What is proprioceptive?
- - having to do with any of the sensory receptors that give information on movement and position of the body
- - golgi tendon
- - joint
- - mm
- - senses- vision, touch, hear, smell
involves that nerves
What is the facilitaiton component of PNF?
- you assisting making the movement easier
What is the aim of PNF?
- promote functional movement through facilitation, inhibition, strengthening and relaxation of mm groups
What is the philosophy of PNF?
- - positive approach- set up for success, achievable tasks
- - highest functional level: functional approach
- - mobilise potential by intensive training: active participation, motor learning, self training
- - consider the total human being work in envt
- - use of motor control and motor learning principles: variability of ractivce/ repetition
- - no pain thru movement
What are the characteristics of PNF?
- - facilitation of spiral and diagonal movement patterns
- - movements performed may be passive, active- assisted, or active depending on pt
- - isotonic and isometric movements can be used
- - sensroy stimulu is used: stretch, traction and approximation (push jts together), maunal contacts, and appropriate verbal commands
- - resistance- overflow/ irridation from strong to weak mm
- - developmental sequence important- cephalocaudal and proximodistal
- - goal directed activites used to hasten learning of functional patterns
What are the essential components of manual contacts of PNF?
- - use pressure as a faciliating mechanism
- - demonstrated by positioning of hands in holds use during patterns (and changes between reciprocal patterns)- lumbrical grip
- - mirror pts direction of movement for effective facilitation
- - in linewith the movementwhere possible
- - move
What are the essential components of PNF?
- - a mm responds with greater force after stretch
- - must be placed in lengthened position
- - stretch reflex can be elicited by repeated stretch through range (can be used to initiate movement in pt who is weak or paralysed)
- - quick stretch increases motor ability- better mm activity
- - prolonged stretch decreases motor activity >15 sec
When is quick facilitory stretch contraindicated?
- - jt hypermobility
- - #
- - P
- - spacsticity
What manual resistance should be part of PNF?
- - movement performed against resistance of sufficient degree to demand maximal effort from pt (match the pts effort with your resistance) = strength
- - defined as greatest amount of resistance that can be applied to isotonic contraction and still allow full range of movement to occur if working on mobility
- - greatest amount of resistance for isometric hod to still allow hold to be sustained which is working on stability
- - maximal resistancec can be dangerous
- - watch for abnormal patterns UMNL
What is irradiation?
- - think of kate sitting up the front
- - resistance- overflow/ irradiation from strong to weak mm
- - increase mm activity in agonist or inhibit in antagonists
- - resistance to trunk flexion produces overflow- hip flexors and DF
- - resistance to trunk ext produces over flow- hip and knee ext
- - resistance to UL ext and adduction overflow - trunk flex
What are the two types of jt facilitation?
- - traction
- - approximation
what is traction?
- - separating jt surfaces
- - directe toward jt receptors
- - used were motion is one of pulling eg flexion
- - facilitate motion and decrease pain
What is approximation?
- - info thru jt receptors
- - directed towards jt reeptors
- - used where motion is one of pushin eg ext
- may be used to gain postural holding response esp in mat work
- - promotes stability and weight bearing
What should the timing of the movement be?
- - speed should be function of the movement and pt
- - sufficient trunk and prox jts control must be attained to be able to move successfully with distal jts
What are the patterns of movements for PNF?
- - diagonal patterns (mm groups work together, mimics function)
- - functional patterns - pt performs functional movements using facilitory or inhibitory techniques
Visual cues of PNF?
- - pt watcheslimb movement
- - corrects body position and alignment
Verbal input of PNF?
- - clear concise commands
- - focus on movement directions
- - volme and intonation important
- - pt needs to be involved
- - volume of voice needs to be considered
Applications of PNF
- - hands on body in direction of movement
- - therapist body aligned wuth movement
- - arm or leg elogated and given a quick stretch
- - concise command at start of movement
- - resistance graded for desired response
- - normal timing reinforced during movement
What is the PNF checklist?
- - pt and therapist position
- - therpist body mechanics
- - manual contacts
- - desired movement
- - stretch
- - verbal commands
- - resistance
What is the biomechnical checklist?
- - BOS
- - COG
- - number of weight bearing jts
- - length of the lever arm
What are the diagonal movement patterns?
- - D1 and D2
- - patterns are named for proximal direction
- - diagonals flex or ext
- - middle joints may be flexed or extended
- - straight arm/ leg patterns impact proximally
- - when middle jts are flexed you get more emphasis distally
What are the cooperative function of mm?
- - the spiral and diagonal patterns of facilitation provide for an optimal contraction of the major mm components
- - they allow mm to contract from completely lengthened state
- - each mm contributes three components of action as far as its location and structure will allow
- - one pattern works the agoinst and antagonist
what are the types of mm contractions?
- - isotonic: active, voluntary shortening of the mm
- - isometic: static hold against equal resistance
- - eccentric: active voluntary lengthening of mm
Appropraite commands for PNF?
- - preparatory commands must be clear and concise
- - tone of voice may influence quality of response
- - instruction of action need to short, accurate and timed- push, pull, hold, relax, let go
What tone should you use when you want a maximal effort?
- strong, shrap commands
What tone do you use when you want your pt to do best efort?
- moderate tone
What tone do you use whenyou want to reassure ur pt?
