LAB Proprioceptive Neuromuscular Facilitation (PNF)

What is D1 Flexion? (UE)

flexion, adduction, external rotation

with finger and wrist flexion

What is D1 Extension?(UE)

extension, abduction, internal rotation

with wrist and finger extension

What is D2 Flexion?(UE)

flexion, abduction, external rotation

with wrist and finger extension

What is D2 Extension?(UE)

extension, adduction, internal rotation

with wrist and finger flexion

What is bilateral symmetricals (BS)?

same direction and same pattern on both extremities

EX) D1F with both UE

What is bilateral asymmetricals (BA)?

different patterns moving in the same direction simultaneously

EX) D1F & D2F

What is a Chop?

lead arm is moving from D1F into D1E while the other arm holds onto of wrist and is guiding

What is a Lift?

lead arm is moving from D2E to D2F while other arm is holding from under wrist to guide

A "lift and chop" is associated with which PNF pattern?

a. bilateral reciprocal in crossed diagonals

b. bilateral reciprocals

c. bilateral asymmetricals

d. unilateral reciprocals

c. bilateral asymmetricals

What is bilateral reciprocals (BR)?

same pattern moving in opposite direction simultaneously

EX) D1F & D1E

Which LE pattern can you do with both LEs that is similar to gait patterns?

LE bilateral reciprocals with D1

What is Bilateral reciprocals in crossed diagonals?

using different patterns moving in opposite directions simultaneously

EX) D1F & D2E

What is D1 flexion?(LE)

flexion, adduction, ER

with foot DF and inversion

What is D1 extension?(LE)

extension, abduction, IR

with foot PF and eversion

What is D2 flexion? (LE)

flexion, abduction, IR

with foot DF and eversion

What is D2 extension? (LE)

extension, adduction, ER

with foot PF and inversion

What is head/neck PNF patterns?

flexion + rotation to the R/L and then extension + rotation to the R/L (opposite side from flexion)

What is head/neck PNF patterns?

head/neck extension with rotation to R or L, then head/neck flexion with rotation to opposite direction

What is rhythmic initiation?

-Passive motion of limb of body thru desired range

-PROM --> AAROM --> AROM (with tracking) --> RROM

What are indications for RI?

-initiate movement

-promote relaxation and increase ROM

-reduce hypertonicity

-assist with ML and communication deficits

What is slow reversal?

-slow isotonic contraction in one direction followed by contraction in opposite direction

-can track/provide resistance in both directions

-no relaxation between directions

What are the indications for SR?

-strengthen agonist and antagonist

-develop ability to reverse direction and coordinate movements

-correct muscle imbalances

-improve endurance

What is slow reversal hold?

-isometric contraction that is held at a point of weakness during SR

-can be held mid range, or EOR

What are indications of SRH?

-strengthen agonist & antagonists

-ability to reverse directions

-correct muscle imbalances

-improve endurance

-dynamic stability at some point during range

What is repeated contractions?

-repeated isotonic contractions induced by a quick stretch and then resistance through any range

-partial range is okay to use

-repeated quick stretches throughout the range

What are indications for RC?

-improve strength & coordination

-improve muscle imbalances and/or diminished muscular endurance

What is timing for emphasis?

-using max resistance to elicit a sequence of contractions of major muscle components

-isometric resistance given to strongest component to allow for overflow to weak components

-once weakest component contracts, can use RCs to facilitate movemen

What are indications for TE?

-improve strength

-regain timing/coordination within an extremity

What is agonistic reversal?

-begins with a slow concentric contraction through range, follows by a slow eccentric contraction of the same muscle group with the PT moving them back down while they eccentrically control

-commonly used with bridges, STS, and step up/downs

What are indications for AR?

-strengthen postural muscles

-promote control of BW eccentrically during movement transition

-promote dynamic postural control

What is resisted progression?

-quick stretch and resistance applied to facilitate progress in walking, creeping, or movement transitions

-PT hands typically on the ASIS

What are the indications for RP?

-improving timing and control of lower trunk/pelvis

-improve endurance

What is rhythmic rotation?

-slowly rotating limb slowly, passively, and rhythmically around a longitudinal axis

-passively places the limb into a new range

What are indications for RRo?

-reduce hypertonicity

-increase ROM

-relaxation technique

What is contract relax?

-relaxation technique performed a range limiting point

-isotonic movement in rotation with an isometric hold of range limiting antagonist (spastic) muscle with increasing relaxation --> then relaxation --> limb is moved passively through newly gained range

What are the indications for CR?

-increase ROM caused by muscle tightness and spasticity

What is CRAC?

Contract-Relax-Active-Contraction

is contract relax technique, but instead of a passive movement into the newly attained range, the pt actively contracts into the new range

-helps maintain the inhibitory effects through reciprocal inhibition

What is hold relax?

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

-isometric contraction in the entire range-limiting antagonist pattern with slowly increasing resistance --> then relax --> then passively moved into newly gained range

What are indications of HR?

-increase ROM caused by muscle tightness, spasm, and pain

What is HRAC?

hold relax active contraction

-follows same technique as hold relax, but at the end, the pt actively contracts into the new range in order to maintain the inhibitory effects through reciprocal inhibition

What is hold relax active motion?

-resisted isometric contraction in mid-shortened range ---> then pt relaxes --> then passively moved into lengthened range --> then quick stretch and isotonic contraction back into shortened range

What are indications for HRAM?

-initiate movement

-improve endurance

-reduce hypotonia

-when pt has marked weakness/imbalances between opposing muscle groups

What is shortened held resisted contraction?

-apply low intensity resistance to isometric contraction muscles for at least 10s

-typically applied to postural extensor muscles in SL or sitting

-tell pt to "hold"

What are indications for SHRC?

-reduce instability in wt bearing and holding

-improve postural control and weakness

What is alternating isometrics?

-isometric holding contractions first in agonists of one side of a joint, followed by the antagonist muscle group on the other side of the joint

-resistance can be applied in any direction (A/P, M/L, diagonals)

-gradual increase/decrease of resisance

What are indications for AI?

-reduce instability in WB and holding

-improve static postural control and/or weakness

What is rhythmic stabilization?

-simultaneous isometric resistance in multidirectional pattern requiring a co-contraction of multiple muscle groups

-gradual increase/decrease of resistance to prevent motion

What are indications for RS?

-increase stability in WB & holding

-improve static postural control and weakness

-increase circulation

Which PNF techniques can help facilitate the first stage in motor control?

1st stage = mobility

-RI

-CR

-RRo

-HR

-HRAM

Which PNF techniques can help facilitate the second stage in motor control?

2nd stage = stability

-AI

-RS

-SRH

-SHRC

What is SHRC mean?

shortened held resisted contraction

What does HRAM mean?

hold relax active motion

What does RP mean?

resisted progression

What PNF techniques can be used to help facilitate the third stage of motor control?

3rd = controlled mobility

-SR

-SRH

-AR

-RC

-TE

What PNF techniques can be used to help facilitate the fourth stage of motor control?

4th = skill

-RP

-TE

-UE patterns with reaching

-combine a bunch of stuff to make something functional and skillful