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2015-03-28 00:55:15
PNF IPA - principles and basics
Show Answers:

  1. What are the 9 principles of PNF?
    • Pt position
    • PT body position and mechanics
    • manual contact
    • elongation, spring test, stretch stimulus (quick stretch)
    • appropriate resistance
    • verbal command
    • visual stimulus
    • pattern (with traction or approximation)
    • facilitation of timing (timing for
    • core first strategies)
  2. Why are the 9 principles of PNF important?
    To enhance accurate assessment and treatment of a MNM dysfunction.

    To facilitate and execute patterns most effectively
  3. What are the learning sequences to assess for each activity

    Learning sequence to assess for each
    Assumption of the position

    Stabilization of the stabilization

    Movement within the position over a fixed distal base of support


    • Example:
    •             Lying supine and bending each leg up appropriately to hooklying position
    •             Stabilizing in the hooklying position against resistance on the legs/arms
    •             Lifting up and down into a bridge
    •             Scooting in bed laterally for bed mobility.
  4. How many pattern are there for each scapula and pelvis? What are they?
    • Anterior Elevation
    • Anterior Depression
    • Posterior Elevation
    • Posterior Depression
  5. What are the 2 diagonal movements of the scapula and pelvis?
    • Anterior Elevation/ Posterior Depression
    • Anterior Depression/ Posterior Elevation
  6. What are the 3 diagonal trunk patterns?
    • Mass flexion
    • Mass elongation           
    • Reciprocal Shoulder/Pelvic Girdle
  7. What are the 8 PNF techniques?
    • Rhythmic Initiation
    • Isotonic Reversal
    • Stabilizing Reversals/Isometric reversals      Repeated Quick Stretch
    • Combination of Isotonics           
    • Irradiation          
    • Contract Relax           
    • Hold Relax           
    • Timing for Emphasis
  8. What is the primary dysfunction treated in rhythmic initiation?
    motor control dysfunction, relating to:

    • Speed
    • Direction
    • Quality of motion
  9. What must the patient already be able to do before utilizing rhythmic initiation?
    They can initiate core response. 

    The motor control issue addressed, is that the TIMING of initiation is off.
  10. What kind of directional intervention is rhythmic initiation?
    uni- directional
  11. What technique is always utilized when there is reversal of direction during rhythmic initiation?
    quick stretch - during all three phases.
  12. What are the 3 phases of rhythmic initiation?
    PROM (Guide) = "relax, let me move you" (still use traction)

    AAROM (Assist) = "Now you help me a little" (still use traction)

    AROM (Resist) = " Now help me a little more" (still use traction)

    (Repeat the top 3 phases)
  13. What other technique can be combined nicely following rhythmic initiation?
    isotonic reversals
  14. What 2 techniques are under the umbrella of reversals of antagonists? 

    What is the significance of reversals of antagonists?
    • Isotonic reversals
    • Stabilizing reversals/isometric reversals

    Most activities require coordinated reciprocal contractions of antagonistic muscle groups for mobility and stability
  15. What is the goal of reversals of antagonists?
    Facilitate coordinated reciprocal contraction for mobility and stability (Hence two reversal techniques - one for stability and one for mobility)
  16. What are the primary dysfunctions treated with isotonic reversals?
    neuromuscular and motor control
  17. What are the goals of isotonic reversals?
    • 1. smooth reversal of direction (MC)
    • 2. facilitate contraction of antagonist (NM)
    • 3. increase endurance/relieve fatigue (NM)
    • 4. improve coordination (MC)
  18. What kind of directional intervention is isotonic reversals?
  19. How can isotonic reversals be made most effective?
    • 1. Speed and ROM specific to pt's needs. 
    • 2. contractions must NOT cease. 
    • 3. No conflicting manual input
    • 4. Apply greater resistance to antagonists that are more strong, which will facilitate a stronger contraction from weaker antagonist

    5. If increasing strength is goal, apply increasing resistance to each reversal
  20. What is isotonic reversals also known as (via Adler)
    Dynamic reversals
  21. What should happen at the transition period during reversal of direction in isotonic reversals?
    Application of stretch stimulus at the fully lengthened ROM, to facilitate reversals

    maintained isotonic OR isometric contractions at point of transition
  22. What are isometric reversals also known as?
    Rhythmic stabilization

    Isometric reversals
  23. What kind of contractions can be used for isometric reversals?

