Proprioceptive Neuromuscular Facilitation

• promoting or hastening the response of the neuromuscular system thru the stimulation of the proprioceptors

• each treatment directed at the whole human not just part

Rhythmic Initiation

• PROM → AAROM → AROM → RROM → I

  • pt starts to actively assist in desired direction and therapist performs return motion

• Goals:

  • increase ability to initiate movement and promote mobility

  • teach the pattern, coordination and timing

Reversal of Antagonists: Dynamic Reversals

• resisted, rhythmic concentric contractions of agonist and antagonist w/o relaxation btwn reversals

  • begin w/ antagonist to facilitate agonist

• Goals:

  • increase motion of agonist, promote mobility

  • increase strength, ROM, endurance

• VC: “push against me, I’m going to resist you”

Reversal of Antagonists: Rhythmic Stabilization

• alternating isometric contractions; no motion allowed; no relaxation

• Goals:

  • stability, co-contraction of agonist and antagonist

  • increase balance, strength and postural control

• VC: “don’t let me move you”; “Hoooollddddd”

Repeated Stretch: Beginning of Range

• start in lengthened range of the pattern, apply initial stretch (quick stretch) followed by appropriate resistance as the pt responds

• Goals:

  • initiation of movement, increase AROM and strength, guide motion

• stretch the entire pattern of motion

Repeated Stretch through Range (Repeated Contractions)

• repeated use of stretch reflex during resisted motion; applied repeated stretch to increase contraction as needed

• Goals:

  • increase AROM, increase strength, prevent or reduce fatigue, endurance, guide motion in desired direction

• only do 3-4 repeated stretches per pattern

Combination of Isotonics

• combined concentric, eccentric and stabilizing contractions of one group of muscles (agonists) without relaxation

• Goals:

  • controlled mobility, coordination, increase AROM, increase strength, functional eccentric control

• VC: “push/pull, hold, let me move you slowly”

Replication

• facilitate motor learning of functional activities; start with the end and work backwards

• place pt at end of movement where agonist is shortened → resist and hold → move pt passively in opposite direction and have pt return to end

• Goals:

  • teach the pt the final position of the movement or posture, facilitate motor learning of a functional task

PNF Techniques and Their Goals

• Stability

  • rhythmic stabilization

  • dynamic reversals with a hold (slow reversal hold)

• Mobility

  • rhythmic initiation

  • dynamic reversals (slow reversals)

  • Repeated Stretch (repeated contractions)

  • Combination of Isotonics

  • Replication