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PNF Lecture 1
PNF Patterns & Philosophy
| Question | Answer |
|---|---|
| What is proprioception? | Concerning sensory receptors that give info about body movement & position |
| What is neuromuscular? | Involving nerves & muscles |
| What is facilitation? | Making easier |
| What are hallmarks of PNF? | Spiraling diagonals |
| Why are diagonal patterns used? | 1. Most developmentally advanced movement patterns; 2. combine all joint ROM; 3. Include rotation around logitudinal axis (muscle groups on a max stretch at beginning of movement) |
| How is PNF a sensory experience? | Uses visual, auditory, & tactile cues |
| How is PNF an approach to therapeutic exercise? | Combines functionally based diagonal patterns with techniques of neuromuscular facilitation to evoke motor responses & improve neuromuscular control & function |
| When are PNF techniques useful? | From the early phase of tissue healing to the final phase of rehab |
| Indications for PNF | Increase strength, flexibility, stability, neuromuscular control, & functional movement |
| Contraindications for PNF | Inflammatory arthritis; Bone fx; Bone disease; Malignancy; Congenital Bone Deformity |
| How are diagonals identified? | By the motions occurring at proximal pivot points, either the shoulder or hip |
| What are diagonals named by? | The position of the shoulder or hip when the diagonal pattern has been completed |
| What are components of each pattern? | Each has a flexion & an extension component which are direct opposites |
| Where do D1 & D2 flexion patterns move in relation to the body's midline? | D1 flexion moves toward midline D2 flexion moevs away from midline |
| In UE D1 flexion what is the shoulder doing? | Flexion Adduction ER |
| In UE D1 flexion what is the scapula doing? | Elevation Protraction Upward rotation |
| In UE D1 flexion what is the elbow doing? | Flexion/Extension Supination |
| In UE D1 flexion what is the wrist doing? | Flexion Radial Deviation |
| In UE D1 flexion what are the fingers & thumb doing? | Fingers- flexion, adduction Thumb- flexion |
| In UE D1 extension what is the shoulder doing? | Extension Abduction IR |
| In UE D1 extension what is the scapula doing? | Depression Retraction Downward Rotation |
| In UE D1 extension what is the elbow doing? | Flexion/Extension Pronation |
| In UE D1 extension what is the wrist doing? | Extension Ulnar Deviation |
| In UE D1 extension what are the fingers & thumb doing? | Fingers- Extension, Abduction Thumb- Extension |
| In UE D2 flexion what is the shoulder doing? | Flexion Abduction ER |
| In UE D2 flexion what is the scapula doing? | Elevation Retraction Upward Rotation |
| In UE D2 flexion what is the elbow doing? | Flexion/Extension Supination |
| In UE D2 flexion what is the wrist doing? | Extension Radial Deviation |
| In UE D2 flexion what are the fingers & thumb doing? | Fingers- Extension, Abduction Thumb- Extension |
| In UE D2 extension what is the shoulder doing? | Extension Adduction IR |
| In UE D2 extension what is the scapula doing? | Depression Protraction Downward Rotation |
| In UE D2 extension what is the elbow doing? | Flexion/Extension Pronation |
| In UE D2 extension what is the wrist doing? | Flexion Ulnar Deviation |
| In UE D2 extension what are the fingers & thumb doing? | Fingers- Flexion, Adduction Thumb- Flexion |
| What is the relationship between shoulder & forearm motions? | They rotate in the same direction Supination with ER, Pronation with IR |
| What is the relationship between the wrist/hand & the shoulder? | Extension of the wrist/hand is combined with shoulder abduction; Flexion of the wrist/hand is combined with shoulder adduction |
| What is the relationship between wrist deviation & forearm rotation? | Ulnar deviation occurs with Pronation (UP) Radial deviation occurs with Supination (RS) |
| What is unique about the elbow in PNF patterns? | It is free to flex or extend |
| In LE D1 flexion what is the hip doing? | Flexion Adduction ER |
| In LE D1 flexion what is the knee doing? | Flexion or Extension |
| In LE D1 flexion what is the ankle doing? | DF Inversion |
| In LE D1 flexion what are the toes doing? | Extension |
| In LE D1 flexoin what is the pelvis doing? | Protraction |
| In LE D1 extension what is the hip doing? | Extension Abduction IR |
| In LE D1 extension what is the knee doing? | Flexion or Extension |
| In LE D1 extension what is the ankle doing? | PF Eversion |
| In LE D1 extension what are the toes doing? | Flexion |
| In LE D1 extension what is the pelvis doing? | Retraction |
| In LE D2 flexion what is the hip doing? | Flexion Abduction IR |
| In LE D2 flexion what is the knee doing? | Flexion or Extension |
| In LE D2 flexion what is the ankle doing? | DF Eversion |
| In LE D2 flexion what are the toes doing? | Extension |
| In LE D2 flexion what is the pelvis doing? | Elevation |
| In LE D2 extension what is the hip doing? | Extension Adduction ER |
| In LE D2 extension what is the knee doing? | Flexion or Extension |
| In LE D2 extension what is the ankle doing? | PF Inversion |
| In LE D2 extension what are the toes doing? | Flexion |
| In LE D2 extension what is the pelvis doing? | Depression |
| What is the relationship between the hip and the ankle? | ER is associated with inversion IR is associated with eversion |
| What does the ankle do (in general)? | Follows the direction of the diagonal |
| What is the relationship between the toes/ankle & the hip? | Extension/DF of toes/ankle is combined with hip flexion Flexion/PF of toes/ankle is combined with hip extension |
| What is unique about the knee in LE diagonal patterns? | It is free to flex or extend |
| What is occurring with a symmetrical bilateral pattern? | Same direction, Same diagonal |
