(PNF) Proprioceptive Neuromuscular Facilitation

PNF

make movement easier/ more efficient

ALL facilitation techniques

Relies on quick stretching and manual resistance of muscle activation of the limbs in functional directions, which often are spiral and diagonal in direction

proprioceptive

having to do with any of the sensory receptors that give information concerning any movement and position of the body

neuromuscular

involving the nerves and the muscles

spiral

diagonal

according to PNF, movement patterns are ___ or ___ in nature and resemble movement in functional activities

verbal

visual

tactile

multisensory cues for PNF include…

principles of PNF

1. development is centered on the patient’s abilities

2. normal motor development moves in cervico-caudal and proximal-distal direction

3. reflex activity dominates early motor behavior and reinforces or supports mature behavior

4. early motor behavior is spontaneous, rhythmic and reversing, oscillating from mass flexion to mass exertion. rhythmic and reversing movements to reestablish interaction of antagonists

5. Developing a motor behavior is expressed in an orderly sequence of

   total patterns of movement and posture requiring interaction of

   component patterns.

   • Diagonal directions requires 3 components of motion Motor behavior develops sequentially in total patterns. These begin as movements forward, then side/side, proceeds to circular direction and finally advances to diagonal form

6. Cyclic trends (shifting from flexor to extensor dominance) are noted in motor development. This ultimately leads to balance and reciprocation of movement.

7. Though normal development is orderly, stages can overlap.

8. Interaction and balance of antagonists are essential for normal movement and posture

9. Techniques for facilitation (inhibition) may be used singly or in combination according to the abilities and needs of the client

10. Frequency of stimulation and repetitions are key to:

    • Promote, retain, and enhance motor learning

    • Increase strength and endurance.

11. Goal directed activities plus techniques of facilitation hasten

    learning of total patterns

total patterns

• It can be used progressively (i.e rolling to develop sitting)

• It allows better performance in the presence of pain; attention is directed toward total movement rather than specific movement of a painful part

• Include:

1. Rolling – D1 LE emerges

2. Crawling – interaction of segments, timing, D2 UE and see emergence of D2 LE

3. Lower trunk rotation

4. Bridging

5. hands and knees rocking

6. creeping

7. plantigrade

8. walking

bilateral patterns

• Combined upper extremity or lower extremity diagonal patterns

• symmetrical

• asymmetrical

• reciprocal

symmetrical patterns

Paired extremities (either UE of LE) perform the same diagonal pattern and

direction

• promotes trunk flexion/extension

asymmetrical patterns

paired extremities perform opposite diagonal pattern but same direction

• facilitates trunk rotation

reciprocal pattern

paired extremities move in opposite diagonal pattern and direction

• promotes head, neck, and trunk stability

combines movements of UE/LE

• ipsilateral

• contralateral

• diagonal reciprocal

ipsilateral

extremities of the same side (UE and LE) move in the same diagonal pattern and direction

contralateral

aka alternating reciprocal pattern

extremities of the opposite sides move in the same diagonal pattern and direction

extremities moving in the same diagonal patterns and directions while opposite contralateral extremities move in the opposite diagonal pattern and direction

unilateral diagonal patterns

Mass movement patterns observed in most functional activities

• Head, neck, trunk

• Flexion with rotation to the right or left

• Extension with rotation to the right or left

reference points: UE shoulder, LE hip

d1 flexion

Shoulder FLEX, ADD, ER

Forearm - Sup

Wrist - Rad. Flexion

Fingers - flexion

d1 extension

Shoulder EXT, ABD, IR

Forearm - Pro

Wrist - Ulnar. extension

Fingers - Extension

d2 flexion

Shoulder FLEX, ABD, ER

Forearm - Sup

Wrist - Rad. Flexion

Fingers - Extension

d2 extension

Shoulder EXT, ADD, IR

Forearm - Pro

Wrist - Ulnar ext.

