S1L1. Proprioceptive Neuromuscular Facilitation

5 Ps

• Past

• Principles

• Patterns

• Progressions

• Procedures

Past: __: Neurologist

Dr. Herman Kabat (1940s)

Past: __: Physiologic and proprioception can be applied to treat pts c neurological conditions

Dr. Herman Kabat (1940s)

Past: __: “Proprioceptive facilitation”

Dr. Herman Kabat (1940s)

Past: __: Keiser’s son: has MS

Kabat-Keiser Institute (1948)

Past: __: Outstanding PT students (made 1st PNF book & still referenced now)

Kabat-Keiser Institute (1948)

Past: __: Co-author of PNF book

Margaret Knott, PT

Past: __: Suggested that Neuromuscular is added to the name

Dorothy Voss, PT

Past: __: Made PNF book in 1956

Authors? lol idk

PNF: A sys. of promoting/facilitating the response of the NM mech. by stimulating the __

proprioceptors

PNF: __ important for proprioception

M. spindle

PNF: Use of __ mvt patterns

spiral & diagonal

PNF: Not only to reduce tone, but also to induce __

Response

Principles

• Sherrington’s Neurophysiological Principles

• Reciprocal innervation

• Successive induction

• Irradiation

• Potentials that have not been fully developed

• Rhythmic and reversing in character of mvt

• Orderly sequence of total patterns of mvt & posture

• Repetition for retention of motor learning

• Goal-directed activities

• Selection of appropriate sensory cues

Principles: Sherrington’s Neurophysiological Principles: These 3 are mainly the basis of PNF:

• Reciprocal innervation

• Successive induction

• Irradiation

Principles: Reciprocal innervation: The contraxn of m.s is accompanied by the __

Simultaneous inhibition of their antagonists

Principles: __: For agonists to move, antagonists must be inhibited

Reciprocal innervation

Principles: Reciprocal innervation: Ex. when moving biceps, what should happen to the triceps

Nothing lol it shouldnt move

Principles: __: An inc excitation of the agonist m.s follows the stimulation & contraction of their antagonists

Successive induction

Principles: Successive Induction: Example (READ)

Biceps (target) → para lumakas pagurin muna yung antagonist = resist triceps → when triceps relax = mas magstistimulate = biceps contraxn will be facilitated

Principles: __: The spreading of excitation leads to inc strength of the response

Irradiation

Principles: __: PNF: If you strengthen biceps, it can spread to other muscles in the UE = inc response of pt

Irradiation

Principles: __: We have potentials that we haven’t fully developed

Lol edi potentials that have not been full developed

Principles: __: Supports neural plasticity

Potentials that have not been fully developed

Principle: Potentials that have not been fully developed: __: = if may nadamage na part, they can take over that func = pt will recover

Neural plasticity

Principles: __: Patterns of PNF, if there's flexion = there's extension → coupled mvts (Pulling-pushing, up-down)

Rhythmic and reversing in character of mvt

Principles: __: There should be coord. & proper execution of patterns involved in on diagonal pattern

Orderly sequence of total patterns of mvt & posture

Principles: __: In our ADLs, multiple jts are involved

Orderly sequence of total patterns of mvt & posture

Principles: __: Same as Rood → practice! = motor learning

Repetition for retention of motor learning

Principles: __: Should have a purpose for doing things

Goal-directed activities

Principles: __: Choose what stimuli you’ll give to target ur goal

Selection of appropriate sensory cues

Patterns

• Unilateral diagonal patterns

• Bilateral patterns

  • Symmetric

  • Asymmetric

  • Reciprocal

• Combined UE/LE Movement Patterns

  • Ipsilateral

  • Contralateral

  • Diagonal Reciprocal

Patterns: Unilateral Diagonal Patterns:

• UE

• LE

• Head, neck, and trunk

Patterns: Unilateral Diagonal Patterns: UE: D1 & D2 extension: Elbow may be __

Flexed, extended, flexing, or extending → ANY position

Patterns: Unilateral Diagonal Patterns: Head, neck, and trunk:

• Will follow __

Wherever the extremity is (look at the direction of the hand)

Patterns: Bilateral Patterns:

• Symmetric

• Asymmetric

• Reciprocal

Patterns: Bilateral Patterns: __: UE both in D2 flexion, LE both in D2 flexion

Symmetric pattern

Patterns: Bilateral Patterns: __:

• R UE: D2 flexion L UE: D1 flexion

• R LE: D1 flexion L LE: D2 flexion

Asymmetric pattern

Patterns: Bilateral Patterns: __: “Chopping pattern”

Asymmetric pattern

Patterns: Bilateral Patterns: __:

• R UE: D1 extension L UE: D2 flexion

• R LE: D1 extension L LE: D2 flexion

Reciprocal pattern

Patterns: Combined UE/LE Movement Patterns: __: R UE & R LE: D2 flexion

Ipsilateral Pattern

Patterns: Combined UE/LE Movement Patterns: __: L UE: D2 flexion, R LE: D2 flexion

Contralateral Pattern

Patterns: Combined UE/LE Movement Patterns: __:

• R UE: D1 extension, L UE: D2 flexion

• R UE: D2 flexion, L LE: D1 extension

Diagonal Reciprocal Pattern

SEE TRANS FOR EXAMPLES & PICS

DO IT

Progressions

• Total to individuated

• Proximal to distal, distal to proximal

• Mobile to stable

• Gross to selective

• Reflexive to deliberate

• Overlapping to integrative

Progressions: __: Patterns first to identify weakest link b4 going to individuals

Total to individuated

Progressions: Proximal to distal, distal to proximal:

• Proximal to distal if goal is __

• Distal to proximal if goal is __

• Stability

• Coordination

Progressions: __: Consistent c Rood

Mobile to stable

Progressions: __: Similar to total to individuated

Gross to selective

Progressions: __: Similar to total to individuated

Gross to selective

Progressions: __: Essentially fr passive → active

Reflexive to deliberate

Progressions: __: We want to apply this to ADLs

Overlapping to integrative

Procedures

• Manual contact (MC)

• Command and communication

• Stretch (STR)

• Traction (TR) and approximation (AP)

• Maximal resistance (MR)

• Timing; timing for emphasis

Procedures: __: Stabilization

Manual contact (MC)

Procedures: __: Assistance or resistance

Manual contact (MC)

Procedures: __: Guiding/facilitating the mvt or pattern

Manual contact (MC)

Procedures: __: PNF is very hands–on

Manual contact (MC)

Procedures: __: Depending on target

Command and communication

Procedures: __: Facilitate contraction & relaxation

Command and communication

Procedures: Command and communication:

• Facilitate contraction: voice/instruction must be with __

• Facilitate relaxation: voice/instruction must be __

• Authority

• Relaxing

Procedures: __: In PNF, there must be stretch bc we r targeting proprioceptors

Stretch (STR)

Procedures: __: Quick stretch before motion

Stretch (STR)

Procedures: __: Applying distraction or approximation to jt before motion

Traction (TR) and approximation (AP)

Procedures: __: Applying resistance depending on the weakest link

Maximal resistance (MR)

Procedures: __: Can stop & focus on a specific motion to strengthen weakest link

Timing; timing for emphasis

Specific Techniques:

Facilitation

Relaxation

Specific Techniques: Facilitation:

• Directed to Agonist

• Reversal of Antagonists

Specific Techniques: Facilitation: Directed to Agonist:

• Repeated contraction

• Rhythmic initiation

• Hold relax active motion

• Alternating isometrics

Specific Techniques: Facilitation: Reversal of Antagonists

• Slow reversal

• Slow reversal hold

• Rhythmic stabilization

• Quick reversal

Specific Techniques: Relaxation:

• Contract relax

• Hold relax

• Slow reversal hold relax

• Rhythmic rotation

Specific Techniques: Facilitation: Directed to Agonist: Equivalent to __

Manual Resistance Strengthening

Specific Techniques: Facilitation: Directed to Agonist:

• The agonist is the muscle that needs to be __

• The antagonist is the muscle thats __

• Strengthened (Target pattern)

• Tight (Spastic pattern)

Specific Techniques: Facilitation: Directed to Agonist: __: Repetition of act. is necessary for the learning process & development of strength & endurance

Repeated Contraction

Specific Techniques: Facilitation: Directed to Agonist: __: Manual resistance against the D1 or D2 pattern

Repeated Contraction

Specific Techniques: Facilitation: Directed to Agonist: __: Resist the entire pattern

Repeated Contraction

Specific Techniques: Facilitation: Directed to Agonist: __: Perform repeated isotonic contractions induced by quick stretches

Repeated Contraction

Specific Techniques: Facilitation: Directed to Agonist: __: Procedure:

• Start at D1 ext. → D1 flex. to enhance D1 flex. (add resistance going towards D1 flex.)