| What is occurring with an asymmetrical bilateral pattern? | Same direction, Different diagonal |
| What is occurring with a reciprocal bilateral pattern? | Different direction, Same diagonal |
| What is occurring with a crossed diagonal bilateral pattern? | Different direction, Different diagonal |
| What is the relationship between flexion/extension patterns & trunk motion? | Flexion results in trunk extension Extension results in trunk flexion |
| Bilateral asymmetrical patterns results in what trunk motion? | Rotation |
| Bilateral asymmetrical lift | 1 UE performs D2 flexion while the other assists by holding under the wrist. The assisting arms performs D1 pattern (facilitates trunk extension, rotation, weight shifting). |
| Bilateral asymmetrical chop | 1 UE performs D1 extension while assisting arm performs a D2 extension pattern (facilitates trunk flexion, rotation, weight shifting). |
| Bilateral Reciprocal Patterns results in what? | Co-contraction of trunk musculature, promiting stability |
| With what common activities does bilateral reciprocal motion occur? | Walking, Running |
| Crossed Diagonal (asymmetrical reciprocal) pattern requires? | Highest level of trunk & extremity control |
| Normal timing | Ensures smooth, coordinated movement |
| What way does normal timing move? | Distal to proximal Rotaiton occurs throughout the pattern |
| Differences between babies & adults with timing | Infants- arm determines where hand goes Adults- hand directs arm |
| Goal of PNF treatment for timing? | Restore normal timing of motion. This is done by resisting all motions of a pattern except the one that needs to be emphasized. |
| Resistance Principles | Light resistance applied to weak mm in combination with light stretch to facilitate mm contraction. Strong resistance used to generate max effort. |
| What types of contractions are used in PNF? | Concentric Eccentric Isometric |
| Most tension per unit of contractile tissue is generated with which type of contraction? Least tension? | Most- eccentric Least- concentric If tension held constant, ecc uses least ATP & concentric uses most |
| Which types of contraction are the most efficient? | Eccentric > Isometric > Concentric |
| Which grip is used most often in PNF? | Lumbrical Grip |
| Where should manual contacts be placed if possible? | Over agonist muscle groups or their tendinous insertions to facilitate underlying mm. |
| In extremity patterns, where should manual contacts be placed? | One placed distally & other more proximally |
| Length-Tension Relationship | Greatest mm tension generaetd in mid-ranges while weak contractive forces occur in shortened ranges. Lengthened ranges can aid in contraction by providing stretch to mm spindles. |
| Body Mechanics | PT in line with desired motion. Resistance applied using body weight, not just through UEs. Use wide BoS & move with pt, pivoting over BoS to allow rotation. |
| What kind of cues enhance motor output? | Auditory |
| Preparatory Commands | Clear, concise, & ready the pt for movement |
| Action Commands | Tell pt when & how to move; Should be strong & dynamic when max stimulation is the goal; should be soft when relaxation is the goal |
| Corrective Commands | Use after the motion is finished |
| Why should the patient move his or her eyes? | Enhances head & body motion. When pt looks in direction they want to move, greater control & stronger contraction are achieved. Head follows eye motion which facilitates larger/stronger trunk motion. |
| Stretch Stimulus | Occurs when mm meant to contract are elongated; Ex: Before initiating D1 flexion, limb placed in D1 extension. "Winds up" or "takes up slack" |
| What is good about "winding up the part" or "taking up the slack"? | Increases excitability & responsiveness of the agonist muscles |
| What is so important about the rotational component? | Elongates muscle fibers & spindles to increase facilitation. Stretch reflex facilitated by a quick stretch followed by sustained resistance to the contracting mm to keep them tensioned throughout pattern. |
| Why might a quick stretch be useful? | Can be applied to any agonist mm group at any point to further stimulate a contraction or direct a pt's attention to a weak component |
| Approximation of Joint Surfaces | Gentle compression of joint surfaces stimulates co-contraction of agonists & antagonists by activating joint mechanoreceptors, & enhances dynamic stability & postural control. |
| Joint Approximation | By doing this, stabilizing, postural mm, primarily type I fibers are activated. Can be done manually or through WB, using weights or fxnally through use of gravity. |
| Joint Traction | Distraction force facilitates mm contraction & motion esp in flexion patterns or pulling motions. Helpful when treating pts with joint pain. |
| Afterdischarge | Effect of stimulus (mm contraction) continues after stimulus stops. Ex: Increased power after maintained static contractoin, which is the afterdischarge. Greater stimulus=longer afterdischarge. |
| Temporal Summation | Weak stimuli applied in succession, one after another in a short time period, they combine to cause excitation |
| Spatial Summation | Weak stimuli applied simultaneously to different areas, different space, they erinforce each other to cause greater excitation |
| Irradiation | aka Overflow; Spread of mm response from stronger mm in a pattern, when resisted, to weaker mm |
| How is irradiation applied to PNF patterns? | Isometrically resisting the stronger mm while allowing the weaker mm to move |
| Successive Induction | Stimulation/contraction of antagonist intensifies the excitation/contraction of agonists |
| Sir Sherrington's 2nd Law | Law of reciprocal innervation When a mm contracts, there's a simultaneous inhibition or its antagonist. This is essential for coordinated movement |
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