Fingers - flexion

symmetrical bilateral pattern is..

d1 flexion

asymmetrical bilateral pattern is…

d1 flexion on one side and d2 flexion on the other side (idk if this is correct)

chop

D1

hand on top is assisting

reverse chop

D1

lift

d2

hand on bottom is lifting

reverse lift

d2

pnf evaluation process

Proximal to distal

• Dominance of tone

• Alignment (midline or shift to one side

• Stability and mobility (more or less needed)

Developmental Postures

• Balance more flexors & extensors

• Move in all planes?

• Able to assume a posture ? Maintain it?

• What sensory input /cues do they respond to?

Analysis of Occupational Performance

PNF intervention techniques

• Proprioceptive /Tactile Stimuli

• Traction and Approximation

• Quick Stretch

• Resistance

• Auditory Stimuli

• Visual Stimuli

proprioceptive/tactile stimuli

• manual contacts to muscles are administered in lengthened range

• grip only 1 side of pt’s limb at a time for appropriate tactile cuing

• lumbrical grip

traction

promotes stability by stimulating joint receptors sensitive to stretch

approximation

promotes joint stability by compression of the joint surfaces

• Light joint compression

• Or have client sit in a WB position, with UE extended , stabilize elbow, as they lean toward extended UE, joint approximation occurs at elbow joint

quick stretch

-unlike Rood, trying to stimulate the ANTAGONIST

- Always applied to all three components of the diagonal pattern

• Emphasis on rotational components

• Therapist’s entire body is involved in application of quick stretch rather than just hands or arms.

resistance

• Used to improve muscle contraction

• Therapist resists movement while still being part of the overall diagonal movement pattern of the patient.

• Can be applied in many different ways

• End of ROM in a pattern

• Intermittently while patient moves through pattern

• Continuously throughout range of pattern

auditory stimuli

• Tone of Voice

• Sharp used for maximum stimulation

• Moderate used to reinforce patient’s best effort

• Soft when patient has pain or is in aroused state

• Commands

• Prepare patient for what is going to happen

• Timed to provide maximum stimulation

visual stimuli

• Used to facilitate movement

• Gaze is in direction of movement

• Timed congruent with other facilitory stimuli at initiation of movement

CONTRACT

isotonic contraction

HOLD

isometric contraction

PNF stretching technique: slow reversal (SR)

isotonic agonist contraction followed by isotonic antagonist contraction

• prep method

PNF stretching technique: slow reversal hold (SHR)

isometric at end

PNF stretching technique: rhythmic stabilization (RS)

alternating isometric contractions of the agonist and antagonist muscles for

stability and relaxation

PNF stretching technique: alternating isometrics (AI)

straight plane, not diagonal, done in WB position

PNF stretching technique: repeated contractions (RC)

isometric contraction anywhere in the ROM followed by an isotonic contraction to facilitate the agonist and relax the antagonist

PNF stretching technique: rhythmic initiation (RI)

• most commonly used type of stretching technique, goal is to help patient initiation

passive motion, than active- assistive, then resistive

PNF stretching technique: contract relax (CR)

• sued for lots of spasticity

• try to fatigue hypertonic muscles

• contract really tight and then relax

PNF stretching technique: hold relax (HR)

similar to contract relax, except no motion or rotation

• passively stretch target muscle and then hold it

ways to approach the patient

• Take a position in the diagonal

• Move so that patient can move

• Think of the patients total movement

• Use visual cues to give direction to patients movement

• Place you hands so as to control the patients movement and posture

• Use meaningful word and tone of voice appropriate for the occasion

• Use your whole body to facilitate the patient’s response, not just you arms. watch body mechanics

advantages of PNF

• time efficient

• tx of multiple joints/ muscles

• movement through functional patterns

• safe motion

disadvantages of PNF

• Not enough evidence to use PNF as sole treatment in neurorehabilitation

patients.

• PNF stretching is supported by evidence when used to treat “healthy populations”