  24. What is isometric reversals
    Alternating contractions of either isometric or MI
  25. What are the goals of isometric reversals?
    • 1. enhance stabilizing contraction (NM)
    • 2. improve control of posture and balance (MC)
    • 3. develop appropriate strength and stretch sensitivity of extensor muscles in their shortened ROM (NM)

    • 4. relaxation
    • 5. pain reduction
    • 6. increase ROM
  26. What are the components of technique when executing isometric reversals?
    1. gradually increase resistance by changing verbal command from iso to MI

    2. shift manual contact (can't allow relaxation between transition)

    3. add 3D component to appropriate resistance! (rotatory AND diagonal)

    4. approximation (good for stimulating stability in WB postures)
  27. What are the goals of using repeated quick stretch?
    1. increase strength and endurance of a pre-existing contraction (NM)

    2. initiate muscular response (NM)

    3. training coordinated movement and proper timing (MC)

    4. increase awareness of motion (MC)

    5. initiate motion (NM)

    6. stimulating muscles not under volitional control (NM)

    In a nut shell.....

    • Direction
    • ROM
    • Endurance
    • Coordination
  28. How is repeated quick stretch applied?
    Repeated initiation of a pattern from LENGTHENED ROM

    always followed by appropriate resistance
  29. By whom and when was combination of isotonics developed?
    Saliba Johnson, 1979
  30. What are the type of contractions used during COI
    • Isometric
    • Maintained isotonic
    • Concentric
    • Eccentric
  31. What are the goals of COI?
    1. efficient transition and timing of contraction between the 4 contractions

    2. increase awareness of specific position or contraction.

    3. treat NM and MC dysfunctions

    4. increase ROM

    5. stability at end ROM
  32. How should combination of isotonics always end in treatment?
    End with prolonged holds and COI at new end ROM
  33. What are the clinical applications of COI?
    1. NMR/motor control training

    (iso-> MI->ecc->concentric to desired ROM)

    2. increase ROM/promote efficient end feel

    (take to end ROM -> spring test -> identify hard end feel and appropriate pattern -> proceed)
  34. How do you treat a hard end feel using COI?
    • 1. segment at end ROM
    • 2. spring test
    • 3. identify pattern of hard end feel
    • 4. re-set segment at mid ROM, loose pack position
    • 5. iso-> MI
    • 6. ecc-> MI (MI when contraction weakens)
    • 7. con back to strong part of ROM
    • 8. MI -> ecc ->repeat to new ROM
  35. How do you treat a boggy end feel using COI?
    Same steps as treating hard end feel, except folding into new ROM using concentric contractions (not eccentric)
  36. Define prolonged holds
    The use of maintained resistance to facilitate an overflow or irradiation to another body part
  37. Define phasic shakes

    Who and when came up with it?
    Irradiation from phasic -> tonic muscles, by using prolonged hold + MI

    Johnson, 1989
  38. Define tonic spread. 

    Who and when came up with it?
    Irradiation from tonic -> local tonic muscles, by using prolonged hold + iso

    resistance used is low and slow

    lots of traction

    Saliba, 2009
  39. What is the significance of tonic spread as it relates to CFS/motor control strategies?
    Tonic spread allows magnetic click that facilitates appropriate motor control strategy
  40. What are the components of an appropriate motor control strategy, and what PNF technique can facilitate it?
    Magnetic click between local tonic/global muscles initiating strength and control.
  41. Define temporal and spatial summation.
    temporal summation = overlapping stimulus from 1 source creates threshold contraction in target muscle

    spatial summation = overlapping stimulus from MULTIPLE sources create threshold contraction in target muscle
  42. What is irradiation?
    spreading of muscular response from Source segment (pattern/body segment with good NM function) to Target segment (pattern/body segment with bad NM function) by altering emphasis of resistance

    Can be used to facilitate:

    • Phasic shakes
    • Tonic spread
  43. What are possible combinations which can facilitate irradiation?
    • ipsilateral
    • contralateral
    • trunk to extremities
    • extremities to trunk
  44. The SPECIFICITY of response from pt during PNF application always depends on:
    precise application of ALL PNF principles
  45. What are the goals of contract relax?
    increase ROM

    facilitate relaxation
  46. How are agonist and antagonist contractions utilized in contract relax?
    At end ROM, resistance isgiven to concentric contractions to either:

    • 1. agonist (direct relaxation)
    • 2. antagonist (reciprocal relaxation)
  47. How is the contract relax technique carried out?
    1. resistance to concentric contraction to either antagonist or agonist

    2. total relaxation

    3. PROM or AROM into new ROM (AROM can be resisted for strengthening,reciprocal inhibition, motor training)
  48. How is the 
    hold relax different and similar to contract relax?
    goals are the same:increase ROM and facilitate relaxation. hold relax is indicated when:

    1. patient is in pain

    2. pt is overpowering with contract relaxHold relax utilizes isometric rather than concentric contraction.
  49. How
    can hold relax technique be specifically applied to a painful patient?
    If pain reduction is goal,carry out isometric contraction in non-painful ROM
  50. Define
    timing for emphasis
    Altering the timing of thepresent neuromuscular response, in order to use a strong element to facilitateresponse of weaker elements. 

