Proprioceptive Neuromuscular Facilitation - PNF Flashcards
Defn: PNF
Methods of promoting the response of the neuromuscular mechanism through stimulation of the proprioceptor
Q: Who are the big names in PNF?
Margaret Knott and Dorothy Voss and Dr. Herman Kabat
Q: What is PNF most used for today?
Strengthening and stretching
Q: PNF is __________ therapy used to improve _________.
manual, function
Content: PNF Principles - Normal movements (3)
- Rhythmic and reversing
- Diagonal
- Syndergy of agonists and antagonists
* We don’t move in single plane motion*
Content: PNF Principles (4)
- Use of pts. strengths or reflex responses to minimize weakness
- Auditory, visual, and tactile stimuli
- Repetition for strength and endurance
- Goal directed activities (focus on function)
Content: PNF Diagonals
- Areas
- Names
- Progression
- Relevant to
- UE, LE, Trunk
- D1 and D2
- Passive > AA > Resisted
- Function
Content: D1 Flexion UE
- Scapula
- Shoulder
- Forearm
- Wrist
- Fingers
- Elevation and protraction
- Flexion, Add, ER
- Supination
- Flexion
- Flexion
Content: D1 Extension UE
- Scapula
- Shoulder
- Forearm
- Wrist
- Fingers
- Depression, retraction
- Extension, Abd, IR
- Pronation
- Extension
- Extension
Content: D2 Flexion UE
- Scapula
- Shoulder
- Forearm
- Wrist
- Fingers
- Elevation, retraction
- Flexion, ABD, ER
- Supination
- Extension
- Extension
Content: D2 Extension UE
- Scapula
- Shoulder
- Forearm
- Wrist
- Fingers
- Depression, protraction
- Extension, ADD, IR
- Pronation
- Flexion
- Flexion
Content: D1 Flexion LE
- Hip
- Knee
- Ankle
- Toes
- Flexion, ADD, ER
- Either
- DF, Inversion
- DF
Content: D1 Extension LE
- Hip
- Knee
- Ankle
- Toes
- Extension, ABD, IF
- Either
- PF, Eversion
- PF
Content: D2 Flexion LE
- Hip
- Knee
- Ankle
- Toes
- Flexion, ABD, IR
- Either
- DF, Eversion
- DF
Content: D2 Extension LE
- Hip
- Knee
- Ankle
- Toes
- Extension, ADD, ER
- Either
- PF, Inversion
- PF
Content: Rhythmic Initations (4)
- Opposite Patterns (D1 flex/ext; D2 flex/ext)
- Start with passive movement
- Graual pt. participation
- Add resistance if goal is strengthening
Content: Resistance (5)
- Amount - allow smooth movement with not pain
- Gravity
- Manual - distal vs. proximal hand placement
- Other
- Types of contraction
Content: Clinical Application
- Verbal Commands
- Manual contacts
- Learn motor sequence, enhance motor output
- Use of effective body mechanics, contact over muscle being facilitated
Defn: Agonist
Muscles that have restricted motion
Defn: Anatgonist
Muscles that oppose the restricted motion
T/F: Angonists and Antagonists are important for PNF Strengthening.
False: Stretching
Content: Hold Relax (Stretching Technique)
- Take muscle to end point of limitation
- End range isometric contraction for 10 s into direction of stretch
- Contraction of antagonist muscles - Relax and passively move limb to new range
- Repeat if indicated
Q: When is the hold relax technique useful?
If the tight muscle (agonist) is painful to contract
Q: What type of inhibition does the hold relax technique use?
Reciprocal - 1a afferents
Content: Hold Relax Rationale (4)
- 1a afferents of muscle spindle respond to stretch/movement
- Monosynaptic reflex with alpha motor neuron of active muscle causes facilitation of muscle group
- Polysynaptic reflex with alpha motor neuron of opposite muscle causes inhibition of muscle group
- Psychologic effect - just as important, effects guarding
Content: Contract Relax (Stretching Technique) (4)
- Take muscle to point of limitation
- End range contraction of agonist with rotation 10 s into opposite direction of stretch
- Relax and passively move limb to new range
- repeat if indicated
Q: What type of inhibition does contract relax use?
Autogenic - 1b of Golgi tendon
Content: Contract Relax Rationale (4)
- 1b afferents of golgi tendon organs respond to stretch of muscle on tendon
- Results in inhibition of that active msucle
- Function of GTO - protection or fatigue response
- Psychological effect - just as important
Q: What are functional activies for UE D1 and D2?
D1 = bring to yourself
D2 = reaching out
Q: What’s great about UE PNF for orthropedics?
- D2 flexion is a combination of motions at the shoulder are that functional
- If you can do D1/D2 with resistance you have worked every muscle group (with just 2 exercises)
Q: What two populations does D2 UE flexion benefit?
- Orthopedics shoulders (Frozen shlds)
- Parkinson’s Disease - do D2 bilaterally (aids posture)
Q: What is LE D1 movement useful for functionally?
Stance phase of gait (especially D1 extension)
Q: What is LE D2 movement useful for functionally?
Swing phase of gait (especially D2 flexion)
Q: Which is more effective, contract relax or hold relax?
Contract relax
Case Study: Ken has isolated weakness (2+/5) in the R scapular adductor and depressor muscles.
What PNF diagonal would you use?
How would you apply resistance?
D1 extension
Position the pt. in sitting (moving with gravity)
Case Study: Joe is a 10 year old boy who fractured his left humerus two months ago. Healing was complicated by infection. He presents with atrophy, pain, and limited passive and active ROM in shoulder flexion, abduction, external rotation, and elbow extension.
What stretching technique?
What strengthening activity?
Hold relax
D2 Flexion
Case Study: Sarah is a 36 year old female who had a compressive injury to the deep peroneal nerve. She has a drop foot deformity in gait and presents with the following:
Dorsiflexion 3-/5 (F-)
Eversion 4/5 (G)
All other muscle groups are in the 4+/5 (G+) to 5/5 (N) range.
What strengthening activity could be used as a HEP?
D2 Flexion (at the ankle)
