Pnf Lab.docx

PROPRIOCEPTIVE NEUROMUSCULAR FACILITATION LABORATORY GUIDE

UNILATERAL PATTERNS 1. D1 Flexion 2. D2 Flexion 3. D1 Extension 4. D2 Extension BILATERAL PATTERNS: 1. Bilateral Symmetrical a. D1 flexion and D1 extension i. Extension ii. Flexion & Extension iii. Extension & Flexion b. D2 flexion and D2 extension i. Extension ii. Flexion & Extension iii. Extension & Flexion c. D1 flexion – ulnar extensor thrust d. D2 extension – radial extensor thrust 2. Bilateral Asymmetrical a. D1 R; D2 L – extension 3. Bilateral Reciprocal (Cross Diagonal) a. Extension b. D1 flexion – ulnar extensor thrust; D1 extension – reversal thrust c. D2 – radial extensor thrust PNF TECHNIQUES TECHNIQUE

PROCEDURES

TYPE OF MUSCLE CONTRACTION Isotonic or Isometric

Manual Contacts

Deep pressure

Traction

Separation of joint surfaces

Superimposed upon isotonic and isometric contractions

Approximation Joint compression

Superimposed upon isotonic and isometric contractions Superimposed upon isotonic and isometric contractions

Stretch

Major muscle components in a lengthened range of pattern

PURPOSES AND BYPRODUCTS

INDICATIONS

CONTRAINDICA TIONS

Stimulate proprioceptors; with or without resistance Stimulates stretchrelated proprioceptors; To make joint motion less painful Stimulates compression-related proprioceptors

Used when contact with patient is necessary Conditions that requires joint surface separation

Post-operative wound site

When maximal facilitation is used

To demand increased responses where response is inadequate to initiate active motion in a lengthened position

Conditions where innervation is inadequate to produce active motion

Fracture Recent postoperative conditions Acute orthopaedic conditions Recent fractures Pain

Fracture Recent postoperative conditions

Recent postoperative conditions Repeated Contractions (RC) “Now push!” (Extension) “Now pull!” (Flexion)

Hold-RelaxActive Motion (HRA) “Hold” “Let go!” “Pull”

Rhythmic Initiation (RI) “Let me move you” “Now help me just a little” “Push or pull”

Slow Reversal (SR) or SlowReversal Hold (SRH) Weakness of D1 flexion pattern (agonist) in LE:

Sustained and repeated effort in one direction. May be performed at any desired point of motion. Repeated effort without sustained effort. Performed from a shortened range to lengthened range

Repeated movement without sustained effort. Performed from lengthened range to shortened range.

May be performed through available range or partial range according to patient’s response

DIRECTED TO AGONIST Isometrics – To stimulate gains in Isotonics range of motion of agonistic pattern To improve endurance, coordination, and strength in a give pattern or a specific part of the range of motion Isometrics To stimulate response (shortened in lengthened range of range) – pattern Voluntary To demand relaxation relaxation (PT or lengthened reaction moves the part to antagonistic pattern quickly to the To improve, lengthened endurance, strength range) – and coordination of Isotonic the agonistic pattern contraction (lengthened range of agonist) Voluntary To promote ability to relaxation – initiate movement and Assisted to increase rate of isotonic movement contraction (move the part to the available range motion – wait for relaxation to occur) – resisted isotonic contraction REVERSAL OF ANTAGONIST (SR) To stimulate active Simultaneous motion of agonistic isometric pattern contraction of To redevelop normal antagonistic reversal of antagonists patterns To achieve relaxation (SRH) as a result of Isotonic stimulation of the (antagonist)agonistic pattern

Weakness Lack of endurance Muscle imbalances

Acute orthopaedic and recent postoperative conditions, CVA (do not permit sustained effort against resistance)

Lack of endurance Extreme weakness that prevails in the lengthened range of pattern. Sustained effort by the patient is not permissible. Muscle imbalances – exists in favor of the antagonistic pattern

Conditions that do not permit full range of passive or resisted motion.

