Card Set Information
What is proprioceptive?
- having to do with any of the sensory receptors that give information on movement and position of the body
- golgi tendon
- senses- vision, touch, hear, smell
involves that nerves
What is the facilitaiton component of PNF?
- you assisting making the movement easier
What is the aim of PNF?
- promote functional movement through facilitation, inhibition, strengthening and relaxation of mm groups
What is the philosophy of PNF?
- positive approach- set up for success, achievable tasks
- highest functional level
: functional approach
- mobilise potential by intensive training
: active participation, motor learning, self training
- consider the total human being work in envt
- use of motor control and motor learning principles
: variability of ractivce/ repetition
- no pain thru movement
What are the characteristics of PNF?
- facilitation of spiral and diagonal movement patterns
- movements performed may be passive, active- assisted, or active depending on pt
- isotonic and isometric movements can be used
- sensroy stimulu is used
: stretch, traction and approximation (push jts together), maunal contacts, and appropriate verbal commands
- resistance- overflow/ irridation from strong to weak mm
- developmental sequence important- cephalocaudal and proximodistal
- goal directed activites used to hasten learning of functional patterns
What are the essential components of manual contacts of PNF?
- use pressure as a faciliating mechanism
- demonstrated by positioning of hands in holds use during patterns (and changes between reciprocal patterns)- lumbrical grip
- mirror pts direction of movement for effective facilitation
- in linewith the movementwhere possible
What are the essential components of PNF?
- a mm responds with greater force after stretch
- must be placed in lengthened position
- stretch reflex can be elicited by repeated stretch through range (can be used to initiate movement in pt who is weak or paralysed)
- quick stretch increases motor ability- better mm activity
- prolonged stretch decreases motor activity >15 sec
When is quick facilitory stretch contraindicated?
- jt hypermobility
What manual resistance should be part of PNF?
- movement performed against resistance of sufficient degree to demand maximal effort from pt (match the pts effort with your resistance) = strength
- defined as greatest amount of resistance that can be applied to isotonic contraction and still allow full range of movement to occur if working on mobility
- greatest amount of resistance for isometric hod to still allow hold to be sustained which is working on stability
- maximal resistancec can be dangerous
- watch for abnormal patterns UMNL
What is irradiation?
- think of kate sitting up the front
- resistance- overflow/ irradiation from strong to weak mm
- increase mm activity in agonist or inhibit in antagonists
- resistance to trunk flexion produces overflow- hip flexors and DF
- resistance to trunk ext produces over flow- hip and knee ext
- resistance to UL ext and adduction overflow - trunk flex
What are the two types of jt facilitation?
what is traction?
- separating jt surfaces
- directe toward jt receptors
- used were motion is one of pulling eg flexion
- facilitate motion and decrease pain
What is approximation?
- info thru jt receptors
- directed towards jt reeptors
- used where motion is one of pushin eg ext
may be used to gain postural holding response esp in mat work
- promotes stability and weight bearing
What should the timing of the movement be?
- speed should be function of the movement and pt
- sufficient trunk and prox jts control must be attained to be able to move successfully with distal jts
What are the patterns of movements for PNF?
- diagonal patterns (mm groups work together, mimics function)
- functional patterns - pt performs functional movements using facilitory or inhibitory techniques
Visual cues of PNF?
- pt watcheslimb movement
- corrects body position and alignment
Verbal input of PNF?
- clear concise commands
- focus on movement directions
- volme and intonation important
- pt needs to be involved
- volume of voice needs to be considered
Applications of PNF
- hands on body in direction of movement
- therapist body aligned wuth movement
- arm or leg elogated and given a quick stretch
- concise command at start of movement
- resistance graded for desired response
- normal timing reinforced during movement
What is the PNF checklist?
- pt and therapist position
- therpist body mechanics
- manual contacts
- desired movement
- verbal commands
What is the biomechnical checklist?
- number of weight bearing jts
- length of the lever arm
What are the diagonal movement patterns?
- D1 and D2
- patterns are named for proximal direction
- diagonals flex or ext
- middle joints may be flexed or extended
- straight arm/ leg patterns impact proximally
- when middle jts are flexed you get more emphasis distally
What are the cooperative function of mm?
- the spiral and diagonal patterns of facilitation provide for an optimal contraction of the major mm components
- they allow mm to contract from completely lengthened state
- each mm contributes three components of action as far as its location and structure will allow
- one pattern works the agoinst and antagonist
what are the types of mm contractions?
: active, voluntary shortening of the mm
: static hold against equal resistance
: active voluntary lengthening of mm
Appropraite commands for PNF?
- preparatory commands must be clear and concise
- tone of voice may influence quality of response
- instruction of action need to short, accurate and timed- push, pull, hold, relax, let go
What tone should you use when you want a maximal effort?
- strong, shrap commands
What tone do you use when you want your pt to do best efort?
- moderate tone
What tone do you use whenyou want to reassure ur pt?
- soft voice
WHat is the PNF belief of development?