Repeated Contraction

Specific Techniques: Facilitation: Directed to Agonist: __: Procedure:

• Apply resistance throughout the range or part of the range at a point of weakness

Repeated Contraction

Specific Techniques: Facilitation: Directed to Agonist: Repeated Contraction: Procedure: Apply hand @ more __ to fully resist the pattern

Distal (hand) & proximal (arm) (huh - ask n confirm)

Specific Techniques: Facilitation: Directed to Agonist: __: Fancy name for PROM

Rhythmic Initiation

Specific Techniques: Facilitation: Directed to Agonist: __: Done passively since pt cannot move or initiate mvt

Rhythmic Initiation

Specific Techniques: Facilitation: Directed to Agonist: __: PT moves and patient just relaxes

Rhythmic Initiation

Specific Techniques: Facilitation: Directed to Agonist: __: Used to improve the ability to initiate movement

Rhythmic Initiation

Specific Techniques: Facilitation: Directed to Agonist: __: Procedure: Voluntary relaxation ff’d by passive mvt through increasing ROM

Rhythmic Initiation

Specific Techniques: Facilitation: Directed to Agonist: __: Procedure: Followed by active-assisted contractions progressing to tracking resistance (light, facilitatory resistance) to isotonic contractions

Rhythmic Initiation

Specific Techniques: Facilitation: Directed to Agonist: __: Techniques of emphasis provide repetition of isotonic contraction without sustained effort

Hold Relax Active Motion

Specific Techniques: Facilitation: Directed to Agonist: Hold Relax Active Motion: When u see the word “hold” = expect __ contractions

Isometric

Specific Techniques: Facilitation: Directed to Agonist: __: Procedure: Apply isometric contraction in the mid to shortened range of the target pattern

Hold Relax Active Motion

Specific Techniques: Facilitation: Directed to Agonist: __: Allow voluntary relaxation to the target pattern

Hold Relax Active Motion

Specific Techniques: Facilitation: Directed to Agonist: __: Passively move the limb → lengthened range of the target pattern

Hold Relax Active Motion

Specific Techniques: Facilitation: Directed to Agonist: __: Perform isotonic contraxn of the target pattern

Hold Relax Active Motion

Specific Techniques: Facilitation: Directed to Agonist: __: Alternating holding contraxns of opposing m. grps

Alternating Isometrics

Specific Techniques: Facilitation: Directed to Agonist: __: Make sure pt can maintain sidelying pos.

• “Huwag niyo pong hayaang mahila/matulak ko kayo”

Alternating Isometrics

Specific Techniques: Facilitation: Directed to Agonist: __: Procedure: Isometric contraction is facilitated first on 1 side of the body / body part

Alternating Isometrics

Specific Techniques: Facilitation: Directed to Agonist: __: Procedure: Followed by isometric contraction of the other side

• Use palm of hand not fingers bc sasakit

Alternating Isometrics

Specific Techniques: Facilitation: Reversal of Antagonist: __: Involves an isotonic contraction of the antagonist, followed by an isotonic contraction of the agonist

Slow Reversal (SR)

Specific Techniques: Facilitation: Reversal of Antagonist: Slow Reversal (SR): Manual resistance on both patterns starting with the __

Antagonist

Specific Techniques: Facilitation: Reversal of Antagonist: __: Involves isotonic contraction, followed by isometric contraction of the antagonist, followed by an isotonic contraction of the agonist

Slow Reversal Hold (SRH)

Specific Techniques: Facilitation: Reversal of Antagonist: __: Requires rapidly alternating isotonic contractions of antagonists (Just make it quick - speed component)

Quick Reversal (QR)

• Faster (to challenge the patient further)

Specific Techniques: Facilitation: Reversal of Antagonist: __: Done slowly

Slow Reversal (SR) & Slow Reversal Hold (SRH)