Proprioceptive Neuromuscular Facilitation (PNF) Flashcards
What is neuromuscular facilitation?
promoting or encouraging normal activity of the neuromuscular system
What is proprioception?
pertaining to the proprioceptors/sensory inputs
What is PNF?
-A form of therapeutic exercise
-Movement with a purpose
-Focus on optimal afferent (sensory) input
-Utilizes tactile, verbal, and visual cues
What does PNF promote?
Optimal neuromuscular activity
What is continuous sensory input provided by?
-Manual contacts to assist, resist, block, or guide motion
-Verbal guidance to cue, coach, and enforce
-Visual feedback
Who created PNF techniques?
-Dr. Kabat
-Maggie Knott
-Dorothy Voss
Why was PNF initially used and what is it used for now?
-It was initially used in patients with polio who had neurological muscle weakness
-Now it is used in rehab for many injuries
Why is PNF utilized?
To improve strength, neuromuscular control, increase flexibility, range of motion, and facilitate stability
What are indicators for PNF?
-To decrease abnormal muscle tone
-To promote optimal, coordinated movement
-To increase strength and endurance
-To stretch tight muscles
What is PNF theory?
-The muscular system is comprised of muscle groups classified as:
-Agonist:produce movement
-Antagonist: relax to allow movement
-Supports: stabilize the trunk and proximal extremities
-Fixators: holds bones steady
-The muscle groups in specific movement patterns must contract in a certain order or sequence
-Contractions are static or dynamic
What is the goal of PNF?
To strengthen gross motor patterns instead of specific muscle actions
What does facilitation of PNF do?
Creates an increase in excitability of motor neurons
What does inhibition of PNF do?
Creates a decrease in excitability of motor neurons which leads to spasticity or tightness of muscles
What is the first historical principle of PNF?
Developmental activities are useful as a bases for treatment of patients of all ages
-Subconscious movement or motor programs such as rolling, walking, or balancing
-Use of such functional activities as therapeutic exercise is beneficial after complex or simple injuries
What is the second historical principle of PNF?
The sensory-reflex mechanisms underlying normal movement are recognized as potent forces influencing movement and posture
-Sensory stimulation has a powerful impact on promoting optimal movement patterns, and should be used for ther ex (ex: protective withdrawal)
-Avenues of sensory facilitation used by the therapist (hand contact, use of voice, use of breathing, pt’s use of eyes)
What is the third historical principle of PNF?
Coordinated, alternating movements between antagonist muscle groups are essential in normal function
-Normal movement requires a balance of strength as well as coordination between muscle groups
-Dynamic and static reversing contractions should be incorporated into optimal ther ex
What is the fourth historical principle of PNF?
Utilize known principles of motor learning in ther ex
-Length tension
-Neuro-irradation (activating weak muscles using surround strong ones)
-Successive induction
-Reciprocal inhibition
-Hierarchy of motor learning goals
What is the fifth historical principle of PNF?
Normal functional movement does not occur in isolated planar motions, but in combined diagonal activities
How many pairs of diagonal patterns are there for upper and lower extremities?
There are two pairs of diagonal patterns for UE and LE and each have a flexion/extension portion
-Diagonal 1 (D1)
-Diagonal 2 (D2)
What are the movements for D1 of the shoulder?
-Flexion: flexion, adduction, external rotation
-Extension: extension, abduction, internal rotation
What are the movements for D1 of the scapula?
-Flexion: elevation, abduction, upward rotation
-Extension: depression, adduction, downward rotation
What are the movements for D1 of the elbow?
-Flexion: flexion or extension
-Extension: flexion or extension
What are the movements for D1 of the forearm?
-Flexion: supination
-Extension: pronation
What are the movements for D1 of the wrist?
-Flexion: flexion, radial deviation
-Extension: extension, ulnar deviation
What are the movements for D1 of the hand?
-Flexion: flexion, adduction
-Extension: extension, abduction
What are the movements for D2 of the shoulder?
-Flexion: flexion, abduction, external rotation
-Extension: extension, adduction, internal rotation
What are the movements for D2 of the scapula?
-Flexion: elevation, abduction, upward rotation
-Extension: depression, adduction, downward rotation
What are the movements for D2 of the elbow?
-Flexion: flexion or extension
-Extension: flexion or extension
What are the movements for D2 of the forearm?
-Flexion: supination
-Extension: pronation
What are the movements for D2 of the wrist?
-Flexion: extension, radial deviation
-Extension: flexion, ulnar deviation
What are the movements for D2 of the hand?
-Flexion: extension, abduction
-Extension: flexion, adduction
What are the movements for D1 of the hip?
-Flexion: flexion, adduction, external rotation
-Extension: extension, abduction, internal rotation
What are the movements for D1 of the knee?
-Flexion: flexion
-Extension: extension
What are the movements for D1 of the ankle?
-Flexion: dorsiflexion, inversion
-Extension: plantar flexion, eversion
What are the movements for D1 of the toes?
-Flexion: extension
-Extension: flexion
What are the movements for D2 of the hip?
-Flexion: flexion, abduction, internal rotation
-Extension: extension, adduction, external rotation
What are the movements for D2 of the knee?
-Flexion: flexion
-Extension: extension
What are the movements for D2 of the ankle?
-Flexion: dorsiflexion, eversion
-Extension: plantar flexion, inversion
What are the movements for D2 of the toes?
-Flexion: extension
-Extension: flexion
What are the PNF stretching/relaxation techniques?
-Hold-relax
-Contact-relax
-Contract-relax-antagonist-contract
What is hold-relax?
-Affected body part is moved until resistance is felt in the agonist muscle
-Then the patient will isometrically contract that muscle for 5-10 seconds while PT is giving resistance
-Then relax the muscle and PT passively moves the body part into increased ROM
-Repeat 3-4 times
-Autogenic inhibition (GTO)
What is contract-relax?
-Affected body part moved until resistance is felt
-Patient will perform a concentric isotonic contraction of the antagonist muscle w/ resistance from PT for 5-10 seconds
-Voluntary relaxation
-PT passively moves limb to new range
-Repeat 3-4 times
-Reciprocal inhibition (muscle spindle)
What is hold-relax-antagonist-contract?
-Pt and PT performs hold-relax
-Then the pt concentrically contracts the antagonist muscle and moves limb into new range
-Hold in new range for 10-15 seconds
-Repeat 3-4 times
What are the PNF strengthening techniques?
-Rhythmic initiation
-Repeated contraction
-Slow reversal
-Slow reversal hold
-Rhythmic stabilization
What is rhythmic initation?
-Used w/ patients that are unable to initiate movement and who have limited range due to increase in tone
-Begin with passive movement
-Then active-assistive
-Then active
What is repeated contraction?
-Used for patients that demonstrate weakness at a specific point in the pattern or ROM
-Repeated, dynamic, concentric contractions against maximal resistance until fatigue
What is slow reversal?
-Isotonic contraction of the agonist muscle followed immediately by an isotonic contraction of the antagonist muscle against resistance
-Useful in the development of active ROM and normal reciprocal timing of the agonist and antagonist muscles
What is slow reversal hold?
-Same as slow reversal, but the patient is told to “hold” the contraction at any point during the ROM
What is rhythmic stabilization?
-Used to promote stability through co-contraction of proximal muscle stabilization of trunk, pelvis, or shoulder girdle
-PT provides perturbations to the pelvis, trunk, or shoulder girdle and the patient is supposed to stabilize and not allow themselves to move
What are strengthening PNF techniques used for?
-Non-optimal motor control
-Strength
-Endurance
-Coordination
What are relaxation/stretching PNF techniques used for?
Muscular tension/tightness
