Proprioceptive Neuro Muscular Facilitation PDF

06-Nov-24 Proprioceptive neuro muscular facilitation DR.MAHMOUD EL-SAYED MIDAN PHD. LECTURER OF PT FOR NEUROLOGY CU, SU 1 Proprioceptive neuromuscular facilitation (PNF) Approach that act through promoting and hastening of neuromuscular mechanisms responses through...

06-Nov-24 Proprioceptive neuro muscular facilitation DR.MAHMOUD EL-SAYED MIDAN PHD. LECTURER OF PT FOR NEUROLOGY CU, SU 1 Proprioceptive neuromuscular facilitation (PNF) Approach that act through promoting and hastening of neuromuscular mechanisms responses through stimulation of proprioceptive input. 2 1  06-Nov-24 Philosophy of PNF: ❑Human body responds in accordance with demand. ❑Human body has hidden untapped potential which can be stimulated and developed by demand. ❑These abilities respond to practice and repetition within which the stronger component can strengthen the weaker one through cooperation in addition to improved coordination and endurance. ❑ Sensory input can be used to increase demand and improve neuromuscular responses. 3 Philosophy of PNF: ❑The PNF-philosophy has five main components, Positive practice: set up the patient for success. Functional training: all exercises are in connection with a functional task setting. Encourages for hidden reserve potentials: stronger involvement of the targeted body area using stronger body parts. Human being is a one unite: physically, mentally and emotionally aspect must integrated in training. Depend on motor control and motor learning principles. 4 2  06-Nov-24 Neurophysiological basis of PNF ❖Muscle spindle: specialised organ present along muscles fibers. contains 2 types of stretch receptors: primary and secondary They respond to quick and slow stretch respectively sending impulses to spinal cord through fastest afferents fibers produce stimulating effect on extrafusal muscle fibers contraction to protect muscles from being injured due to over stretching. 5 Neurophysiological basis of PNF ❖ Reciprocal innervation: the neural circuit connections that permit coordination between antagonistic muscle groups. A. contraction of group of muscles they send impulses to their antagonist to be relaxed and permit smooth mobility. Also, B. by stretch of a muscle, the spindle within it sends impulses ❑to facilitate contraction of stretched muscle ❑and in same time send inhibitory impulses to antagonistic muscles. This inhibitory effect is called reciprocal inhibition. 6 3  06-Nov-24 Neurophysiological basis of PNF ❖ Golgi tendon organ: Specialized structure in muscle tendons Aligned perpendicular in series with all muscle fibers. Responds to tension applied on it Send impulse to spinal cord through slower afferent fibers Inhibitory effect on the same muscle to protect muscle of excessive tension. This form a base for autogenic inhibition. 7 Neurophysiological basis of PNF ❖Immediate induction and Irradiation: ❑As movement initiated, immediate induction or facilitation occurs to groups of motor unite from different muscles responsible for the wanted functional pattern. ❑Unless the isolated control of movement is present, the brain is mainly dealing in term of functional movement patterns and not in isolated movement pattern. ❑Resistance is powerful proprioception input has strong facilitatory effect on muscle contraction. ❑Increase firing in these group and impulses spreads to all motor unite in this pattern ❑facilitation of these muscles weak within the pattern in a phenomenon called “Irradiation”. ❑For optimal effect usually maximal resistance is needed. 8 4  06-Nov-24 Neurophysiological basis of PNF ❖ Successive induction: It describes the facilitation of antagonist muscle in the end range of agonist muscle. Eg: elbow extensors are facilitated at the end of elbow flexion. certain cells type called Renshaw cell in the spinal cord inhibits agonist muscle activities at end of movement prepare for antagonist to contract. 9 Basic principles: Movement: functional movement patterns are used that is related to ADL. Line of movement: Movement pattern characterized by being diagonal and spiral. it resembles the topographical orientation of muscle fibers. Permit optimal contraction of all muscle fibers Diagonals: Each body part has two diagonals for movement. Each diagonal has two patterns of movement. 