Proprioceptive Neuro Flashcards
PNF utilize what input to produce functional improvement in motor output?
Proprioceptive
Cutaneous
Auditory
PNF combines what two things to improve muscle control and function?
- function based diagonal patterns
2. techniques to facilitate the neuro motor units
PNF utilized across populations to improve what 3 things?
- Muscle endurance
- Stability
- Control
How would you progress level of difficulty of PNF?
Beginning with PROM -> isometrics -> active assisted movement -> higher velocity resisted movements
T/F PNF requires skilled application of tactile and verbal cues to achieve desired patterns and facilitate quality contractions
True
Overflow (irradiation):
- Spread of a muscle response from stronger to weaker muscles
- Primarily achieved through applying resistance
Manual contact:
stimulates the muscle to reinforce the movement AND guide the direction of the movement
Therapist position:
Needs to be directly in line with the desired motion and should be facing the direction of the desired movement
Approximation:
May facilitate increased stability, may be applied either manually or facilitated by gravity in upright, weight bearing positions
Traction:
Applied manually during PNF patterns to facilitate muscle contraction
verbal cues -
both preparatory (to explain what is about to occur and why), as well as energetic, strong and active verbal cues during movement when require strong recruitment
Encourage visual attentiveness by the patient -
watching the distal segment, mirrors, etc.
timing -
encouraging movement of distal segments first, then moving to proximal; rotation occurs throughout the entire movement
resistance -
facilitates the contraction by recruiting motor units
Diagonal patterns -
- Composed of multi-joint, multi-planar, diagonal, and rotational movements of the extremities, trunk, and neck.
- D1 Flexion or D1 Extension
- D2 Flexion or D2 Extension
UE D1 Flexion:
Shoulder flex, add, ER
Forearm supination
Wrist radial deviation
Fingers flexed
UE D1 Extension:
Shoulder ext, abd, IR
Forearm pronation
Wrist ulnar deviation
Fingers extended
UE D2 Flexion:
Shoulder flex, abd, ER
Forearm supination
Wrist radial deviation
Fingers extended
UE D2 Extension:
Shoulder ext, add, IR
Forearm pronation
Wrist ulnar deviation
Fingers flexed
How are diagonal patterns identified?
Patterns are identified by the position of the shoulder or hip when the diagonal pattern has been completed (flexion or extension)
T/F Motions of body segments distal to the shoulder or hip also occur simultaneously during each diagonal pattern
True
LE D1 Flexion:
Hip flex, add, ER
Dorsiflexion
Inversion
Toes extended
LE D1 Extension:
Hip ext, abd, IR
Plantar flexion
Eversion
Toes flexed
LE D2 Flexion:
Hip flex, abd, IR
Dorsiflexion
Eversion
Toes extended
LE D2 Extension:
Hip ext, add, ER
Plantar flexion
Inversion
Toes flexed
Rhythmic Initiation -
- used to promote the ability to initiate a movement pattern
- Utilized for treatment of dysfunctions which affect initiation, speed, direction, or quality of contraction
Goal of rhythmic initiation -
allow the patient to become familiar with the sequence of movement and the rate at which movement is to occur
Steps of rhythmic initiation:
Step 1: Therapist moves patient passively through pattern
Step 2: Therapist asks patient to perform active assisted movement
Step 3: Active movement
Step 4: Active movement against manual resistance
Indications for rhythmic initiation -
- Improves coordination
- May “break up” tone
- Improves motor planning
- Beneficial for people who respond better to tactile than verbal cues
Alternating isometrics -
Technique to improve isometric strength and stability of the postural muscles of the trunk or proximal stabilizing muscles of the shoulder girdle and/or core
Steps for alternating isometrics -
- Manual resistance is applied in a single plane on one side of a body segment and then on the other
- The patient is instructed to “hold” his or her position as resistance is alternated from one direction to the opposite direction.
T/F No joint movement should occur when doing alternating isometrics
True
T/F Alternating isometrics strengthens agonists and antagonists, and it can be applied to one extremity, to both extremities simultaneously, or to the trunk.
True
T/F Alternating isometrics can be applied with the extremities in weight-bearing or non weight-bearing positions.
True
Rhythmic stabilization -
- isometric contractions “from all sides”
- Focus is on eliciting co contractions for stability
Technique of rhythmic stabilization:
- Progression of alternating isometric
- Co-contractions of agonist and antagonist performed by placing hands on opposite sides of body and applying simultaneous resistance
- No motion is allowed
- “build” your resistance to allow patient build a strong contraction
- Shift hand placement opposite to the muscles you were just recruiting
Indications for rhythmic stabilization:
- Impaired strength and coordination
- Can work through limited ROM
- Appropriate for patients who have issues with postural stability and balance
- Appropriate for patients with decrease stability at a given joint
rhythmic stabilization exercises can provide therapists what information?
on patient’s ability to reinforce and maintain contractions
Dynamic (slow) reversals -
agonist -> antagonist contractions eliciting bidirectional movement from patient
Technique for Dynamic (slow) reversals:
Step 1 - Elicit contraction and movement of the muscle you desire to recruit first
Step 2 - When patient has almost completed first movement, switch hand placement and ask the patient to move in the opposite direction
Indication for Dynamic (slow) reversals:
- Improve coordination specifically for those patients who demonstrate co contractions
- Can be modified to work through limited ROM
- Can improve strength and coordination
Goal with dynamic (slow) reversals is to do what so not to confuse your patient with “mixed up hand placement”?
to cue the muscle you want to be active.
Due to dynamic (slow) reversals continuous nature, what is it improving?
- Improves muscle endurance due to continuous nature
Fast/quick stretch -
- Provide a quick stretch of the agonist when changing directions
- Produces a relatively short-lived contraction of the agonist’s muscle and short-lived inhibition of the antagonist muscle which facilitates a muscle contraction (muscle spindle)
Repeated contraction/stretch -
- Move through a pattern pausing and applying a quick stretch, press through more motion, pause, quick stretch, push.
- Emphasizes strengthening in specific ranges throughout the motion
Dynamic (slow) reversal hold -
- Same as dynamic reversals but with an isometric hold at end of the motion prior to changing directions
Agonist reversals -
Reversing the type of contraction you are eliciting from your patient, working concentrically, isometrically, and eccentrically
