copyright 2005 lippincott williams & wilkins proprioceptive neuromuscular facilitation national...
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Copyright 2005 Lippincott Williams & Wilkins
Proprioceptive Neuromuscular Facilitation
National Rehabilitation Center
Kim, Seok-Hwan
Copyright 2005 Lippincott Williams & Wilkins
Proprioceptive Neuromuscular Facilitation (PNF)
Methods of promoting or hastening the response of the neuromuscular mechanism through
stimulation of the proprioceptor.
Major Goal – Restore or enhance postural responses or normal patterns of motion.
Copyright 2005 Lippincott Williams & Wilkins
Basic Neurophysiologic Principles of PNFDiagonals of Movement
Innate path in which maximal response of the trunk and extremities can be
facilitated.
Components associated with antagonistic motion:
Flexion versus extension. Abduction versus adduction in extremities and
lateral movement of trunk. Internal vs. external rotation.
Copyright 2005 Lippincott Williams & Wilkins
Normal coordinated patterns of motion are diagonal in direction with spiral components – Facilitate
strongest output.
Reflects functional relationship of trunk and extremities.
Diagonals may be used to identify:
1. Quality of contractions2. Range of motion3. Functional impairments/limitations
Copyright 2005 Lippincott Williams & Wilkins
Motor Development
PNF is based on 11 principles drawn from:
Neurophysiology Motor learning Motor behavior
Copyright 2005 Lippincott Williams & Wilkins
Examination and EvaluationAssessed Areas:
1. Impaired ROM and muscle length
2. Impaired muscle power
3. Impaired muscle endurance
4. Impaired balance
5. Impaired posture
6. Impaired motor control
7. Pain
Copyright 2005 Lippincott Williams & Wilkins
Factors Included During the Evaluation
Patient’s short-term and long-term goals.
Patient’s receptive potential for language, vision, and manual contacts to promote cuing.
Patient’s strengths.
Patient’s weaknesses.
Copyright 2005 Lippincott Williams & Wilkins
Treatment Implementation
Treatment interventions may include:
1. Modification of environment
2. Education and compensation for the impairment
3. Treatment directed at changing the patient’s neuromuscular capabilities
Copyright 2005 Lippincott Williams & Wilkins
Patterns of Facilitation
Manually resistive exercises that create the diagonals of movement by coupling pairs of antagonistic patterns, providing a path for reversing motions, and using the agonist–
antagonist relationship of the nervous system as techniques are applied.
Copyright 2005 Lippincott Williams & Wilkins
Procedures
1. Body positioning and mechanics2. Manual contacts3. Manual and maximal resistance4. Irradiation5. Verbal and visual cuing6. Traction and approximation7. Stretch8. Timing
Copyright 2005 Lippincott Williams & Wilkins
Body Positioning and Mechanics
Be positioned in the diagonal plane or treatment plane whenever possible.
Shoulders and hips face toward direction of movement.
Forearms in this plane is important.
Copyright 2005 Lippincott Williams & Wilkins
Copyright 2005 Lippincott Williams & Wilkins
Manual Contacts
Use contacts overlying agonist muscle group to strengthen contractions and/or direction of movement.
Use lumbrical grip to provide contact.Contact the target group (direct effect)
or synergist or antagonist (indirect).
Copyright 2005 Lippincott Williams & Wilkins
Manual and Maximal Resistance
Resistance to motion enhances muscle activation.
Direction, quality, and quantity of resistance are adjusted according to treatment goals.
Resistance should be no greater than the resistance that allows full ROM.
Copyright 2005 Lippincott Williams & Wilkins
Irradiation (Overflow)
Spread of energy from agonist to complimentary agonists and antagonists within a pattern.
Irradiation is stimulated through clinician’s use of resistance.
Weaker muscle groups benefit while working in synergy with more normal partners.
Copyright 2005 Lippincott Williams & Wilkins
Verbal Cuing
Should be clear and concise.Begin by detailing a particular
patient response.Change to more simple cues for
subsequent repetitions.Alter tone according to goal (e.g.,
soft voice for inhibition)
Copyright 2005 Lippincott Williams & Wilkins
Approximation and Traction
Stimulates receptors to facilitate co-contraction and stability around the joint.
Employed through the use of weight-bearing developmental postures.
Traction is commonly used with pulling movements to inhibit compression.
Copyright 2005 Lippincott Williams & Wilkins
Stretch
Often performed at the starting position of a pattern or movement.
Result – Reflex activation.Resistance through entire range provides
continued stretch through tension.Stretch can be repeated at start of range
or superimposed during a pattern.
Copyright 2005 Lippincott Williams & Wilkins
Techniques of Facilitation
1. Rhythmic initiation
2. Repeated contractions
3. Reversals of antagonists
4. Dynamic reversals of antagonists
5. Stabilizing reversals
6. Rhythmic stabilization
7. Hold and relax
8. Contract and relax
9. Combination of isotonics (dynamics)
Copyright 2005 Lippincott Williams & Wilkins
Uses of Rhythmic Initiation
Initiate movement.Define the direction or pattern of
movement.Set the appropriate rate of movement.Improve coordination and sense of
motion.Promote general relaxation.
Copyright 2005 Lippincott Williams & Wilkins
Uses of Repeated Contractions
Help to initiate movement.Strengthen agonist movement
pattern from lengthened range.Strengthen agonist movement
pattern within available ROM.Redirect motion within pattern or
task.
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Use of Reversals of Antagonists
To facilitate agonist.
Improve balance between agonist and antagonist.
Copyright 2005 Lippincott Williams & Wilkins
Use of Dynamic Reversals of Antagonists
Increase active ROM.Improve strength in the available
ROM.Improve balance and coordination
of antagonist.Improve endurance of antagonistic
patterns.
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Use of Stabilizing Reversals
Improve balance and stability.Improve strength.Integrate a new posture or ROM into function.
Copyright 2005 Lippincott Williams & Wilkins
Use of Rhythmic Stabilization
Improve strength of antagonists.Improve balance of antagonists.Improve stability.Increase active and passive ROM
following technique.Decrease pain.
Copyright 2005 Lippincott Williams & Wilkins
Use of Hold and Relax
Improve PROM.Provide relaxation.Reduce pain.
Copyright 2005 Lippincott Williams & Wilkins
Use of Contract and Relax
Improve passive ROM.
Provide relaxation.
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Use of Combination of Isotonics
Increase strength of agonist.
Increase active ROM.
Teach functional control.
Copyright 2005 Lippincott Williams & Wilkins
SummaryPNF is a manual therapy approach that applies
postures, movement patterns, contacts, cues, and goals. All = Maximally facilitating.
Treatment is based on improving function, and using functions that are possible to reach those are attainable goals.
PNF lends itself to use as an adjunct to other treatment approaches.
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