Proprioceptive Neuromuscular Facilitation (PNF)

Who developed Proprioceptive Neuromuscular Facilitation (PNF)?

Dr. Herman Kabat, along with physical therapists Margaret Knott and Dr. Dorothy Voss in the 1940's and 1950's

Who did these doctors use PNF on?

neuromuscular and musculoskeletal disorders

What is the primary purpose of PNF?

Combines functionally based diagonal patterns of movement with techniques of neuromuscular facilitation to evoke motor responses and improved motor control and function.

What types of stimulation does PNF utilize?

Proprioceptive, sensory, and visual stimulation.

What are the key benefits of using PNF?

Developing muscular strength, endurance, stability, mobility, and coordination.

How is PNF defined by its creators?

As the ability to sense stimuli regarding position, motion, and equilibrium, and methods to promote neuromuscular responses through proprioceptor stimulation.

What characterizes PNF patterns- triplanar motion?

They consist of multijoint, multiplanar, diagonal, and rotational movements of the extremities, trunk, and neck. Multiple muscle groups contract simultaneously during the execution of these patterned motions

What are the general indications of PNF?

Initiation deficits,

Altered rate, rhythm, accuracy,

Weakness / Instability,

Fatigue, endurance deficits,

Muscle tightness,

Pain or discomfort, and

General tension

What is the goal when a patient has initiation deficits?

Initiate or improve initiation of motion

What is the goal for altered rate, rhythm, or accuracy?

Improve coordination, control, and motor learning.

What is the goal when a patient has weakness or instability?

Increase strength and stability

What is the goal for fatigue or endurance deficits?

Increase endurance.

What is the goal for muscle tightness?

Increase ROM.

What is the goal when a patient reports pain or discomfort?

Decrease pain

What is the goal when a patient has general tension?

Relaxation

What are the relative contraindications to be cautious with?

Pain, Instability: Flaccid limb, fractures, wounds, Cardiovascular Tolerance, and Cognition

What are the two diagonal patterns used in PNF for upper and lower extremities?

Diagonal 1 (D1) and Diagonal 2 (D2), each with flexion and extension directions.

Does motion occur throughout the entire extremity?

Yes

How are diagonal patterns identified and named?

by the motion that's occurring at the most proximal joint

What is the significance of the proximal joint in PNF diagonal patterns?

The patterns are named based on the motion occurring at the most proximal joint.

What is the role of the elbow in upper extremity PNF patterns?

The elbow acts as a pivot point for motion, allowing for mid-range movements.

Is the scapula included in D1 flexion?

Yes the scapula is included however the scapula and pelvis have their own specific descriptions

What is happening at the shoulder in D1 flexion?

Flexion,

Adduction, and

External rotation

What is happening at the scapula in D1 flexion?

Elevation,

Abduction, and

Upward rot

What is happening at the elbow in D1 flexion?

Flexion

What is happening at the forearm in D1 flexion?

Supination

What is happening at the wrist in D1 flexion?

Flexion and

Radial deviation

What is happening at the fingers in D1 flexion?

Flexion and

Adduction

What is happening at the shoulder in D1 extension?

Extension,

Abduction, and

Internal Rot

What is happening at the scapula in D1 extension?

Depression,

Adduction, and

Downward rotation

What is happening at the elbow in D1 extension?

Extension

What is happening at the forearm in D1 extension?

Pronation

What is happening at the wrist in D1 extension?

Extension and

Ulnar deviation

What is happening at the fingers in D1 extension?

Extension and

Abduction

What is happening at the shoulder in D2 flexion?

Flexion,

Abduction, and

External Rotation

What is happening at the scapula in D2 flexion?

Elevation,

Abduction, and

Upward rotation

What is happening at the elbow in D2 flexion?

extension

What is happening at the forearm in D2 flexion?

supination

What is happening at the wrist in D2 flexion?

Extension and

Radial deviation

What is happening at the fingers in D2 flexion?

Extension and

Abduction

What is happening at the shoulder in D2 Extension?

Extension,

Adduction, and

Internal rotation

What is happening at the scapula in D2 Extension?

Depression,

Adduction, and

Downward rotation

What is happening at the elbow in D2 Extension?

Flexion

What is happening at the forearm in D2 Extension?

Pronation

What is happening at the wrist in D2 Extension?

Flexion and

Ulnar deviation

What is happening at the fingers in D2 Extension?

Flexion and

Adduction

In upper extremity patterns, what is the pivot point?

the elbow- Not as strict with flexion and extension.

-Existing more in mid range.

What is happening at the Hip in D1 Flexion?

Flexion,

Adduction, and

External Rotation

What is happening at the Knee in D1 Flexion?

flexion

What is happening at the Ankle in D1 Flexion?

dorsiflexion and inversion

What is happening at the Toes in D1 Flexion?

extension

What is happening at the Hip in D1 Extension?

