Proprioceptive Neuromuscular Facilitation

Proprioceptive Neuromuscular Facilitation

1. Proprioceptive Neuromuscular Facilitation Seminar Presentation – 4 Presenter – Simran A. Mishra,

2. Contents Definition PNF Physiology Neurophysiological Principles Procedures of facilitation Patterns of PNF Techniques Recent advances

3. Definition Proprioceptive Neuromuscular Facilitation (PNF) is a concept of treatment. Its underlying philosophy is that all human beings, including those with disabilities, have untapped existing potential (Kabat 1950)

4. Proprioceptive neuromuscular facilitation (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.

5. PNF Physiology Positive approach Use of motor control and motor learning Mobilize potential by intensive training Highest functional level Consider the total human being

6. Basic Neurophysiologic Principles

7. Basic Procedures for Facilitation Resistance Irradiation and reinforcement Manual contact Verbal (commands) Vision Traction or approximation Stretch Timing Patterns

8. Resistance Facilitate the ability of the muscle to contract. Help the patient gain an awareness of motion and its direction. Increase strength Irradiation and Reinforcement Properly applied resistance results in irradiation and reinforcement. This response can be seen as increased facilitation (contraction) or inhibition (relaxation) in the synergistic muscles and patterns of movement. The response increases as the stimuli increase in intensity or duration (Sherrington 1947).

9. Facilitate motion, especially pulling and antigravity motions. Aid in elongation of muscle tissue when using the stretch reflex. Resist some part of the motion . Traction Promote stabilization. Facilitate weight-bearing and the contraction of antigravity muscles. Facilitate upright reactions. Resist some component of motion. Approximation

10. Patterns The upper extremity has two diagonals 1. Flexion–abduction–external rotation and extension–adduction–internal rotation. 2. Flexion–adduction–external rotation and extension–abduction–internal rotation.

11. D1 flexion of upper extremity

12. D1 extension of upper extremity

13. D2 flexion of upper extremity

14. D2 extension of upper extremity

15. The lower extremity has two diagonals: 1. Flexion–abduction–internal rotation and extension–adduction–external rotation. 2. Flexion–adduction–external rotation and extension–abduction–internal rotation.

16. D1 flexion of lower extremity

17. D1 extension of lower extremity

18. D2 flexion of lower extremity

19. D2 extension of lower extremity

20. Techniques Goals Rhythmic motion of the limb or body through the desired range Aid in initiation of motion Improve coordination and sense of motion. Indications Difficulties in initiating motion Movement too slow or too fast. Uncoordinated or dysrhythmic motion. Regulate or normalize muscle tone. Rhythmic Initiation

21. Indications Decreased eccentric control. Lack of coordination or ability to move in a desired direction. Decreased active range of motion. Lack of active motion within the range of motion . Active control of motion. To Improve Coordination. Increase the active range of motion. Strengthen. Combination of Isotonics

22. Reversal of Antagonist

23. Increase stability and balance Increase muscle strength Increase coordination between agonist and antagonist Indications Decreased stability Weakness Patient is unable to contract muscle isometrically. Stabilizing Reversals

24. Rhythmic Stabilization Increase active and passive range of motion Increase strength Increase stability and balance Decrease pain Indications Limited range of motion Pain Joint instability Weakness in the antagonistic muscle group Decreased balance

25. Facilitate initiation of motion Increase active range of motion Increase strength Prevent or reduce fatigue Guide motion in the desired direction Repeated Stretch Indications Weakness Inability to initiate motion due to weakness or rigidity Fatigue Decreased awareness of motion

26. References IPNFA (2007) International PNF Association. http://www.ipnfa.org . Sherrington C (1947) The integrative action of the nervous system. Yale University Press, New Haven Hammond PH (1956) The influences of prior instruction to the subject on an apparently involuntary neuromuscular response. J Physiol ( Lond ) 132:17P-18P Kabat H (1961) Proprioceptive facilitation in therapeutic exercise. In: Licht S Johnson EW (eds) Therapeutic exercise, 2nd edn . Waverly, Baltimore Susan S. Adler Dominiek Beckers Math Buck PNF in Practice An Illustrated Guide, third edition. Caroly Kisner , Therapeutic Exercise Foundations and Techniques FIFTH EDITION. Video credits :- Dr. Abhishek Sharma, Dehradun, physio classroom.

27. Thank you