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PNF

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chandlerrice's version from 2016-12-13 18:10

PNF (general)

Question Answer
What is therapeutic exercise?It is carefully graded stresses and forces applied to the body systems in a controlled, progressive, and appropriately planned manner to improve the overall function of an individual to meet the demands of daily living.
What are some of the goals of PNF?Force production, Endurance - muscular & cardiovascular/pulmonary, Mobility & flexibility, Stability, Relaxation, Coordination, Timing, Sequencing, Gradation & fractionation of contractions, Versatility within & between contractions & contraction types, Balance control, Functional skills
What are some of the proprioceptive receptors stimulated in PNF?sensory (both exteroceptors & interoceptors), muscle spindles, GTOs, joint receptors, joint connective tissue, skin receptors, visual, auditory, vestibular systems.
What is the neuromuscular portion of PNF?repeated activation of pathways to increase power, endurance, coordination and the ability to repeat the motion with less effort & concentration.
What is PNF?proprioceptive neuromuscular fascilitation. Used to promote or hasten the response of neuromuscular mechanism through stimulation of proprioceptors.
What is the difference between isotonic & isometric contractions?isotonic is a contraction where the intention of the contraction is movement (concentric/eccentric). Isometric is a contraction in which there is minimal to no joint motion
What are the 8 responses to resistance?initiation of movement, ROM, muscle strength, muscle & postural stability, endurance, relaxation, coordination, timing sequencing & recruitment of responses.
What is overflow?the spreading of muscular responses from one muscle or group of muscles to another. Overflow from stronger synergistic segments may enhance the motor unit activation of the involved or weaker segment to promote strengthening.
What are the 4 ways overflow may work?1). Ipsilateral 2). Contralateral 3). From extremities to the trunk 4). Trunk to extremities
What are some forms of resistance?patient’s body weight, gravity, manual resistance, and/or any external device.
What is the general response to approximation?It may facilitate muscular stability around a joint through co-contractions
What is the general response to traction?distraction, separation, or elongation of the limb to enhance motion through the range. (applied away from the direction of the desired motion) Can also be applied slowly to relieve painful joints.
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Quick Stretch

Question Answer
What is a quick stretch?it is a stretch applied by elongating a muscle group to the lengthened or slightly taut range and then quickly, but gently providing a subtle elongation or stretch further into the direction of the pattern.
What is quick stretch used for?1). Facilitate initiation of movement 2). Increase strength of a muscle contraction 3). Increase endurance by decreasing muscle fatigue and decreasing the effort needed to produce movement (facilitation via the stretch reflex). 4). Influence the direction of the movement.
What are common mistakes with doing a quick stretch?1. Stretching through too great a range, 2. Stretching too far at the end of the range, 3. Failure to time the stretch with the ability to follow it with appropriate resistance, 4. Failure to time the stretch with appropriate verbal commands
What is a contraindication for quick stretch?PAIN
What is a precaution of doing quick stretch?hyperactive stretch reflex not under volitional control
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Verbal/Visual Stimuli

Question Answer
What are the “musts” of verbal stimuli?Your verbal commands must be simple, concise, audible, and specific to the contraction desired as the quality of the verbal command significantly influences the patient's response.
How might verbal commands be used?A. Coordinate volitional effort with the facilitated response B. Define the type of muscular contraction desired C. Define the direction of the movement D. Signal timing of the relaxation of a contraction E. Signal timing of changes in direction of the movement F. Signal changes in effort and magnitude of contraction G. Stimulate increased patient arousal and responsiveness H. Facilitate generalized relaxation.
How does visual stimulation assist in PNF?A. Initial learning of activities B. Attention of the individual C. Identifying direction of movement D. Identifying position in space E. Directing motion of the head, trunk and extremities across midline and on the same side; incorporating head/ neck into the functional movement pattern
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Stages of motor control

Question Answer
What are the stages of motor control from least to greatest difficulty?Mobility, Stability, Controlled Mobility, Static-Dynamic, Skill
What are “parameters” in PNF?The duration, intensity, and frequency which are varied to achieve appropriate physiologic stress, tissue healing, & relief of pain.
How is the mobility stage defined?As the ability to initiate and sustain active movement through a ROM. May be limited by strength or tissue tightness.
What are the prerequisites for mobility?achieving ROM & initiation of movement.
How is stability defined?The ability to maintain a posture or position.
What is muscle (tonic) holding?the ability of tonic postural muscles to maintain a contraction in the shortened position.
What is co-contraction?(maintaining postures) a coordinated simultaneous contraction of the muscles surrounding a joint while maintaining a posture…stabilization of proximal musculature to maintain or support distal structures.
What is controlled mobility?It is the development of proximal dynamic stability by weight shifting or movement in weight bearing postures.
What does controlled mobility develop?equilibrium, proprioceptive reactions, postural control, strength through the available ROM, and proximal dynamic stability
What is the static dynamic phase?it is the transitional stage between controlled mobility & skill where a previously weight bearing limb, as in controlled mobility, is now lifted from the supporting surface. (usually starting w/ stronger limb providing initial support)
What is the skill phase?a phase of functional tasks while seeking economy of effort & normal timing. (UE is usually open-chain activities, while LE is a combination of open & closed chain)
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PNF activities

