chapter 32: traditional sensorimotor approaches PNF approach (test 1)

what does PNF stand for

proprioceptive neuromuscular facilitation

(sensory input to elicit a guided movement)

PNF approach

-it is based on normal movement/development

-addresses posture, mobility, strength, effort, and coordination

PNF foundations an movement patterns

-mass movement patterns are spiral and diagonal

-paterns resemble movement in FUNCTIONAL activities

-patterns used as a preparatory methods or within task performance

t or f: the brain register total movement, not individual muscle action

true

PNF Facilitation methods

-multisensory approach to facilitate movement

- use of MANUAL CONTACTS, VERBAL commands, and VISUAL cues

-facilitation layered onto movement patterns and postures

t or f: sensory stimulation supports motor response

true

Principles of PNF intervention

-emphasis on abilities and untapped potential

-cervicaudal and proximodistal development guides interventions

-postural control precedes distal skill development

-balance between antagonistic muscle groups is essential

motor development and motor control in PNF

-early movement dominated by reflex activity

-matures movement reinforced by postural reflexes

-reversing movements (flexion/extension) support control

-eccentric control critical for functional control

what movement is dominated by reflex activity

early movment

what movement is reinforced by postural reflexes

-mature development

what movements (flexion/extension) support control

reversing movements

what type of control is essential for functional transitions

eccentric control

"when muscles "grows"/stretches

Motor learning principles in PNF

-Motor learning supported by multisensory input

-repetition and frequency reinforce learning

-goal-directed activity enhances skill acquisition

-external cues gradually withdrawn as learning occurs

Motor learning supported by multisensory input: examples

integration of auditory, visual, and tactile systems

-sensory input must be individualized and adjusted ot the client's progress

auditory systems

VERBAL COMMANDS: they should be brief and clear

-timing of the command must match the motor act (not too early of too late)

-tone of voice influences response (soft for reassurance/smooth movement; sharp of maximal activation; moderate for best effort)

-VERBAL MEDIATION: can improve sequencing and retention of safety routines (e.g. - transfer steps)

visual system

-visual stimuli assist initiation and coordination of movement

-monitor that the client tracks in the direction of movement

-therapists positioning provides visual cues (e.g. diagonally in front to cue forwards movement)

-placement of OT activities can facilitate rotation and ligament

-diagonal patterns can reinforce oculomotor control and eye teaming when indicated

placement of OT activities can facilitate rotation and ligament example

tasks placed font-left to promote head/neck/trunk rotation

tactile system

-touch provides temporal and spatial discrimination

-client should feel coordinated and balanced movement patterns (especially with ataxia)

- PNF supplies tactile input through the therapist's (manual contacts) to guide and reinforce desired responses

which system matures first

tactile system matures first before auditory and visual systems and is highly efficient

Manual contacts: grading and precautions

-Tactile facilitation may include gentle guidance, stretch to

initiate movement, and resistance to strengthen movement

-Avoid stretch or resistance with musculoskeletal instability or early fracture healing

- Do not use stretch or resistance if they increase pain or create tone imbalance

practice for motor learning

-motor learning requires opportunities to practice to increase speed and accuracy

-repetition builds habit patterns

what type of practice does PNF uses

-part-task practice

-whole task practice

stepwise procedures

-emphasize difficult parts during performance of the whole task, then fade as skill improves

part-task practice

targets components the client cannon perform independently

-as coordination improves, part-task practice decreases and facilitation is withdrawn

whole task practice

integrates components into the full functional task

assessment PNF approach

-assessment requires astute observational skills and knowledge of normal movement

-initial assessment identifies abilities, deficiencies, and potential

-assessment is ongoing to evaluate interventions effectiveness and guide modification

-PNF assessment emphasizes quality of movement and balance bewtween stability and mobility

Sequence of PNF assessment (proximal to distal)

-allows a proximal-to-distal sequence

-begin with vital and related functions, breathing, swallowing, voice, facial/oral musculature, visual ocular control

