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Questions and Answers
What is the primary purpose of PNF techniques according to their theoretical basis?
What is the primary purpose of PNF techniques according to their theoretical basis?
Which mechanism primarily affects the excitability of alpha motor neurons?
Which mechanism primarily affects the excitability of alpha motor neurons?
Which of the following techniques is NOT considered a basic procedure for facilitation in PNF?
Which of the following techniques is NOT considered a basic procedure for facilitation in PNF?
How does maximum resistance contribute to proprioceptive stimulation in PNF?
How does maximum resistance contribute to proprioceptive stimulation in PNF?
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Which of the following statements about reflexes in PNF is accurate?
Which of the following statements about reflexes in PNF is accurate?
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What is a key outcome of using traction or approximation in PNF techniques?
What is a key outcome of using traction or approximation in PNF techniques?
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Which of the following describes the role of vision in PNF?
Which of the following describes the role of vision in PNF?
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What is one of the outcomes of using resistive techniques in PNF?
What is one of the outcomes of using resistive techniques in PNF?
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What concept describes the phenomenon where a stimulus effect continues after the stimulus has ceased?
What concept describes the phenomenon where a stimulus effect continues after the stimulus has ceased?
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Which principle suggests that weak stimuli can combine to create a stronger excitation when applied in succession?
Which principle suggests that weak stimuli can combine to create a stronger excitation when applied in succession?
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Which term describes the simultaneous inhibition of antagonist muscles when an agonist muscle contracts?
Which term describes the simultaneous inhibition of antagonist muscles when an agonist muscle contracts?
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What is the primary goal of Proprioceptive Neuromuscular Facilitation (PNF)?
What is the primary goal of Proprioceptive Neuromuscular Facilitation (PNF)?
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Which process involves increased strength and spreading of a response due to enhanced stimulation?
Which process involves increased strength and spreading of a response due to enhanced stimulation?
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Which principle indicates that stimulating antagonistic muscles can increase excitation of agonist muscles?
Which principle indicates that stimulating antagonistic muscles can increase excitation of agonist muscles?
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What must occur for coordinated motion with muscle contractions?
What must occur for coordinated motion with muscle contractions?
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How did Sir Charles Sherrington's work contribute to neurophysiology in relation to PNF?
How did Sir Charles Sherrington's work contribute to neurophysiology in relation to PNF?
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What is the primary principle behind PNF techniques in improving movement ability?
What is the primary principle behind PNF techniques in improving movement ability?
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What role do peripheral receptors play in motor neuron excitability according to Sherrington's findings?
What role do peripheral receptors play in motor neuron excitability according to Sherrington's findings?
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What effect does the overlap of subthreshold impulses have on motor neurons?
What effect does the overlap of subthreshold impulses have on motor neurons?
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Which concept is primarily associated with the facilitation techniques in PNF?
Which concept is primarily associated with the facilitation techniques in PNF?
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How does a decrease in the synaptic threshold affect muscle contraction force?
How does a decrease in the synaptic threshold affect muscle contraction force?
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What is a mechanism through which learning is thought to occur in the nervous system?
What is a mechanism through which learning is thought to occur in the nervous system?
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What is the primary effect of peripheral stimulation on spinal motor neurons during voluntary movements?
What is the primary effect of peripheral stimulation on spinal motor neurons during voluntary movements?
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Which statement best reflects the theoretical basis of facilitation and inhibition techniques in PNF?
Which statement best reflects the theoretical basis of facilitation and inhibition techniques in PNF?
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Study Notes
Proprioceptive Neuromuscular Facilitation Techniques
- PNF is a set of techniques used to improve posture and movement.
- It's based on the principle that physiological movements in the body have a rotational and oblique character, and that a greater response can be achieved by moving against maximum resistance.
- The techniques use hand contact, visual and verbal stimulation to improve posture and movement ability.
History
- 1948: Kabat defined the principles of Knott PNF for the first time.
- 1953: Kabat and Knott conducted EMG studies.
- 1956: Kabat highlighted the importance of sense in movement.
Definitions
- Proprioceptive: Relating to sensory receptors that give information about movement and body position.
- Neuromuscular: Associated with nerves and muscles.
- Facilitation: Making a process easier.
Basic Neurophysiological Principles
- Afterdischarge: The continued effect of a stimulus after it stops, increasing with stimulus strength and duration. A maintained static contraction leads to an increased feeling of power due to afterdischarge.
- Temporal summation: Repeated weak stimuli combine to create a stronger stimulus over a short period.
- Spatial summation: Simultaneous weak stimuli in different body areas combine to produce a stronger stimulus.
- Irradiation: A spreading increased response strength caused by increased number or intensity of stimuli, leading to either excitation or inhibition.
- Successive induction: Increased excitation of agonist muscles following stimulation of antagonist muscles.
- Reciprocal innervation (reciprocal inhibition): Muscle contraction is accompanied by simultaneous inhibition of its antagonist, essential for coordinated movement.
Neurological Basis of PNF
- Theoretical basis of facilitation and inhibition techniques is based on Sherrington's findings on the spinal reflex arch.
- Peripheral receptors and impulses originating from peripheral nerves increase the excitability of the spinal alpha motor neuron.
- Overlapping subthreshold impulses lower the neuron's excitation threshold and trigger discharge.
- Increased extensibility leads to a facilitator effect.
Learning and Synaptic Connection
- Reduction in synaptic resistance with repetitive stimulation of a pathway forms the basis for learning in the central nervous system.
