Week 14- PNF Common Techniques Flashcards
What does PNF stand for and what does each term mean?
- Proprioceptive = Having to do with any of the sensory receptors that give information concerning movement and position of the body.
- Neuromuscular = Involving the nerves and muscles.
- Facilitation = Making easier.
PNF utilizes what 3 inputs to produce functional improvement in motor output?
- Procripceptive
- Cutaneous
- Auditory
PNF combines function based diagonal patterns with techniques to facilitate the neuro motor units to improve muscle ________ and __________.
control and function
PNF is utilized across populations to improve what?
- muscle endurance
- stability
- control
What is the progression of difficulty with PNFs?
-PROM to isometrics to active assisted movement to higher velocity resisted movements
PNF requires skilled application of _______ and ________ cues to achieve desired patterns and facilitate _______ __________.
- tactile and verbal cues
- quality contractions
PNF techniques can be used to develop what?
- Muscular strength
- Muscular endurance
- Stability
- Mobility
- Neuromuscular control
- Coordinated movement
- Foundation for restoration of function
Describe these PNF terms.
- Overflow (irradiation)
- Manual contact
- Therapist position
- Approximation
- Traction
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.
PNF Cueing.
- _______ 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 __________ by the patient: watching the distal segment, mirrors, etc.
- _______: encouraging movement of distal segments first, then moving to proximal; rotation occurs throughout the entire movement
- ___________: facilitates the contraction by recruiting motor units
- Verbal
- attentiveness
- Timing
- Resistance
What are some specific PNF techniques used?
- Diagonals
- Lift
- Reverse lift
- Chop
- Reverse chop
- Quick Stretch
- Rhythmic initiation
- Alternating isometrics
- Rhythmic stabilization
- Dynamic reversals
DIAGONAL PATTERNS
DIAGONAL PATTERNS
- Diagonal patterns are composed of _____-joint, multi-planar, diagonal, and rotational movements of the extremities, trunk, and neck.
- What are the 2 pairs of diagonal pattern for the UE and LE?
-multi-joint
- D1 Flexion or D1 Extension
- D2 Flexion or D2 Extension
UE D1 Flexion End Position?
- Shoulder flexion, ADD, ER
- Forearm supination
- Wrist radial deviation
- Fingers flexed
UE D1 Extension End Position?
Shoulder extension, ABD, IR
- Forearm pronation
- Wrist ulnar deviation
- Fingers extender
UE D2 Flexion End Position?
- Shoulder flexion, ABD, ER
- Forearm supination
- Wrist radial deviation
- Fingers extended
UE D2 Extension End Position?
- Shoulder extension, ADD, IR
- Forearm pronation
- Wrist ulnar deviation
- Fingers flexed
Diagonals:
- Patterns are identified by the position of the ________ or ______ when the diagonal pattern has been completed (flexion or extension)
- Flexion or extension of the shoulder or hip is coupled with abduction or adduction as well as external or internal rotation
- Motions of body segments ______ to the shoulder or hip also occur simultaneously during each diagonal pattern
- shoulder or hip
- distal
What is a good way to remember UE D1 flexion/extension cues?
- D1 flexion = Reach up for your seatbelt
- D1 extension = Pull seatbelt down and buckle up
What is a good wat to remember UE D2 flexion/extension?
- D2 flexion = Draw the sword
- D2 extension = Replace your sword
LE D1 Flexion End Position?
- Hip flex, ADD, ER
- Dorsiflexion
- Inversion
- Toes extended
LE D1 Extension End Position?
- Hip ext, ABD, IR
- Plantar flexion
- Eversion
- Toes flexed
LE D2 Flexion End Position?
- Hip flex, ABD, IR
- Dorsiflexion
- Eversion
- Toes extended
LE D2 Extension End Position?
- Hip ext, ADD, ER
- Plantar flexion
- Inversion
- Toes flexed
What is a good way to remember LE D1 flexion/extension cues?
- D1 flexion = pull up and across
- D1 extension = push down and out
What is a good way to remember LE D2 flexion/extension cues?
- D2 flexion = get frog legged
- D2 extension = from frog to ballerina
LIFT, REVERSE LIFT, CHOP, REVERSE CHOP
LIFT, REVERSE LIFT, CHOP, REVERSE CHOP
Lift pattern involves one side helping lift the other into ____ flexion.
D2
Reverse lift pattern involves one side helping lower the other into ______ extension.
D2
Chop pattern involves one side helping lower the other into ___ extension.
D1
Reverse chop involves one side helping lift the other into _____ flexion.
D1
RHYTHMIC INITIATION
RHYTHMIC INITIATION
Rhythmic initiation is used to promote the ability to initiate a _________ ________.
movement pattern
Rhythmic initiation is utilized for treatment of dysfunctions which affect _______, __________, ______, or ________ of contraction.
initiation, speed, direction, or quality
How is difficulty progressed with rhythmic initiation?
patient response
What are the goals of rhythmic initiation?
Allow the patient to become familiar with the sequence of movement and the rate at which movement is to occur.
What are the 4 steps in the technique (progression) 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.
What are the 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
ALTERNATING ISOMETRICS
Alternating isometrics is a technique to improve isometric strength and stability of the _______ muscles of the trunk or proximal stabilizing muscles of the shoulder girdle and/or core.
postural
In alternating isometrics, manual resistance is applied in a _________ plane on one sode of a body segment and then on the other.
-single
With Alternating Isometrics:
- The patient is instructed to “hold” his or her position as resistance is alternated from one direction to the opposite direction.
- _____ joint movement should occur.
- This procedure isometrically strengthens agonists and antagonists, and it can be applied to one extremity, to both extremities simultaneously, or to the trunk.
- Alternating isometrics can be applied with the extremities in ____ or _____positions.
- No
- WB or NWB
RHYTHMIC STABILIZATION
RHYTHMIC STABILIZATION
Rhythmic stabilization involves isometric contraction “______ ___ _____” and the focus is on eliciting co-contractions for _________.
- from all sides
- stability
Rhythmic Stabilization Technique:
- Progression of alternating isometric
- ___-___________ of agonist and antagonist performed by placing hands on opposite sides of body and applying simultaneous resistance.
- No motion is allowed
- “______” your resistance to allow patient build a strong contraction
- Shift hand placement opposite to the muscles you were just recruiting
- Co-contraction
- “Build”
What are the 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
- Can provide therapist information on patient’s ability to reinforce and maintain contractions
DYNAMIC REVERSALS
DYNAMIC REVERSALS
Dynamic (slow) reversals involve _______ -> __________ contractions eliciting bidirectional movement from patient.
agonist -> antagonist
What are the 2 steps in the technique of dynamic 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.
What are the indications for dynamic reversals?
- Improve coordination specifically for those patients who demonstrate co contractions
- Can be modified to work through limited ROM
- Can improve strength and coordination
- Improves muscle endurance due to continuous nature
What are some other PNF techniques used?
- Fast/quick stretch
- Repeated contraction/stretch
- Dynamic (slow) reversal hold
- Agonist reversals
Explain 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)
Explain 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
Explain dynamic (slow) reversal hold?
Same as dynamic reversals but with an isometric hold at end of the motion prior to changing directions
Explain agonist reversals?
Reversing the type of contraction you are eliciting from your patient, working concentrically, isometrically, and eccentrically
