Exercise-PNF-8-11 (PDF)

Proprioceptive neuromuscular facilitation (PNF)  DEFINITION Proprioceptive: having to do with any of the sensory receptors that give information concerning movement and position of the body Neuromuscular: involving the nerves and muscles Facilitatio...

Proprioceptive neuromuscular facilitation (PNF)  DEFINITION Proprioceptive: having to do with any of the sensory receptors that give information concerning movement and position of the body Neuromuscular: involving the nerves and muscles Facilitation: making easier  DEFINITION PNF is an approach to therapeutic exercise that combines functionally based diagonal patterns of movement with techniques of neuromuscular facilitation to evoke motor responses and improve neuromuscular control and function PNF techniques can be used to develop muscular strength and endurance; to facilitate stability, mobility, neuromuscular control, and coordinated movements; and to lay a foundation for the restoration of function  PNF MAIN FEATURES (Hallmarks) Diagonal pattern of movement---- these are the patterns needed during Stronger muscle group of functional activities a diagonal pattern will facilitate the responsiveness of the weaker muscle groups The application of sensory cues – Proprioceptive Augment the motor response – Cutaneous – Auditory stimuli Facilitation  Applications It has applications in: – Neurorehabilitation – Musculoskeletal conditions  USES of PNF PNF techniques are useful through the continuum of rehabilitation: – Early phases/ isometric techniques – Final phases/ high speed diagonal movement performed against maximum resistance – PNF can be used in active and passive ROM, and to improve flexibility  BASIC PRINCIPLES OF PNF 1. Diagonal patterns 2. Manual contact 3. Resistance 4. Stretch 5. Verbal commands 6. Traction and approximation 7. Timing 8. Body positioning and body mechanics  DIADONAL PATTERNS Patterns of movemnet associated with PNF are: – Multiplanner, diagonal, rotational of extremities, trunk and neck – Two pairs of diagonal patterns are associated for the upper and lower extremities; diagonal 1 (D1), diagonal 2 (D2)  PNF PATTERNS Each pattern has three dimension – 1. Flexion or extension 2. Abduction or adduction 3. Rotation Movement occurs in a straight line, in diagonal direction with a rotatory component  PNF PATTERNS Two pairs of diagonal patterns are associated for the upper and lower extremities; diagonal 1 (D1), diagonal 2 (D2) Each of these patterns can be performed in either flexion or extension Terminology used D1 flexion; D1 extension; D2 flexion; D2 extension Patterns are identified by the motion that occurs at the proximal pivot points (hips or shoulders) Pattern is named by the ending position of the hip or the shoulder  UPPER EXTREMITY F-ABD-ER F-ADD-ER E-ABD-IR E-ADD-IR  PATTERNS D2 Flexion D1 Flexion Shoulder FLEX, ABD, Shoulder FLEX, ADD, ER ER Forearm - Sup Forearm - Sup Wrist - Rad. Flexion Wrist - Rad. Flexion Fingers - Extension Fingers - flexion R/ SHOULDER D1 Extension D2 Extension Shoulder EXT, ABD, IR Shoulder EXT, ADD, IR Forearm - Pro Forearm - Pro Wrist - Ulnar. extension Wrist - Ulnar ext. Fingers - Extension Fingers - flexion F-ADD-ER E-ABD-IR F-ABD-ER E-ADD-IR Diagonal One Diagonal Two  LOWER EXTREMITY F-ABD-IR F-ADD-ER E-ABD-IR E-ADD-ER LOWER EXTREMITY  Basic Procedures with PNF Patterns Manual Contacts: refers to how and where the therapist's hands are placed on the patient. Whenever possible, manual contacts are placed over the agonist muscle groups or their tendinous insertions. Maximal Resistance: The amount of resistance applied during dynamic concentric muscle contractions is the greatest amount possible that still allows the patient to move smoothly and without pain through the available ROM  Basic Procedures with PNF Patterns Position and Movement of the Therapist: The therapist remains positioned and aligned along the diagonal planes of movement with shoulders and trunk facing in the direction of the moving limb. Stretch: Stretch stimulus: The stretch stimulus is the placing of body segments in positions that lengthen the muscles that are to contract during the diagonal movement pattern. For example, prior to initiating D1Flexion of the lower extremity, the lower limb is placed in D1Extension.  Basic Procedures with PNF Patterns Stretch reflex: The stretch reflex is facilitated by a rapid stretch (overpressure) just past the point of tension to an already elongated agonist muscle. Usually applied to distal part. Normal Timing: A sequence of distal to proximal, coordinated muscle contractions occurs during the diagonal movement patterns. The distal component motions of the pattern should be completed halfway through the pattern. Traction: Traction is the slight separation of joint surfaces, theoretically, to inhibit pain and facilitate movement during execution of the movement patterns  Basic Procedures with PNF Patterns Approximation: The gentle compression of joint surfaces by means of manual compression or weight bearing stimulates co-contraction of agonists and antagonists to enhance dynamic stability and postural control via joint and muscle mechanoreceptors. Verbal Commands: Auditory cues are given to enhance motor output. Visual Cues: The patient is asked to follow the movement of a limb to further enhance control of movement throughout the ROM.