[PT10117] [1T1S] [1.2] Proprioceptive Neuromuscular Facilitation (PNF)

Who believed that physiologic and proprioception can be applied to trat patients with neurological conditions?

Dr. Herman Kabat

Aside from Dr. Kabat, who are his two students who helped develop a book discussing PNF?

1. Margarett Knott

2. Dorothy Voss

A system of promoting/facilitating the response of the neuromuscular mechanism by stimulating the proprioceptors

Proprioceptive Neuromuscular Facilitation (PNF)

How can you differentiate PNF from Rood’s?

PNF stimulates proprioceptors

Rood stimulates tactile and sensory receptors

What movement patterns does PNF utilize?

Spiral and diagonal movement patterns

Three Sherrington’s Neurophysiological Principles (3)

1. Reciprocal innervation

2. Successive induction

3. Irradiation

SHERRINGTON’S NEUROPHYSIOLOGICAL PRINCIPLES

What principle is described below:

• The contraction of muscles is accompanied by the simultaneous inhibition of their antagonists

Reciprocal innervation

SHERRINGTON’S NEUROPHYSIOLOGICAL PRINCIPLES

What principle is described below:

• Increased excitation of the agonist muscles follows the stimulation and contraction of antagonists

Successive induction

SHERRINGTON’S NEUROPHYSIOLOGICAL PRINCIPLES

What principle is described below:

• The spreading of excitation leads to increased strength of the response

Irradiance

Six Principles of PNF Techniques (6)

1. Potentials that have not been fully developed

2. Rhythmic and reversing in character of movement

3. Orderly sequence of total patterns of movement and posture

4. Repetition for retention of motor learning

5. Goal-directed activities

6. Selection of appropriate sensory cues

Three Unilateral Diagonal Patterns (3)

1. UE

2. LE

3. Head, neck and trunk

Three Bilateral Patterns (3)

1. Symmetric patterns

2. Asymmetric patterns

3. Reciprocal patterns

What bilateral pattern is shown on the picture?

Symmetrical

What bilateral pattern is shown on the picture?

Asymmetrical

What bilateral pattern is shown on the picture?

Reciprocal

BILATERAL PATTERNS

• Paired extremities perform like movements at the same time

Symmetrical patterns

BILATERAL PATTERNS

• Paired extremities perform movements toward one side of the body at the same time

• Facilitates trunk rotation

• Chopping and lifting patterns

Asymmetrical patterns

BILATERAL PATTERNS

• Paired extremities perform movements in the opposite direction at the same time

Reciprocal patterns

Three Combined UE/LE Movement Patterns (3)

1. Ipsilateral pattern

2. Contralateral pattern

3. Diagonal reciprocal pattern

What combined movement pattern is shown on the picture?

Contralateral

What combined movement pattern is shown on the picture?

Ipsilateral

What combined movement pattern is shown on the picture?

Diagonal reciprocal

COMBINED MOVEMENT PATTERNS

• Extremities of the same side moving in the same direction at the same time

Ipsilateral pattern

COMBINED MOVEMENT PATTERNS

• Extremities of the opposite sides moving in the same direction at the same time

Contralateral pattern

COMBINED MOVEMENT PATTERNS

• Contralateral extremities moving in the same direction at the same time while opposite contralateral extremities move in the opposite direction

Diagonal reciprocal patterns

Six Progressions in Performing PNF techniques (6)

1. Total to individuated

2. Proximal to distal, distal to proximal

3. Mobile to stable

4. Gross to selective

5. Reflexive to deliberate

6. Overlapping of integrative

In performing PNF techniques, what muscle is considered as the agonist (weak/normal)?

Normal muscle = agonist

Weak = antagonist

BASIC PROCEDURES

Refers to how and where the therapist places his/her hands on the patient

Manual contact (MC)

BASIC PROCEDURES

Manual contact may be used for: (3)

1. Facilitatory mechanism

2. Give patient security in the presence of pain

3. Sensory cue (to understand the direction of anticipated movement)

BASIC PROCEDURES

Tone of voice may influence considerably the quality of response

Command and communication

BASIC PROCEDURES

The stretch stimulus is the placing of body segments in positions that lengthen the muscles

Stretch (STR)

BASIC PROCEDURES

Muscle responds with (greater/lesser) force after stretch

Muscle responds with greater force after stretch

BASIC PROCEDURES

How can you manually elicit the stretch reflex?

By “quickly” taking the part past the point of tension

BASIC PROCEDURES

Separating the joint surfaces to promote movement and inhibit pain (pulling action)

Traction (TR)

BASIC PROCEDURES

What is the indication for traction (TR)?

Stimulate afferent nerve endings → facilitate flexor muscles (mobilizing patterns)

BASIC PROCEDURES

Compressing the joint surfaces promotes stability, weight bearing or maintenance of posture (pushing action)

Approximation (AP)

BASIC PROCEDURES

What is the indication for approximation (AP)?