- development is cephalocaudal and proximodistal
- use of positioning related to primitive reflexes to facilitate movement patterns
- goals are directed
- strengthening goals
- functional goals important
Technique of PNF
- passive active light resistance- need to ensure the right communication
Hold- relax active movement does?
- facilitates agonists
- - stretches/ relaxes/ inhibits antagonists
What is the contract relax technique?
- similar to hold relax but with rot
- rot is good for parkinsons disease
- usually rotationary
- for pt with decrease strength, coordination
What is the slow reversal
- concentric contractions of alternating mm groups
- can vary as slow reversal holds (hold at end of range each direction), agonist reversal (works 1 mm group concentric, then eccentric)
All patterns of PNF can be applied?
- diagonal patterns
- functional movements
What are the disadvantages of PNF?
- outdated theory- 1930s
insufficient use of time
- can teach pt to be helpless
What are the PNF techniques for the lower limb?
- D1 and D2 flexion
- D1 and D2 extension
- pelvic patterns
Perform a PNF LL D1 flexion?
- pt supine
- hip ext, abduction, internal rotation, knee extension, ankle PF, eversion
- end in flexion, adduction, ext rot, knee flexion, ankle PF, inversion
- eg to cross one leg over the other in sitting to eg take off shoe
Perform a PNF LL D1 extension?
- start in hip flexion/ adduction/ external rotation, knee flexion, ankle DF, eversion
- have pt on a diagonal and face out
- push your foot down and out
- end in hip ext/ abduction/ internal rot, knee extension and ankle plantar flexion and eversion
eg stance phase of gait and coming up to stand from a seat
Perform a PNF LL D2 flexion
- dog coking its leg
- start in hip ext/ adduction and ext rot, knee ext and PF/ inversion
- pullyour foot up and lift your leg out to the side
- end in hip flex/ abduction and internal rot, knee flexion, DF and inversion
Perform a PNF for lower extremity D2 extension?
- hip flexion/ abduction and internal rotation, knee in flexion and DF, eversion
- stepdown into my hand
- end in hip ext/adduction and ext rot, knee ext, PF and inversion
- eg soccer kicking in standing
- can put opp leg on a stool
Perform PNF anterior elevation of the pelvis
- arch of movement- rock over elvis
- lumbical grip over asis
- pull back for stretch
- pt- pull up
Perform a PNF of the pelvis with posterior depression
- hand on ischial tuberosity- rock
- use body
- push up
- pt pull back
SEE PAGE 86 in manual
What do you use for jt proprioception?
- traction and proximation
Perform upper extremity D1flexion
- start- shoulder ext/ slight abd/ medial rot, scap in anterior elevation, elbow ext, forearm pronation, wrist flex and ulnar deviation
- tell pt to squeeze my hand, turn your hand and pull acros your body
- end position- shoulder flex/ add/ lateral rot, scapposterior depression, forearm supination, wrist and fingers flexed and radial deviation
eg- reaching up to bring a scarf off the op shoulder.
Perform a D1 extension of the UL?
- start with shoulder flexion/ adduction/ lateral rot, scap posterior depression, elbow ext, forearm, wrist and finger flexed ad radial deviation
- have ur hand over the back
- tell pt to turn your hand down, push down and out to the side
- end with shoulder ext/ slight abduction/ medial rotation, scapular anterior elevation, elbow ext, forearm pronantion, fingers extended and radial deviation
- eg feeding movement
Perform a PNF on the upper extremity D2 flexion
start- shoulder ext/ add/ medial rot/ scap ant depression, elbow ext, forearm supination and wrist flex, ulnar deviation
- open ur hand, lift your thumb up and out and move arm up
end- shoulder flexion/ add/ lateral rot/scap posterior elevation, forearm promation, wrist ext, radial deviation and finger ext
- like throwing a bouquet over same shoulder
Perform a PNF upper extremmity D2 extension?
- start- shoulder flex/abd/ext rot, scap posterior elevation, elbow ext, forearm pronation, wrist ext/ radial deviation and finger ext
- squeeze my hand, turn your thumb down and forward to ur opp hip
- end- shoulder ext/add/ med rot, scap ant depression, forearm supination, wrist flex/ ulnar deviation and finger flex
- eg placing a sword into a sheath
Perform a PNF scapula D1 flexion
- anterior elevation
- pt sidelying- hips, knee 70-90 degrees
- head in neutral
- lumbricals grip- hands on each other
- stand behind pt
- get pt to pull up to ear
- you resist
- eg shrug ur shoulder towards your ear
Perform posterior depression aka D1 extenion of the scap
- pt sidelying
- hand on scappush up angle of scap
- pt push down against u
- think of putting your inferior angle of the right scap into the left hippocket
Perform D2 flexion of the scap- posterior depression
- along the line of humerus
- pt sidelying
- stand in line with diagonal
- hands on top of acromion
- pt push up
- lift fingers off- so palm just touched
Perform D2 extension ant depression of scap
- sidlying- hand around shoulders so on either side of axilla
- when pull down- you go up and over
- ensure you move your entire body
- good to use to assist getting up off bed