Question Answer
What are the biomechanical considerations for PNF?BoS, CoG, # of joints involved, length of lever arm, weight bearing through a joint causing approximation
What tonal considerations are there?if phasic reflexes such as a stretch reflex used to facilitate movement in presence of weakness or difficulty initiating movement, or if tonic reflexes need to be reduced through different postures
What neurophysiologic considerations are there in PNF?resistance(manual, mechanical, or gravitational, and the direction angle of resistance), overflow, ROM, approximation/traction, cutaneous & pressure input (placement)
How does overflow assist in PNF?Overflow facilitates as increased effort (usually in synergistic muscles) alters the excitatory threshold level at the anterior horn cell.
What are the 4 postural progressions in PNFSupine progression, prone progression, lower trunk progression, upright progression
What are the positions in the supine progression?supine, sidelying, rolling
What are the positions in the prone progression?pivot prone, prone on elbows, prone on hands, quadruped
What are the positions in the lower trunk progression?hooklying, bridging, kneeling, half kneeling
What are the positions in the upright progression?sitting, modified plantigrade, standing
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Extremity patterns

Question Answer
In the UE, is ER associated w/ flexion or extension?flexion
In the UE, is IR associated w/ flexion or extension?Extension
In the LE, is ER associated w/ Adduction or Abduction?Adduction
In the LE, is IR associated w/ Adduction or Abduction?Abduction
What is normal timing?when movement starts from distal to proximal through their full range.
How are the patterns of the extremities named?based on the motion occurring at the proximal joints or pivots of action (shoulder/hip)
What are the 5 areas of motion in UE patterns?scapula, shoulder, forearm, wrist, fingers
Name actions of UE D1F1. Scapula..ant. elevation 2. shoulder…flexion, adduction, & ext rotation. 3. Forearm…supination. 4. Wrist…flexion, ulnar deviation. 5. Finger…flexion to ulnar side w/ thumb add.
Name actions of UE D1E1. Scapula..post. depression 2. shoulder…ext, abd, & IR 3. Forearm…pronation. 4. Wrist…extension, radial deviation. 5. Finger…extension to radial side w/ thumb abd.
Name actions of UE D2F1. Scapula… post. elevation 2. shoulder…flex, abd & ER 3. Forearm…supination. 4. Wrist…extension, radial deviation. 5. Finger…extension to radial side w/ thumb abd.
Name actions of UE D2E1. Scapula..ant. depression 2. shoulder…extension, adduction, & int rotation. 3. Forearm…pronation. 4. Wrist…flexion, ulnar deviation. 5. Finger…flexion to ulnar side w/ thumb opp.
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Terminology

Question Answer
What are the terms that signify direction?flexion, extension, bilateral, reciprocal
What are the terms that signify pattern?D1/D2, symmetrical, asymmetrical
What does BS mean?Bilateral Symmetrical….same direction, same pattern
What does BA mean?bilateral asymmetrical….same direction, opposite pattern
What does BR mean?reciprocal symmetrical…opposite direction, same pattern
What does RA mean?reciprocal asymmetrical…opposite direction, opposite pattern
What does ATE stand for?Activity, Technique, Element(parameter)
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Abbreviations

Question Answer
HRhold relax
RSrhythmic stabilization
CRcontract relax
RRrhythmic rotation
RIrhythmic initiation
RCrepeated contractions
REPLreplication
HRAMhold relax active movement
SHRCshortened held resisted contractions
AIalternating isometrics
SRslow reversal
SRHslow reversal hold
ARagonistic reversals
RPresisted progression
RCrepeated contractions
TEtiming for emphasis
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Techniques

Question Answer
What are the 2 main categories in mobility?ROM & initiation
What are the 4 techniques used in ROM?HR, CR, RS, RR
What are the 4 techniques used in initiation?RI, RC, REPL, HRAM
What are the 2 main categories in Stability?non WB tonic mm holding and WB’ing postural stability co-contraction
What technique is used for non WB tonic mm holding?SHRC?
What 2 techniques are used for WB’ing postural stability co-contraction?AI & RS
What is the category for controlled mobility?WB’ing/Wt shifting
What 3 techniques are used in WB’ing/Wt shifting?SR, SRH, AR
What are the 6 techniques that could be used in the Skill phase?RP, RC, TE, SR, SRH, AR
What are the 6 techniques that could be used to increase strength/endurance?SR, SRH, AR, TE, RC, RP
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Techniques

Question Answer
When is HR used?for ROM. Effective when pain accompanies or limits motion and when there is tightness on one side of a joint
How is HR applied?isometric contraction of ANTAGONIST for 5-8 seconds. Then relax and apply tracking resistance into new range toward agonist (autogenic inhibition)
When is CR used?to increase ROM when there is NO pain (contraindication is pain)
How is CR applied?patient actively moves to end or ROM and then isometrically contracts the ANTAGONISTS. After a hold the patient quickly turns the limb followed by an abrupt relaxation and actively moving into the new range of motion.
What is AC?Agonist Contraction. Similar to HR, but with the agonist instead of antagonist. (effective when pain and muscle guarding cause the limitation)
What is RI?4 steps…move pt passively, active assist, active, resist
What are contraindications for RC?joint instability, pain, damaged muscle/tendon, fracture
What is REPL?it is replication. Used for teaching new movement patterns. Body moves unidirectionaly through increasing increments of range
What is HRAM?hold relax active movement. Used when movement in a direction can’t be initiated due to weakness or difficulty.
How is HRAM applied?(example sidelying holding in mass flexion. Pt relaxes at the same time the PT quickly moves to the fully lengthened position and the pt contracts to resume the held position)…isometric hold in shortened mm, abrupt relaxation w/ immediate full stretch followed by immediate resumption of the contraction. (building gamma bias)
What is SHRC?“superman”
What is AI used for?co-contraction, postural stability
What is AR?agonistic reversals…combination of isotonics…concentric, isometric, eccentric (like the pelvic planking)
What is RP?resisted progression, applied during locomotion, especially gait to facilitate & reinforce the sequencing of proximal components… hands on superior anterior iliac crest
What is TE?timing for emphasis. An isometric hold is elicited of the stronger components of a pattern while a concentric contraction of the weaker components (often accompanied w/ a quick stretch or RC) is completed. Then continue through range of the pattern
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