10 5  06-Nov-24 Basic principles: Pivots of movement: each limb has Proximal pivot: shoulder in upper limb and hip in lower limb. Distal pivot: forearm, wrist, and fingers in upper limb and ankle and foot in lower limb. Middle pivot: Elbow in upper limb and knee in lower limb Component of patterns: Pattern termed by component of motion in the proximal pivot Flexion vs Extension. Abduction vs Adduction. External rotation vs Internal rotation. Trunk and head pattern has two components only: Flexion vs extension External rotation vs internal rotation 11 Basic principles: Relation between motions in different pivot: Certain movement activated with each other in limb patterns, Upper limb: Shoulder flexion = shoulder external rotation Forearm supination radial deviation. And vice versa. Shoulder abduction = scapular adduction wrist and fingers extension abduction. And vice versa. 12 6  06-Nov-24 Basic principles: Lower limb: Hip flexion = ankle dorsi flexion. And vice versa. Hip abduction = Hip internal flexion eversion. And vice versa. NB: The intermediate joint (elbow or knee) are variable. 13 Basic principles: Movement: functional Line of movement: Diagonals Pivots of movement: each limb has Component of patterns: Relation between motions in different pivot: 14 7  06-Nov-24 15 16 8  06-Nov-24 extension with rotation Extension with rotation to to right left Flexoin with rotation to Flexion with rotation to left right 17 Procedures of PNF: Manual contact: way of contact between therapist and patient. stimulates exteroceptors guiding movement. Firm lumbrical grasp used to gain needed effect of Applying resistance Guidance Facilitation. (EXTRO OR PROPRIOCEPTIVE) 18 9  06-Nov-24 Procedures of PNF: Command: way of communication between the patient and therapist. It represent a powerful input that can alter the response during activity facilitation command must be sharp, loud and short. relaxation command must be calm, and quit. In PNF there are three types of commands preparatory; pre treatment exercise for education detailed explanation and education Action command starting pattern in actual for stimulation or short as push, pull, relax. practice relaxation Corrective during action for correction and keep pushing with foot or guidance hold. 19 Procedures of PNF: Stretch: ◦ Proper length of targeted muscle is a must for optimal activation. ◦ So, any pattern start at stretched position. ◦ In addition quick stretch stimulus at the start of any pattern ◦ a powerful proprioceptive input for activation Resistance: ◦ the most powerful proprioceptive input. ◦ directly related to number of motor unit activated. ◦ Maximal resistance permit better irradiation of contraction. Maximum isometric R: represent the maximum resistance the patient is able to hold against. Maximum isotonic R is the maximum resistance that still permits movement. 20 10  06-Nov-24 Procedures of PNF: 1. Traction: Proprioceptive stimulus Therapist try to lengthen the limb or trunk. It facilitate strength and mobility and awareness. 1. Approximation: proprioceptive input Therapist exert axial loading as if shortening the limb or trunk. It stimulate awareness, stability and weight bearing. 21 Procedures of PNF: Normal timings: smooth coordination of movement from distal to proximal with smooth overlapping progression all movement tend to end simultaneously. Time of emphasis: Time of emphasis is to stress on specific targeted weak muscle group. 22 11  06-Nov-24 Procedures of PNF: Proper body mechanics of the therapist: Essential for therapist usually position of step standing permits smooth mobility and control. therapist use body position and movement to apply resistance hand remain relaxed. Reinforcement: Using of different techniques to improve strength of response or contraction time of emphasis by changing normal timing sequence either by hand contact that apply resistance to the stronger component or by auditory stimulus. 23 Procedures of PNF: Visual stimulus It is a powerful reinforcement which is important locating the goal. vestibular and visual input (central proprioceptors) 24 12  06-Nov-24 Flexion Adduction External rotation Proximal hand Antero medial Distal hand Radial side in the hand Extension Abduction Internal rotation Prox.hand Postero lateral Dist. hand Dorso Lateral 27 Flexion abduction external rotation Prox. hand Antro lateral Dist. hand Dorso lateral Extension Adduction Internal Rotation Prox.hand Postero Medial Dist. hand In hand medial 28 13  06-Nov-24 Flexion Adduction External rotation Prox. hand Antero medial Dist. hand Dorso medial Extension Abduction Internal rotation Prox.hand Postero lateral Dist. hand Lateral planter 29 Flexion abduction Internal – rotation ‘ Prox.hand Antro lateral Dist. hand Dorso lateral Extension Adduction External Rotation Prox.hand Postero medial Dist. Hand medial planter 30 14