    Principles used: irradiation and ability to treat segments indirectlyoften combined with COI.
  51. What
    is the assessment and treatment sequence for PNF diagonals?
  52. What
    are the functional tests and techniques used to assess and direct
    intervention of NM and MC dysfunctions?
    1. tension (tone) at rest -ability to allow passive movement

    2. quality of initiation - controlled, quick, sluggish, delayed

    3. Quality of concentric contraction - smooth and coordinated, jerky, weak,fluctuating strength, ability of reinforcement 

    4. control of direction - achievement of motor planning

    5. ability to switch between 4 different COI contractions

    6. ability to stabilize in shortened ROM - especially one joint extensors

    7. quality of power and control of power

    8. ability to reverse direction - isotonic reversals

    9. ability to quickly adjust

    10. balance and balance reactions
  53. What
    are the functional tests and techniques used to assess and direct
    intervention of mechanical dysfunctions?
    11. passive mobility - softtissue and articular considerations

    12. ability for joint and soft tissue to move through full ROM
  54. What
    are the functional tests and techniques used to assess and direct
    intervention of MC dysfunctions?
    13. Ability to perform atvarying speeds

    14. awareness of position in space

    15. relaxation of antagonistic muscles

    16. ability to breath during contractions

    17. ability for patient to visualize motion
  55. What
    are the functional tests and techniques used to assess and direct
    intervention of NM dysfunctions?
    18. Quality of endurance

    19. Quality of irradiation and reinforcement
  56. What
    are the functional tests and techniques used to assess and direct
    intervention of M, NM and MC dysfunctions?
    20.Can movement cross midline?

    21.Is patient able to control power and do fine motor activities?
  57. What are the primary muscles responsible for pelvic AE?
    Internal Oblique

    External Oblique
  58. What are the primary muscles responsible for pelvic PD?
    contralateral internal oblique

    contralateral external oblique
  59. What are the primary muscles responsible for pelvic PE?
    Ipsilateral QL

    Ipsilateral Lats

    Ipsilateral longissimus thoracis

    Ipsilateral Iliocostalis lumborum
  60. What are the primary muscles responsible for pelvic AD?
    Contralateral QL

    Contralateral iliocostalis lumborum

    Contralateral longissimus thoracis
  61. What are the primary muscles responsible for scapular AE?
    Levator scapulae


    Serratus Anterior
  62. What are the primary muscles responsible for scapular PD?
    serratus anterior (power)


    latissimus dorsi
  63. What are the primary muscles responsible for scapular PE?

    levator scapulae
  64. What are the primary muscles responsible for scapular AD?

    serratus anterior

    pectoralis minor and major
  65. Which joints compose the lower extremity patterns?
    Hip and Ankle complex tied in synergy

    Knee free to move into flex/ext/stay still
  66. What are the two flexion LE patterns?
    1. flex/add/ER (hip), DF/sup/invert/toe ext (ankle)

    2. flex/abd/IR (hip), DF/pro/evert/toe ext (ankle)
  67. What are the two extension LE patterns?
    1. ext/add/ER (hip), PF/sup/invert/toe flex (ankle)

    2. ext/abd/IR (hip), PF/pro/evert/toe flex (ankle)
  68. What are the joint components for UE patterns?
    shoulder and wrist are in synergy

    elbow can flex/ext/motionless
  69. What are the flexion UE patterns?
    flex/add/ER (shoulder), sup/RD/wrist and finger flex/finger add (wrist)

    flex/abd/ER (shoulder), sup/RD/wrist and finger ext/finger abd (wrist)
  70. what are the extension UE patterns?
    ext/add/IR (shoulder), UD/pro/wrist and finger flex/finger add (wrist)

    ext/abd/IR (shoulder), UD/pro/wrist and finger ext/finger abd (wrist)
  71. What is the UE pattern for scapular AE?
  72. What is the UE pattern for scapular PD?
  73. What is the UE pattern for scapular PE?
  74. What is the UE pattern for scapular AD?
  75. What is the LE pattern for pelvic PD?
  76. What is the LE pattern for pelvic AE?
  77. What is the LE pattern for pelvic PE?
    hip flex/abd/IR
  78. What is the LE pattern for pelvic AD?