-impairment in vital functions may limit occupational performance

when Is the head and neck assessed

after vital functions

-deficits directly affect trunk and upper extremity function

-observed across posture, total patterns, and functional activities

what is the segmental and delevoplemtal assessment order

vitals - head and neck- upper trunk- upper extremities- lower trunk- lower extremities

Assessment area: vital function

observed: breathing, swallowing, voice, ocular

OT relevance: determines endurance and ability to sustain occupation

Assessment area: head and neck

observed: tone dominance, alignment, stability vs mobility

OT relevance: foundation for trunk and UE control

Assessment area: upper trunk

observed: postural control, symmetry, endurance

OT relevance: supports reaching and manipulation

Assessment area:UE

observed: QUALITY, coordination, synergy dominance

OT relevance: impacts ADLS and IADLs performance

Assessment area: lower trunk

observed: stability, weight shifting, alignments

OT relevance: affects transfer and mobility

Assessment area: LE

observed: movement quality, balance, tone

OT relevance: influences gait and functional mobility

Assessment area: developmental posture

observed: ability to assume and maintain posture

OT relevance: guides task grading and positioning

patterns are __ and __, not isolated joint motions

spiral and diagonal

-PNF uses mass movement patterns observed in functional activities

how many motions does each body region have

-each body region has two diagonal motions with flexion and extension components

diagonal patterns combine __ ___ and __ towards or away from midline

flexion/extension, rotation, and movement

extremity diagonal patterns (D1 and D2)

-UE and LE diagonals described by movements at shoulder and hip

-components include flexion/extension, abduction/adduction, and rotation

-D1 and D2 include flexion and extension components

reference point for UE is shoulder for LE is the hip

D1 flexion

end position: flexion

functional exam: feeding or brushing hair on the opposite side

D1 extension

end position: extension

functional exam:pushing a car door open from the inside, a tennis backhand stroke, or buckling a seatbelt.

D2 flexion

ending position: shoulder flexion (lifting ur sword)

functional exam: Lifting a plate to a high shelf, reaching for a seatbelt, pulling a cord on a machine, or reaching upward to hang clothes.

d2 extension

ending position: shoulder extension (DRAWING UR sword)

functional exam: Putting a sword back into its sheath, pushing a heavy object down and across the body, or taking a dish from a high shelf and putting it into the dishwasher.

d1 flexion example

brushing hair on opposite side

d2 flexion example

brushing hair on same side

d1 extension example

-used to push a car door open

d2 extension example

-used to button trousers on the opposite side

bilateral patterns

-bilateral patterns reinforce extremity movement through combined diagnosis

-patterns influence trunk stability, flexion, extension, and rotation

what are the 3 types if bilateral patterns

symmetric, asymmetric, and reciprocal patterns

bilateral symmetrical pattern

paired extremities perform like movements at the same time (pattern, time and direction)- ex: starting to take off pullover sweater, reaching to lift large item off high shelf.

bilateral asymmetrical pattern

same pattern, timing but different direction

weight shifting?

bilateral reciprocal pattern

opposite timing, pattern, direction

ex) running, swimming, walking

Extremities move in opposite directions simultaneously

• Combined diagonal reciprocals stabilize head, neck, and trunk

• Same-diagonal reciprocals facilitate trunk rotation

• Observed in walking, swimming, and higher-level balance tasks

bilateral symmetric and asymmetric patterns

symmetric patterns- both extremities move similarly at the same time

- facilitate trunk flexion or extension

-asymmetric patterns: extremities move towards one side simultaneously

- facilitate trunk rotation and increased control

which facilitates trunk rotation and increased control

bilateral asymmetric pattern

which facilitates trunk flexion or extensio

bilateral symmetric pattern

a client performs a bilateral PNF pattern in which one UE moves upwards while the opposite UE moves downwards in the same diagonal pattern? which bilateral patten is being used

asymmetrical

which bilateral PNF pattern places the highest demand on the trunk coordination and postural control

reciprocal

ipsilateral patterns

same-side extremities move together

contralateral patterns

opposite-side extremities move together

diagonal reciprocal

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