Proprioceptive neuromuscular facilitation

PPT on introduction, principles, Basic Procedures For Facilitation, Diagonal patterns and techniques of PNF

1. PROPRIOCEPTIVE NEUROMUSCULAR FACILITATION Bhawna MPT (pediatrics)

2. Proprioceptive , means receiving stimulation within the tissues of the body. Neuromuscular , means pertaining to the nerves and muscles. Facilitation , means the effect produced in nerve tissue by the passage of an impulse.

3. INTRODUCTION: HERMAN KABAT ► Developed a method of PNF.   SHERRRINGTON ► Provided Neurophysiological principles.   GELLHORN ► Studied Proprioception and Cortically induced movement. GESSEL ► Studied the development of motor behavior. MCGRAW ► Studied the development of behavior and maturation of Neural structures. HELLEBRANDT ► Studied the combination of movements and mass movements

4. In 1956 the first edition of PNF text book was written by the two Physical therapists who worked with Dr.Kabat , Margaret Knott and Dorothy Voss. The book was revised in 1968 and 1985.

5. Definition: Techniques of proprioceptive neuromuscular facilitation may be defined as “ Methods of promoting or hastening the response of the neuromuscular mechanism through stimulation of the proprioceptors”.

6. PRINCIPLES: All human beings have potentials that are not fully developed. Motor development takes place in cerviocaudal sequence or proximodistal direction. Early motor behavior is dominated by reflex activity whereas mature motor behavior is supported or reinforced by postural reflex. The growth of motor behavior has cyclic trends as evidenced by shifts between flexor and extensor dominance. The goal directed activity is made up of reversing movements. Normal movement and posture are dependent upon synergism and a balanced interaction of antagonist. Developing motor behavior is expressed in an orderly sequence of total patterns of movements and posture. Normal development has an orderly sequence but lacks a step by step quality and generally shows overlap. Improvement in motor ability depends upon motor learning. Frequency of stimulation and repetitive activity are used to promote and retain motor learning as well as for the development of strength and endurance.

7. The Basic Procedures For Facilitation Are: Manual contacts Traction Approximation Stretch Timing for emphasis Maximal Resistance Verbal (commands) Vision Timing Body position and mechanics Patterns

8. MANUAL CONTACTS  The therapist’s grip stimulates the patient’s skin receptors and other pressure receptors. The therapist’s hand should be placed to apply the pressure opposite the direction of motion. To stimulate proprioceptors in muscles, tendons and joints. May be used with or without resistance.

9. TRACTION AND APPROXIMATION Traction is elongation of trunk or an extremity. It is used to facilitate motion and aid in elongation of muscle when using stretch reflex. Approximation is the compression of the trunk or extremity. It promotes stabilization, facilitates weight bearing and facilitates upright reactions.

10. STRETCH Stretch stimulus: Occurs when the muscle is elongated. It facilitates muscle contraction. Precaution :- use of stretch reflex is not advisable during the early stage of soft tissue healing after injury or surgery.

11. TIMING Timing is a sequencing of motions. Normal timing provides continuous coordinated motion until the task is accomplished. Timing for emphasis involves changing the normal sequencing of motions to emphasize a particular muscle or desired activity.

12. MAXIMAL RESISTANCE The amount of resistance provided during an activity must be appropriate for the patients condition and the goal of the activity. Facilitates muscle contraction. Increases motor control and learning. Increases strength.

13. BODY POSITION AND MECHANICS The therapist’s body should be in line with desired motion or force. The resistance comes from the therapist’s body, while the hands and arms stay comparatively relaxed. By using body weight, the therapist can give prolonged resistance without fatigue.

14. VERBAL STIMULATION (COMMANDS) The verbal command tells the patient what to do and when to do it. The command is divided into three parts . Preparation Action Correction

15. VISION The feedback from the visual sensory system can promote a more powerful contraction. It helps the patient to correct position and motion. It provides another avenue of communication and helps to ensure co-operative interaction.

16. Patterns

17. Diagonal patterns The patterns of movement associated with PNF are composed of multijoint, multiplanar, diagonal and rotational movements of extremities, trunk and neck. There are two pairs of diagonal patterns for upper and lower extremities. Diagonal 1 Diagonal 2 Each of these pattern patterns can be performed in either flexion or extension.

18. D1 flexion D1 extension D2 flexion D2 extension of the upper and lower extremities

19. D1 flexion D2 flexion D1 extension D2 extension

20. Upper Extremity Component Motions

21. Shoulder D1 flexion:- flexion, adduction, external rotation D1 extension:- extension, abduction, internal rotation D2 flexion:- flexion, abduction, external rotation D2 extension:- extension, adduction, internal rotation

22. Elbow D1 flexion:- flexion or extension D1 extension:- flexion or extension D2 flexion:- flexion or extension D2 extension:- flexion or extension

23. Forearm D1 flexion:- Supination D1 extension:- Pronation D2 flexion:- Supination D2 extension:- Pronation

24. Wrist D1 flexion:- flexion, radial deviation D1 extension:- extension, ulnar deviation D2 flexion:- extension, radial deviation D2 extension:- flexion, ulnar deviation

25. Fingers and Thumb D1 flexion:- flexion, adduction D1 extension:- extension, abduction D2 flexion:- extension, abduction D2 extension:- flexion, adduction

26. Lower Extremity Component Motions

27. Hip D1 flexion:- flexion, adduction, external rotation D1 extension:- extension, abduction, internal rotation D2 flexion:- flexion, abduction, internal rotation D2 extension:- extension, adduction, external rotation

28. Knee D1 flexion:- flexion or extension D1 extension:- flexion or extension D2 flexion:- flexion or extension D2 extension:- flexion or extension

29. Ankle D1 flexion:- dorsiflexion, inversion D1 extension:- plantarflexion, eversion D2 flexion:- extension, eversion D2 extension:- plantarflexion, inversion

30. Toes D1 flexion:- extension D1 extension:- flexion D2 flexion:- extension D2 extension:- flexion

31. Rhythmic Initiation Rhythmic motion of the limb or body through the desired range, starting with passive motion and progressing to active resisted movement. Goals:- Improve coordination and sense of motion. Teach the motion Help the patient to relax Normalize the rate of motion, either increasing or decreasing it

32. Indications:- Difficulties in initiating motion Movement too slow or too fast Uncoordinated or dysrhythmic motion, i.e.,ataxia and rigidity Regulate or normalize muscle tone