- soft voice
WHat is the PNF belief of development?
- - development is cephalocaudal and proximodistal
- - use of positioning related to primitive reflexes to facilitate movement patterns
- - goals are directed
- - strengthening goals
- - functional goals important
Technique of PNF
- passive active light resistance- need to ensure the right communication
Hold- relax active movement does?
- - facilitates agonists
- - - stretches/ relaxes/ inhibits antagonists
What is the contract relax technique?
- - similar to hold relax but with rot
- - rot is good for parkinsons disease
- - usually rotationary
- - for pt with decrease strength, coordination
What is the slow reversal
- - concentric contractions of alternating mm groups
- - can vary as slow reversal holds (hold at end of range each direction), agonist reversal (works 1 mm group concentric, then eccentric)
All patterns of PNF can be applied?
- - diagonal patterns
- - functional movements
What are the disadvantages of PNF?
- - outdated theory- 1930s
- insufficient use of time
- - can teach pt to be helpless
What are the PNF techniques for the lower limb?
- - D1 and D2 flexion
- - D1 and D2 extension
- - pelvic patterns
Perform a PNF LL D1 flexion?
- - leg
- - pt supine
- - hip ext, abduction, internal rotation, knee extension, ankle PF, eversion
- - hands
- - end in flexion, adduction, ext rot, knee flexion, ankle PF, inversion
- - eg to cross one leg over the other in sitting to eg take off shoe
Perform a PNF LL D1 extension?
- - start in hip flexion/ adduction/ external rotation, knee flexion, ankle DF, eversion
- - have pt on a diagonal and face out
- - push your foot down and out
- - end in hip ext/ abduction/ internal rot, knee extension and ankle plantar flexion and eversion
- eg stance phase of gait and coming up to stand from a seat
Perform a PNF LL D2 flexion
- - dog coking its leg
- - start in hip ext/ adduction and ext rot, knee ext and PF/ inversion
- - pullyour foot up and lift your leg out to the side
- - end in hip flex/ abduction and internal rot, knee flexion, DF and inversion
Perform a PNF for lower extremity D2 extension?
- - hip flexion/ abduction and internal rotation, knee in flexion and DF, eversion
- - stepdown into my hand
- - end in hip ext/adduction and ext rot, knee ext, PF and inversion
- - eg soccer kicking in standing
- - can put opp leg on a stool
Perform PNF anterior elevation of the pelvis
- - arch of movement- rock over elvis
- - lumbical grip over asis
- - pull back for stretch
- - pt- pull up
Perform a PNF of the pelvis with posterior depression
- - hand on ischial tuberosity- rock
- - use body
- - push up
- - pt pull back
What do you use for jt proprioception?
- traction and proximation
Perform upper extremity D1flexion
- - start- shoulder ext/ slight abd/ medial rot, scap in anterior elevation, elbow ext, forearm pronation, wrist flex and ulnar deviation
- - tell pt to squeeze my hand, turn your hand and pull acros your body
- - end position- shoulder flex/ add/ lateral rot, scapposterior depression, forearm supination, wrist and fingers flexed and radial deviation
- eg- reaching up to bring a scarf off the op shoulder.
Perform a D1 extension of the UL?
- - start with shoulder flexion/ adduction/ lateral rot, scap posterior depression, elbow ext, forearm, wrist and finger flexed ad radial deviation
- - have ur hand over the back
- - tell pt to turn your hand down, push down and out to the side
- - end with shoulder ext/ slight abduction/ medial rotation, scapular anterior elevation, elbow ext, forearm pronantion, fingers extended and radial deviation
- - eg feeding movement
Perform a PNF on the upper extremity D2 flexion
- start- shoulder ext/ add/ medial rot/ scap ant depression, elbow ext, forearm supination and wrist flex, ulnar deviation
- - open ur hand, lift your thumb up and out and move arm up
- end- shoulder flexion/ add/ lateral rot/scap posterior elevation, forearm promation, wrist ext, radial deviation and finger ext
- - like throwing a bouquet over same shoulder
Perform a PNF upper extremmity D2 extension?
- - start- shoulder flex/abd/ext rot, scap posterior elevation, elbow ext, forearm pronation, wrist ext/ radial deviation and finger ext
- - squeeze my hand, turn your thumb down and forward to ur opp hip
- - end- shoulder ext/add/ med rot, scap ant depression, forearm supination, wrist flex/ ulnar deviation and finger flex
- - eg placing a sword into a sheath
Perform a PNF scapula D1 flexion
- - anterior elevation
- - pt sidelying- hips, knee 70-90 degrees
- - head in neutral
- - lumbricals grip- hands on each other
- - stand behind pt
- - get pt to pull up to ear
- - you resist
- - eg shrug ur shoulder towards your ear
Perform posterior depression aka D1 extenion of the scap
- - pt sidelying
- - hand on scappush up angle of scap
- - pt push down against u
- - think of putting your inferior angle of the right scap into the left hippocket
Perform D2 flexion of the scap- posterior depression
- - along the line of humerus
- - pt sidelying
- - stand in line with diagonal
- - hands on top of acromion
- - pt push up
- - lift fingers off- so palm just touched
Perform D2 extension ant depression of scap
- - sidlying- hand around shoulders so on either side of axilla
- - when pull down- you go up and over
- - ensure you move your entire body
- - good to use to assist getting up off bed