Stimulate afferent nerve endings → facilitate extensor muscles (stabilizing patterns)

BASIC PROCEDURES

Greatest amount of resistance possible that can be applied to an isotonic or active contraction → allowing full smooth ROM without pain

Maximal resistance (MR)

BASIC PROCEDURES

Movement performed against resistance of sufficient degree to demand maximal effort → increase in strength

Maximal resistance (MR)

BASIC PROCEDURES

Indications for maximal resistance (MR)? (2)

1. Weakness

2. Muscle imbalances

BASIC PROCEDURES

Sequence of distal to proximal muscle contraction that occurs in any motor activity → coordinated movement

Timing

BASIC PROCEDURES

Maximal resistance is superimposed upon patterns of facilitation with due regard for normal timing

• Order that overflow/irradiation may occur from stronger to weaker muscles

Timing for emphasis

BASIC PROCEDURES

Indications for Timing (2)

1. Weakness

2. Incoordination

SPECIFIC TECHNIQUES

This set of interventions focuses on improving the strength and coordination of a target movement or pattern

Directed to agonist

BASIC PROCEDURES

This set of interventions focuses on the importance of coordinated agonist and antagonist muscle contractions (resist antagonistic pattern first)

Reversal of antagonist

BASIC PROCEDURES

This set of interventions focuses on training the patient to have control over hypertonia, spasticity, and muscle spasm

Relaxation

DIRECTED TO AGONIST

What are the four specific techniques? (4)

1. Repeated contraction

2. Rhythmic initiation

3. Hold relax active motion

4. Alternating isometrics

DIRECTED TO AGONIST

Repetition of activity is necessary for the learning process and the development of strength and endurance

Repeated contraction

DIRECTED TO AGONIST

Indications for Repeated Contraction (3)

1. Weakness

2. Muscle imbalances

3. Lack of endurance

DIRECTED TO AGONIST

Used to improve the ability to initiate movement

Rhythmic initiation

DIRECTED TO AGONIST

Indications for Rhythmic Initiation (5)

1. Spasticity

2. Rigidity

3. Inability to initiate movement (apraxia)

4. Motor learning deficits

5. Communication deficits (aphasia)

DIRECTED TO AGONIST

Technique of emphasis provides repetition of isotonic contraction without sustained effort

Hold relax active motion (HRA)

DIRECTED TO AGONIST

Indications for Hold Relax Active Motion (HRA)? (4)

1. Inability to initiate movement

2. Hypotonia

3. Weakness (lengthened range)

4. Marked imbalances between antagonists

DIRECTED TO AGONIST

Alternating holding contractions of opposing muscle groups

Alternating isometrics

DIRECTED TO AGONIST

Indications for Alternating Isometrics (4)

1. Instability in weight bearing and holding

2. Poor antigravity control

3. Weakness

4. Ataxia

REVERSAL OF ANTAGONISTS

What are the four specific techniques? (4)

1. Slow reversal

2. Slow reversal hold

3. Rhythmic stabilization

4. Quick reversal

REVERSAL OF ANTAGONISTS

Involves an isotonic contraction of the antagonist → isotonic contraction of the agonist

Slow reversal (SR)

REVERSAL OF ANTAGONISTS

Involves an isotonic contraction → isometric contraction of the antagonist → isotonic contraction of the agonist

Slow reversal hold (SRH)

REVERSAL OF ANTAGONISTS

Indications for Slow Reversal/Slow Reversal-Hold/Quick Reversal (5)

1. Inability to reverse directions

2. Muscle imbalances

3. Weakness

4. Incoordination

5. Lack of endurance

REVERSAL OF ANTAGONISTS

Rapidly alternating isotonic contractions of antagonists

Quick reversal (QR)

REVERSAL OF ANTAGONISTS

Progression of alternating isometrics; co-contraction of opposing muscle groups

Rhythmic stabilization

REVERSAL OF ANTAGONISTS

Indications of Rhythmic Stabilization (6)

1. Instability in weight-bearing and holding

2. Poor antigravity control

3. Weakness

4. Ataxia

5. LOM d/t muscle tightness

6. Painful muscle splinting

RELAXATION

What are the four specific techniques? (4)

1. Contract relax (CR)

2. Hold-relax (HR)

3. Slow reversal-hold-relax (SRHR)

4. Rhythmic rotation (RRO)

RELAXATION

Indication for Contract-Relax (CR)

Limitation of motion d/t tightness and spasticity

RELAXATION

A relaxation technique usually performed at the point of limited ROM in the agonist pattern

Hold-relax (HR)

RELAXATION

Indication of Hold-Relax (HR)

LOM d/t muscle spasm, pain, or tightness

RELAXATION

Under HR, _______ into the newly gained range of the agonist can also be performed and serves to maintain the inhibitory effects (through reciprocal inhibition)

Hold relax - active contraction (HRAC)

RELAXATION

Indication for Rhythmic Rotation

Hypertonia that results to LOM