Extension,

Abduction, and

Internal Rotation

What is happening at the Knee in D1 Extension?

Extension

What is happening at the Ankle in D1 Extension?

Plantarflexion and eversion

What is happening at the Toes in D1 Extension?

Flexion

What is happening at the Hip in D2 Flexion?

Flexion,

Abduction, and

Internal Rot

What is happening at the Knee in D2 Flexion?

Flexion

What is happening at the Ankle in D2 Flexion?

Dorsiflexion and eversion

What is happening at the Toes in D2 Flexion?

extension

What is happening at the Hip in D2 Extension?

Extension,

Adduction, and

External Rot

What is happening at the Knee in D2 Extension?

Extension

What is happening at the Ankle in D2 Extension?

Plantarflexion and inversion

What is happening at the Toes in D2 Extension?

Flexion

What are the components of the PNF procedure?

PT positioning, manual contacts, appropriate resistance, verbal and visual cues, timing, stretch, traction/approximation, and irradiation

How should the PT be positioned when performing PNF?

In line with desired motion or direction of resisted motion -PT should be aligned with the diagonal pattern with trunk and shoulder facing the moving limb.

Where should the hand placement be for PNF?

When possible the proper hand placement is over agonist muscle groups allows for accurate force transmission.

What can improper placement lead to?

Incorrect placement can provide patient with misleading tactile cue (lumbrical grip)

What is the proper amount of resistance is used in PNF?

The greatest force possible that allows for full, pain-free range of motion without compensations.

What can be changed about the force to created the desired motion?

It is important to adjust the amount of force often to allow for successful motion - Force direction creates desired motion

What are verbal cues in PNF?

Simple, concise, unidirectional commands that guide the patient, such as 'push' or 'pull'.

If you want an isometric contraction what should you cue?

"Hold"

If you want an concentric contraction what should you cue?

"push" "pull"

If you want an eccentric contraction what should you cue?

"slowly let me win"

What is the visual cue to give during PNF?

Patient is asked if they can to follow the motion with their head and to assist with correct motion

What is the purpose of timing in PNF?

To sequence muscle contractions from distal to proximal segments so When teaching motion start with most distal segment to initiate the motion

What is the stretch stimulus in PNF?

Initiating every action in its lengthened position

for example with the Goal completing D1 Flexion patient starts in D1 extension

What is the stretch reflex in PNF?

A rapid stretch or overpressure applied to an agonist muscle positioned for a stretch stimulus

Where does the stretch reflex usually start?

usually distally and followed by immediate muscle resistance

Where can the stretch reflex be applied?

Can be applied at the beginning of the motion or throughout to improve contraction

What is approximation in PNF?

gentle compression force at the joint either manually or weight bearing to stimulate dynamic and postural stability.

What is traction in PNF?

slight separation of joint forces that can inhibit pain and facilitate movement

What does irradiation refer to in PNF?

Spread muscular response from one muscle group to another- where stronger components facilitate contraction in weak/inhibited muscles

What is rhythmic initiation in PNF?

A technique used to teach movement patterns by providing appropriate speed and timing.

What are the facilitation techniques?

Rhythmic Initiation,

Reversal of Antagonists

- Dynamic reversals / Rhythmic Stabilization, and

Combination of isotonics,

What is rhythmic initiation used for?

to teach the desired movement pattern which provides patient with appropriate speed and timing

How does force occur in rhythmic initiation?

Force occurs in ONE direction and returned to start passively during Rhythmic initiation

What to cue when using PROM?

"Let me move you"

What to cue when using AAROM?

"Move with me"

What to cue when using AROM?

"Move on your own"

What to cue when using RROM?

"Meet my force" and "Push" or "pull"

What does combination of isotonics mean in PNF?

Combined dynamic contractions of one pattern maintained without relaxation such as

Concentric → Isometric → Eccentric

Does hand position change in combination of isotonics?

No

What is the goal of combination of isotonics in PNF?

To increase strength and endurance of the agonist, increase ROM, and teaching functional control (eccentric control)

What are dynamic reversals in PNF?

Alternating concentric contractions which includes smooth transition of manual contact and hand position changes

Does hand position change in dynamic reversals?

Yes

What are the goals of dynamic reversals?

Increase active ROM,

Improve ability to smoothly reverse direction,

Prevent or relieve fatigue of one muscle group, and

Improve balance and coordination of antagonists

What is rhythmic stabilization in PNF?

Alternating isometric contractions that can be performed in open or closed chain.

What is the significance of AAROM in PNF?

It encourages the patient to move with assistance, promoting engagement in the movement.

What does RROM stand for in PNF?

Resisted Range of Motion, where the patient meets the therapist's force

What is the focus of the lab component in PNF training?

To apply PNF techniques manually and progress to functional strengthening