- Pavlov's studies demonstrated the effect of these mechanisms in the formation of new synaptic connections.
Sensory-Motor Organization
- Any stimulus travels through different levels of the nervous system to the alpha motor neuron.
Facilitation Techniques
- Facilitation techniques are based on facilitating voluntary effort by applying peripheral stimulation to the patient.
- Peripheral stimulation causes spinal motor neurons to discharge more quickly for voluntary movement, depending on signals from the descending paths.
- Facilitation techniques also produce inhibitory effects to better control the response to stimuli in the central nervous system.
- Response is sensory-motor in organization.
- Contraction force depends on the number of stimulated motor units, which increases with a decrease in synaptic threshold.
Types of Muscle Contraction
-
Isotonic (dynamic): The intent is to produce motion.
- Concentric: Agonist muscle shortens to produce motion.
- Eccentric: Outside force (gravity or resistance) produces motion, with controlled lengthening of the agonist.
- Stabilizing Isotonic: The intent is motion, but outside force prevents this motion.
- Isometric (static): The intent is for no motion to occur.
Resistance
- This is an important element of PNF and is adjusted based on the patient's condition, activity goals, and muscle strength and coordination.
- Techniques include:
- Maximal resistance.
- Reflexes.
- Force spread.
- Induction.
Reflex and Voluntary Movements
- Reflex and voluntary movements are tightly interconnected; reflexes can inhibit or facilitate voluntary movement, and vice versa.
Basic Procedures for Facilitation
- Resistance: Aids muscle contraction and motor control; increases strength and aids motor learning.
- Irradiation and reinforcement: Uses spread of response to stimulation.
- Manual contact: Increases power and guides motion through grip and pressure.
-
Body position and body mechanics: Guides and controls motion and stability.
- Verbal commands: Use of words and appropriate vocal volume to direct patients.
- Vision: Guides motion and increases force.
- Traction or approximation: Elongation or compression of limbs and trunk to aid motion and stability.
-
Stretch: Uses muscle elongation to facilitate contraction and decrease muscle fatigue.
- Timing, involves normal timing of contractions, for emphasis, to redirect energy from strong to weak muscles.
- Patterns relate to synergistic mass movements and components of functional motion.
Therapeutic Goals of Different Techniques
- Resistance: facilitates muscle contraction, increases motor control and learning, helps patients increase awareness of motion, and increases strength (includes reciprocal inhibition).
- Irradiation and Reinforcement: aims to spread response to stimulation to other muscles to promote a stronger response.
- Manual Contact: aids muscle ability to contract, provides security and confidence to patient, promotes tactile-kinesthetic perception.
- Body position and body mechanics: gives the therapist effective control of patient's motion and direction of the resistance and enables the therapist to do this without fatiguing.
- Verbal stimulation (commands): guides the start of movement and muscle contractions, affects the muscle contraction strength, and provides opportunities for patient corrections.
- Vision: promotes more powerful muscle contractions, helps patient correctly position and control their motion, both the head and body movement, and provides an avenue of communication and cooperative interaction.
- Traction: used to increase or facilitate motion, specifically aid in the elongation of muscle tissue for better response, and to resist some motion.
- Approximation: used to facilitate weight bearing, contraction of anti-gravity muscles, and facilitate upright reactions.
- Stretch stimulus: includes facilitating muscle contractions and contractions of associated muscles and the use of this for normal or preparatory motion.
Interaction Between Reflexes and Voluntary Movements
- Reflexes can facilitate or inhibit voluntary movements.
- There are several forms of interactions, including facilitation of other voluntary movements by voluntary movement or induction of another movement after an initial voluntary movement.
- Different forms of reflex movements are used, such as the stretching reflex, postural reflexes, or pain reflexes or various interactions between reflexes.
Muscle, Tendon, and Joint Receptors
- These receptors are located in skeletal muscles, tendons, and joints. Examples include muscle spindles, Golgi tendon organs, and some receptors in the fascia or tissues of muscles and joints like Pacinian capsules.
Muscle Spindle
- When stimulated, muscle spindle excitation leads to facilitation in synergy muscles and inhibition of antagonists. Afferent and efferent endings in the muscle spindle activate its activity and lead to reflex contraction.
Timing
- Normal timing of movements is from distal to proximal initially and proceeds from cranial to caudal and from proximal to distal during development.
- Normal timing - ensures continuous and coordinated motions until task is completed.
- Timing for emphasis - redirects the energy of a strong contraction to weaker muscles to facilitate a smoother movement.
Methods of Altering Timing
- Blocking or preventing all motions except for the one intended.
- Resisting isometric or maintained contractions of strong muscles while exercising weaker ones to "lock in" the segment.
Vision
- Feedback to increase muscle activity and influence position and body motion using visual cues.
- Eye contact gives additional communication between patient and therapist.
- Visual input can be more important for elderly patients than the verbal input.
Traction and Approximation
- Traction: Is elongation of the trunk or extremity to stimulate receptors in joints and muscles to aid in movement or stabilize positions.
- Approximation: Compresses trunk or extremities. To counteract any postural disturbances or improve or facilitate the treatment of unstable or painful joints
- Both are helpful to aid in the movement by the patient affected.
Summary of Techniques
- Techniques are used to facilitate voluntary control at the CNS level.
- This is done by applying peripheral stimulation through different muscles, and in coordination with other sensory factors like visual cues, verbal instructions, and positioning to promote quicker and more efficient movement, strength, and stability.
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