and isotonic contraction with manual resistance. Performed from a shortened range to a lengthened range to build power or induce fatigue.
Indication: Lack of endurance, extreme weakness in lengthened range, marked imbalance toward antagonistic patterns.
Contraindication: Full PROM and RROM avoided due to pain (e.g., in conditions like MS, GBS).

Answer 10

Directed to Agonist - Hold Relax Active Motion (HRA)

Question 11

Progresses through relaxation, passive range of motion (PROM), active-assistive range of motion (AAROM), active range of motion (AROM), to resisted range of motion (RROM). Aims to promote initiation and increase rate of movement.
Indication: Rigidity, severe spasticity, lethargy, bradykinesia, decreased position sense.
Contraindication: Conditions where passive movement is contraindicated.

Answer 11

Directed to Agonist - Rhythmic Initiation (RI)

Question 11

Uses antagonist contraction to facilitate agonist contraction, based on the principle of successive induction.

Answer 11

Directed to Agonist - Reversal of Antagonist

Question 12

Alternates slow, rhythmical concentric contractions of agonists and antagonists, performed through the range of motion or partial range.
Indication: Weakness, stimulation of agonistic pattern.
Contraindication: Acute orthopedic conditions.

Answer 12

Directed to Agonist - Slow Reversal (SR)

Question 13

Combines isotonic contractions with isometric holds of antagonists and agonists. Helps develop stability and isometric contraction in specific patterns.
Indication: Same as Slow Reversal.
Contraindication: Same as Slow Reversal.

Answer 13

Directed to Agonist - Slow Reversal Hold (SRH)

Question 13

Involves rhythmic isometric contractions against various contact points, resisting movement of the agonist and antagonist without allowing relaxation. Aims to enhance stability and circulation.
Indication: Weakness, deficient isometrics in ataxia, pain, limited range of motion from joint splinting.
Contraindication: Conditions where stabilization does not stimulate agonistic pattern.

Answer 13

Directed to Agonist - Rhythmic Stabilization (RS)

Question 14

Involves rapidly alternating isotonic contractions of agonist and antagonist to correct imbalances, particularly in shortened range of agonist.
Indication: Marked antagonist imbalance.
Contraindication: Any condition where quick movements are hazardous.

Answer 14

Directed to Agonist - Quick Reversal (QR)

Question 15

Combines isometric contraction of the antagonist with active or passive movement of the agonist to achieve a lengthening reaction of the muscle.
Indication: Muscle spasm with pain, acute orthopedic conditions.
Contraindication: Active motion against resistance is not permitted.

Answer 15

Directed to Antagonist - Hold Relax (HR)

Question 16

Involves isometric and isotonic contractions of the antagonist and agonist at the point of range limitation to achieve relaxation of the antagonist and stimulate the agonist.
Indication: Limited range of motion.
Contraindication: Active motion against resistance is not permitted.

Answer 16

Directed to Antagonist - Slow Reversal Hold Relax (SRHR)

Question 17

Involves passive range of motion (PROM) of the agonist followed by isometric contraction of the antagonist with manual resistance, then relaxation and PROM.
Indication: Spasticity, marked limitation of motion with no active motion in the agonist.
Contraindication: Acute orthopedic conditions.

Answer 17

Directed to Antagonist - Contract Relax (CR)

Question 18

: Involves repeated passive rotational movement of the limb or trunk to promote balance between flexor and extensor responses.
Indication: Reflex imbalance secondary to spinal cord trauma, lack of flexibility, hypertonia with no active motion.
Contraindication: Acute orthopedic conditions, recent post-operative conditions, circulatory conditions.

Answer 18

Directed to Antagonist - Rhythmic Rotation (RRo)

Question 19

Functional Activities Using UE D2 Flexion

Answer 19

Examples include combing hair on the right side with the right hand and performing a backstroke in swimming.

Question 19

Basic Principle - Manual Contact

Answer 19

Involves placing the clinician’s hands on the patient’s skin to stimulate pressure receptors and guide movement. Optimal placement of hands over target muscles aligns with the direction of the movement. A lumbrical grip is preferred for control and minimal discomfort.

Question 19

Functional Activities Using UE D1 Extension

Answer 19

Examples include pushing a car door open from the side, rolling from supine to prone, and executing a tennis backhand stroke.

Question 20

Functional Activities Using UE D1 Flexion

Answer 20

Examples include hand to mouth motion in feeding, combing hair on the left side with the right hand, rolling from supine to prone, and performing a tennis forehand stroke.