NDT, PNF, muscle tone

• proprioceptive neuromuscular faciliation
• Dorothy Voss
• Herman Kabat
• Margaret Knott

• approximation
• stretch reflexes
• resistance
• traction
• manual contacts
• *to faciliate mvmt

sensory receptors stimulated by some aspect muscle length, m tension, joint angle, head position, and or touch/temp

increase ease of performance of any action, resulting from the lessening of nerve resistance by continued, successive application of the necessary stimulus

hand placement on  the body/skin provides info about the mvmt you would like to perform

key points of control- instructions you are giving with hands

imperative the clinicians mvmt mirrors the pts

• utilized to facilitate m activity
• quick stretch -> strengthen

internal or external force that alters that alters the difficulty of moving

spread of m activity in response to resistance (overflow, carry over, reinforcement)

• traction - elongates
• approximation - compresses

can use with active mvmts or stabilization

normal mvmt requires smooth sequencing of m activation

PNF utilizes diagonal patterns of mvmt (mm work together syngergistically)

can help pt control and correct body position and motion

the command should be concise and provide a directional cue

• resistance
• approximation
• QS-quick stretch
• AI-alternating isometrics
• RS-rhythmic stabilization
• prolonged stretch
• vibration
• inhibitory pressure

• manually or mechanically
• increase feedback from the mm to joint receptors
• improves kinesthetic awareness and improves strength and stabilization

• compression
• facilitate extensor motor control and stability around the joint
• facilitates holding responses of postural mm
• contraindication- acute inflammatory condition
• low tone pts

• gentle push or force to a muscle in the lengthened range
• facilitates m contraction
• most effective when m is lengthened

isometric contractions are alternated from one side to another without relaxation between contractions

• simultaneous isometric contraction of the agonist and antagonist without relaxation between contractions
• rotation

• produces inhibition or dampens m response
• manual, mechanical, or through gravity and positioning
• lengthened range of m is most effective

• facilitory or inhibitory
• mechanical or manual
• sustained contraction is elicted

• inhibits m tone
• firm, moderate pressure is applied to tendon of the m you wish to reduce tension

• manual contact
• repetitive brushing
• prolonged icing
• maintained touch
• slow stroking
• neutral warmth
• vestibular stimulation (slow, fast, inverted head position)

• facilitate mvmt and direction, alter tone, provide security, support unstable body segment
• contraindicated in pts with arousal instability
• location, time, pressure is important

• stimulates tactile receptors to facilitate mvmt
• battery powered brush is used to stimulate skin surface of m

• inhibits postural tone and pain
• ice chips, iced towels, ice packs, cold baths
• for high toned pts

• desensitize hypersensitive areas
• for pts who overreact to stimulation
• firm, maintained pressure
• use the pressure that bothers them

• produces calming effect
• slow deep pressure
• high toned areas

• inhibitory technique to reduce postural tone and pain
• wrap in towels, blanket, snug clothing, tepid bath or shower

• increase or decrease tone and mvmt of the head, trunk , or extremities
• can aid in coordinated eye mvmt..may produce nystagmus, nausea, vomiting

• slow- for decreased tone, produces calming, soothing effect and inhibits postural tone
• fast- for increased tone, stimuli are irregular, rapid, and of high intensity..use swiss ball
• inverted head position- either tone, depression of sympathetic responses and arousal of the parasympathetic responses

• slow, repetitive, used when hypertonicity or abnormal development patterns are present
• decreased tone

• estim
• placing in reflex-inhibiting positions
• slow, sustained stretch
• prolonged application of ice, immersion of limb in ice bath
• facilitation of antagonists of spastic mm
• neutral warmth
• slow stroking
• gentle shaking or rocking
• slow rolling
• pressure on the insertion of the m

• soft tone of voice
• regular rhythms in speech
• reduction in environmental sounds

• warm fluids may be inhibitory to hyperactive oral pathology
• pleasant odors have calming effect

• cool colors, monotone color scheme
• removal of excess visual stimuli from the immediate environment

• decreased pulse rate, BP, and general reduction in excitiability
• slow stroking
• maintained pressure on palms, soles of feet or over lip

• timing of care giving routines and avoid overstimulating and loss of control
• space out activities
• give 15 min recovery periods
• prep for stressful events
• avoid interruptions in sleep cycle
• maintain calm environment
• establish predictable patterns with sleep and waking events

• prefer voice to mechanical sound
• prefer female to male voice
• perfer sounds within range of human voice
• particularly sensitive to rhythmic and continuous speed (singing, heartbeat)
• avoid slamming doors, loud talking over bed

• initially sees black and white colors (avoid cluttered crib)
• prefer contrasting lines and colors
• prefers complex vs simple shapes
• prefers human face to anything
• infant may not appear to have visual capabilites until at state 4 (quiet alert)
• can use toys visually to stimulate but dont use random toys
• infants between 32-38 weeks gestation place object 19-22 cm away
• reduce light by shielding eyes, placing blanket over crib, or dim light

smell, taste, internal stimuli

sensitive to light

sensitive to stimulation by heat

excited by mechanical pressures or distortions (touch, ms contractions)

for pain caused by injury, physical, or chemical to body tissues

sensitive to stimuli originating at a distance, such as a nerve ending existing in the ear, nose, or eye

• from the spinal cord to the brain
• posterior columns
• spinothalamic tracts

• fine touch
• stereognosis (perceiving and understanding the form and nature of objects by touch - close eyes, grab object, and feel/tell what it is)
• weight discrimination
• proprioception
• vibration sense

• lateral - pain and temp
• ventral - crude touch/pressure