Rigidity (PD) or spasticity (that prevents initiation of movement) Lethargic patients Elderly people

If passive movement is contraindicated

Weakness

Acute orthropaedic conditions

“Push your foot down and out toward me” (D1 ext power) “Pull your foot up and across your body isometric” (D1 flexion) Repeat. Last “And pull, and pull and pull again” Rhythmic Stabilization “Hold”

Quick Reversal Weakness of D1 flexion with marked imbalance on D1 extension “Push your foot down and out toward me” – isotonic with resistance “Now pull your foot up and across” – isotonic with assistance to shortened range “And Hold it” – isometrics “Let go” “Now pull” Contract Relax (CR)

isometric (agonist)

May be performed at any point of available range of motion

Isometrics of agonist – isometrics of antagonist

To stimulate active motion of agonistic pattern To develop stability To achieve relaxation To stimulate circulation

Used to facilitate agonist by resistance to antagonist through full range of motion followed by sudden reversal with isotonic contraction of agonist and with assistance to shortened range

Isotonic – isometric contraction of the agonist

To correct imbalance at shortened range of agonist by assisting agonistic pattern to shortened range

May be performed at succeeding

Isotonics of antagonistic pattern – no

RELAXATION To achieve relaxation of antagonistic pattern where active motion

Weakness Where active motion is not permitted (pain) Ataxia (Isometric contractions is deficient) Stability is the goal of treatment Marked imbalance of antagonist with sufficient strength in shortened range of agonist to facilitate response through full range

Where stabilization does not stimulate agonistic pattern

Spasticity

Active motion of the agonist is present

Any condition for which sudden movement may be hazardous

“Pull your foot down and in” (D2 extension) “Let go” “Now pull up and out toward me” (D2 flexion) “And hold” “And pull, and pull and pull again” Hold Relax (HR)

points of range of motion beginning with the point where limitation by antagonistic pattern prevents itself

May be performed at any point of Fracture – range where weak limitation extension of presents itself elbow as the result of pain and “Just hold your muscle spasm elbow bent and don’t let me move it – resistance is at the radially flexed wrist” (D1 flexion) “Let go” “Open your hand and push it down and away – isotonic without resistance” “Try to straighten your elbow and hold it” Slow-Reversal- Performed at Hold-Relax exact point of (SRHR) range of motion where ACTIVE LOM limitation by AT 15 deg OF antagonistic LE FABIR (D2 pattern flexion) presents itself “Pull your foot up and out toward me as far as you

range of motion is allowed – passive motion of agonistic pattern

cannot be initiated from stretch range of agonistic pattern

No active motion is available from a stretch stimulus

Acute orthopaedic conditions

Isometric of antagonist – Free active motion of agonist – Isometric contraction of agonist

To achieve relaxation of antagonist To encourage active motion of agonist

Where pain prevents active motion Acute orthopaedic conditions

Where ability to perform isometric contraction is grossly deficient

Isotonic – isometric of antagonistic pattern – no range of motion is allowed – voluntary relaxation – isotonic of agonistic patten

To achieve relaxation of antagonistic pattern To stimulate agonist following relaxation of agonist

Limitation of motion (motion against resistance is permitted)

No relaxation during the technique Active motion with resistance is not allowed

can” (D2 flexion) “Now pull your foot down and in” (D2 extension) – isometrics “Relax” “Now pull up and out” “And hold” “And pull, pull, and pull” Rhythmic Rotation (RR) Self-directed technique “Rolls your legs outward, toes away! Now turn your knees and feet inward. And roll outward again. And inward again.” “Now with toes pointed toward ceiling, spread your legs apart, as far as you can. Now roll out, all the way, and in again. And, relax. Spread your legs again. And roll out, and in, and relax.”

Repeated rotation of a segment at the point in the range where limitation is noted

Voluntary relaxation – isotonic contraction of range-limiting muscles occurs

To achieve relaxation of the range-limiting muscles Stimulation of rotation components

Imbalances of reflexes exists due to trauma of spinal cord Lack of flexibility of soft tissue structures

Acute orthopaedic conditions Recent postoperative conditions Circulatory conditions