PNF%20techniques.pptx

PNF techniques in details

1. PNF techniques Presented to : Dr. Binash Afzal

2. Proprioception Neuromuscular Facilitation Developed by “Herman Kabat ” Proprioceptive Neuromuscular Facilitation (PNF) is a set of stretching techniques commonly used in clinical environments to enhance both active and passive range of motion in order to improve motor performance and aid rehabilitation.  PNF helps to restore normal movement by focusing on the developing sequence of movement and how the agonist and antagonist muscles work together to produce volitional movement. PNF uses reflexive movement as a basis for learning more volitional movement. The idea is that one must be able to roll before he can crawl and crawl before he walks It relies mainly on stimulation of proprioceptors for increasing the demand made on neuromuscular mechanism to obtain and facilitate its response.c

3. Theoretical Mechanisms Four theoretical physiological mechanisms for increasing ROM were identified autogenic inhibition Autogenic Inhibition is what occurs in a contracted or stretched muscle in the form of a decrease in the excitability because of inhibitory signals sent from the GTOs of the same muscle  reciprocal inhibition Reciprocal inhibition is what occurs in the TM when the opposing muscle is contracted voluntarily in the form of decreased neural activity in the TM .

4. Basic Principles

5. Resistance • Tracking or Light Resistance applied to weak muscles is facilitatory and is usually applied in combination with light stretch. • Maximal Resistance (the greatest amount of resistance tolerated by the patient) is used to generate maximal effort and adjusted to ensure smooth, coordinated movement; maximal resistance varies according to the individual patient

6. Irradiation Irradiation is defined as the overflow of excitation from stronger components to weaker or inhibited components. This is accomplished through the application of graded resistance to stronger components to facilitate irradiation and produce an appropriate and enhanced contraction in weaker ones Example: In patients where more trunk or neck facilitation is desired maximal resistance is given to the shoulder girdle to facilitate appropriate irradiation Indications: Enhance synergistic actions of muscles, increase strength

7. Manual contact

8. Manual contact

9. Commands for voluntary movement are always synchronized with stretch to enhance the response • Repeated stretch can be applied throughout the range to reinforce contraction in weak muscles that are fading out. Indications : Enhance strength of muscle contraction and synergistic patterns of movement STRETCH

10. Approximation Approximation (compressing the joint surfaces) is used to facilitate extensor/stabilizing muscle contraction and stability. It facilitates an increased muscular response and promotes stability, and is often used when facilitating stability in weight bearing postures or positions Indications : Weakness, inability of extensor muscle to function in weight bearing for stabilization control Example. Use of approximation can be used to retrain postural awareness in sitting by facilitating a more stable and improved response of the trunk musculature and improve trunk stability

11. Traction Indications : Weakness, inability of flexor muscles to function in mobilizing or antigravity patterns Example. Use of general traction when treating a patient with an acute cervical spine can assist the patient in his/her ability to perform controlled contractions without pain.

12. Verbal commands The therapist's verbal command is a primary link between reflex responses and the patient's volitional response. Verbal commands allow for the use of well-timed words and appropriate vocal volume to direct the patient’s movements • Preparatory commands • Action commands • Corrective commands

13. Timings

14. Body positions and body mechanics Indications: Enhance therapist’s control of the patient’s movements; reduce therapist fatigue through effective use of body weight and position.

15. Techniques of PNF

16. Repeated contractions

17. Reversal of Antagonists: A group of techniques that allow for agonist contraction followed by antagonist contraction without pause or relaxation Dynamic Reversals (Slow Reversals): Utilizes isotonic contractions of first agonists, then antagonists performed against resistance. Contraction of stronger pattern is selected first with progression to the weaker pattern. The limb is moved through full ROM. Indications : Impaired strength and coordination between agonist and antagonist, limitations in ROM, fatigue

18. Slow reversal

19. Stabilizing Reversals: Utilizes alternating isotonic contractions of first agonists, then antagonists against resistance, allowing only very limited ROM. Indications : Impaired strength, stability and balance, coordination Rhythmic Stabilization (RS): Utilizes alternating isometric contractions of first agonists, then antagonists against resistance; no motion is allowed. Indications : Impaired strength and coordination, limitations in ROM; impaired stabilization control and balance

20. Rythmic initiation Purpose. RI is used to evaluate and treat the patient's ability: • to allow passive motion, • to actively contract in a smooth, rhythmical fashion • to perform movement at a consistent rhythm against resistance. Indications. RI is utilized for the treatment of dysfunctions which affect the initiation, speed, direction, or quality of the contraction. Inability to relax, hypertonicity (spasticity, rigidity); difficulty initiating movement; motor planning deficits (apraxia or dyspraxia); motor learning deficits; communication deficits (aphasia)

21. Combination of Isotonics (Agonist Reversals, AR) Resisted concentric, contraction of agonist muscles moving through the range is followed by a stabilizing contraction (holding in the position) and then eccentric, lengthening contraction, moving slowing back to the start position; there is no relaxation between the types of contractions. Typically used in antigravity activities/assumption of postures (i.e., bridging, sit-to stand transitions). Indications : Weak postural muscles, inability to eccentrically control body weight during movement transitions, poor dynamic postural control.

22. Resisted Progression (RP): Stretch, approximation, and tracking resistance is applied manually to facilitate pelvic motion and progression during locomotion; the level of resistance is light so as to not disrupt the patient’s momentum, coordination, and velocity RP can also be applied using elastic band resistance. Indications : Impaired timing and control of lower trunk/ pelvic segments during locomotion, impaired endurance

23. Rhythmic Rotation ( RRo ) Relaxation is achieved with slow, repeated rotation of a limb at a point where limitation is noticed. As muscles relax the limb is slowly and gently moved into the range. As a new tension is felt, RRo is repeated. The patient can use active movements (voluntary effort) for RRo or the therapist can perform RRo passively. Voluntary relaxation when possible is important. Indications : Relaxation of excess tension in muscles (hypertonia) combined with PROM of the range-limiting muscles

24. Stretching techniques

25. Contract relax The contraction is held for 5 to 8 seconds and is then followed by voluntary relaxation and movement into the new range of the agonist pattern.

26. Hold relax Strong isometric contraction of the restricting muscles (antagonists) is resisted, followed by voluntary relaxation, and passive movement into the newly gained range of the agonist pattern.

27. PNF patterns

28. Upper extremity

29. Patterns

30. Lower extremity