PNF Approach and Techniques!!!!!!! .pptx

PNF is an approach to therapeutic exercise that combines functionally based diagonal patterns of movement with techniques of neuromuscular facilitation to evoke motor responses and improve neuromuscular control and function
PNF techniques can be muscular strength and endurance; to facilitate stability, mobility, neuromuscular control, and coordinated movements; and to lay a foundation for the restoration of function

1. Dr. Quazi Ibtesaam Huma MPT Neurosciences Assistant Professor Proprioceptive Neuromuscular Facilitation

2. DEFINITION P roprioceptive: having to do with any of the sensory receptors that give information concerning movement and position of the body N euromuscular: involving the nerves and muscles F acilitation: making easier

3. DEFINITION PNF is an approach to therapeutic exercise that combines functionally based diagonal patterns of movement with techniques of neuromuscular facilitation to evoke motor responses and improve neuromuscular control and function PNF techniques can be muscular strength and endurance; to facilitate stability, mobility, neuromuscular control, and coordinated movements; and to lay a foundation for the restoration of function

4. Definitions of PNF: Therefore, PNF can be defined as, methods of promoting or hastening the response of the neuromuscular mechanism through stimulation of the proprioceptors. Principles : Patient must be taught the pattern. Have the patient watch the moving limb moved passively. The patient must give proper verbal command. Manual contact with appropriate pressure is very important.

5. PNF MAIN FEATURES (Hallmarks) -- - these are the patterns needed during functional activities The application of Proprioceptive Cutaneous Auditory stimuli Stronger muscle group of a diagonal pattern will

6. Physiology PNF exercises are based on the stretch reflex which is caused by stimulation of the Golgi tendon and muscle spindles. This stimulation results in impulses being sent to the brain, which leads to the contraction and relaxation of muscles. -When a body part is injured, there is a delay in the stimulation of the muscle spindles and Golgi tendons resulting in weakness of the muscle. PNF exercises help to re-educate the motor units which are lost due to the injury

7. • : Neurorehabilitation Musculoskeletal conditions

8. – – – PNF can be used in active and passive ROM, and to improve flexibility PNF techniques are useful through the : / isometric techniques / high speed diagonal movement performed against maximum resistance

9. The method of PNF: Greatest emphasis was placed on the application of maximal resistance throughout the range of motion using many combinations of motions, which allowed for two component actions at two or more joints.

10. BASIC PROCEDURES Resistance Irradiation and reinforcement Manual contact Body positioning and body mechanics Verbal commands Visual cues Traction and approximation Stretch Timing Patterns

11. RESISTANCE The amount of resistance provided during an activity must be correct for the patient’s condition and the goal of the activity. This is called optimal resistance. Resistance is used in the treatment to: Facilitate the ability of the muscle to contract Increase motor control Help the patient gain an awareness of motion and its direction Increase strength

12. IRRADIATION & REINFORCEMENT Irradiation : the spread of response to stimulation Reinforcement : means “to strengthen, make stronger”

13. IRRADIATION & REINFORCEMENT Increasing the amount of resistance will increase the amount and extent of the muscular response. Examples: Resist muscle activity of the sound limb to produce contraction of the muscles in the immobilized contralateral limb. Resist supination of the forearm to facilitate contraction of the external rotators of that shoulder

14. MANUAL CONTACT This refers to how and where the therapist’s hands are placed on the patient. Effects: Stimulates the muscle’s extroceptores Stimulates the synergistic muscle to reinforce the movement

15. BODY POSTION & BODY MECHANICS The therapist body should be in line of motion Shoulder and pelvis face the direction of motion. Therapist stands in walk standing position. The resistance comes from the therapist’s body weight, while the hands and arms stay comparatively relaxed .

16. VERBAL STIMULATION (COMMANDS ) Tells the patient what to do and when to do Instructions need to be clear and concise without the use of unnecessary words. May be combined with passive movement to teach the patient the desired motion The timing of the command is very important The volume with which the command is given affects the strength of resulting muscle contraction. Louder command when strong muscle contraction is required. Softer and calmer tone when the goal is relaxation and relief of pain.

17. VISUAL CUES The feedback from visual sensory system can promote a more powerful muscle contraction Helps the patient to control and correct his position and motion Moving the eyes will influence both the head and body motion Eye contact between patient and therapist provides a mode of communication

18. TRACTION & APPROXIMATION The therapeutic effects of traction and approximation is due to stimulation of joint receptors. Traction is applied when the movement is occurring against the gravity Approximation is applied when the movement occurs in the direction of gravitational pull

19. APPROXIMATION Compression through a joint stimulate receptors joint Facilitate stability The approximation is always maintained, whether done quickly or slowly When the therapist feels that the active muscle contraction decreases the approximation is repeated and resistance is given

20. STRETCH The stretch stimulus occurs when the muscle is elongated The lengthened position of the muscle is the starting position of each pattern and the stretch is maintained throughout the movement. All the components of a pattern must be stretched simultaneously Stretching will Stimulate the activity of muscle spindle

21. TIMINGS Timing is the sequencing of motions Normal timing of most coordinated and efficient motions is from distal to proximal

22. DIAGONAL Patterns of movement associated with PNF are: Multiplanner, diagonal, rotational of extremities, trunk and neck Two pairs of diagonal patterns are associated for the upper and lower extremities; diagonal 1 (D1), diagonal 2 (D2)

23. • 1. • Each pattern has three dimension – Flexion or extension Abduction or adduction Rotation Movement occurs in a straight line , in diagonal direction with a rotatory component

24. • • • • • are associated for the upper and lower extremities; diagonal 1 (D1), diagonal 2 (D2) Each of these patterns can be performed in either flexion or extension Terminology used D1 flexion; D1 extension; D2 flexion; D2 extension Patterns are identified by the motion that occurs at the proximal pivot points (hips or shoulders) Pattern is named by the ending position of the hip or the shoulder

25. UPPER EXTREMITY

26. PATTERNS Shoulder FLEX, ADD, ER Forearm - Sup Wrist - Rad. Flexion Fingers - flexion Shoulder FLEX, ABD, ER Forearm - Sup Wrist - Rad. Flexion Fingers - Extension Shoulder EXT, ABD, IR Forearm - Pro Wrist - Ulnar. extension Fingers - Extension Shoulder EXT, ADD, IR Forearm - Pro Wrist - Ulnar ext. Fingers - flexion

27. Diagonal One Diagonal Two

28. LOWER EXTREMITY

29. LOWER EXTREMITY

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