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Pt Management '11
PNF
| Question | Answer |
|---|---|
| Definition of PNF | -Proprioceptive Neuromuscular Facilitation -A therapeutic technique that utilizes concepts of normal development, biomechanics & proprioceptor function to maximize performance of motor skills |
| Primary underlying therapeutic concepts | -Re-education of neural pathways -Application of progressive muscular stress -Direct functional parallels |
| Re-education of neural pathways allows for... | -reestablishing patterns of neurologic movement which enables an efficient & functional (quality) movement -and allows for the person to move through these functional patterns even when on 'autopilot' |
| Example of application of progressive muscular stress | -a progression from laying to sitting (encorporating core/trunk mm along with other mm) then moving to standing (or all fours and elbows) for additional muscle stability |
| Direct functional parallels involve... | -using a particular pattern to address a particular movement (walking, reaching, etc) |
| When is PNF appropriate? (application) | Techniques can be effectively used in persons with deficits in muscular strength or length or movement control of muscular, neurological or combine origin |
| What is normal development? (definition) | The neurophysiological changes that occur in the normal human after birth |
| Stages of Motor Control | 1. Mobility 2. Stability a. Tonic Holding b. Cocontraction 3.Controlled Mobility a. Static Dynamic Activity b. Skill |
| Mobility | ability to assume a posture -passive and active mm function |
| Stability | ability to hold a posture |
| Tonic holding | rocking back and forth (feeling out the posture) |
| Cocontraction | fixed holding/isometric holding of a posture (all the mm around joints are contracting) |
| Controlled mobility | maintaing a fixed base of support (distal segment stays fixed and COG is moved over and within base of support) |
| Static dynamic activity | maintaining a posture and moving with that posture including changing base of support (generally reducing base of support) |
| Skill | movement through space involving freeing the distal segment & the proximal segment with have dynamic demands -LE: some type of locomotion -UE: freeing of a hand to produce some type of activity |
| Prone Sequence | 1. prone 2. pivot prone 3. prone on elbows 4. prone on hands (spine stability) 5. commando crawl (beginning of reciprocal movements) 6. quadruped 7. creeping (aka crawling) |
| As progression occurs, the following occur... | *raises COG *increase lever arm *increases number of involved joints *decrease base of support |
| Upright sequence | 1. supine 2. pivot supine 3. rolling 4. sitting 5. plantigrade (modified/full) 6. supported standing 7. standing 8. walking |
| Slow Twitch muscles are used for what type of contraction... | stability |
| Fast Twitch muscles are used for what type of contraction... | controlled mobility |
| Muscular factors related to PNF | -fiber type -type of contraction -working range |
| PNF & the CNS control of movement patterns | the CNS doesn't know what 'normal' is, it only knows what the 'usual' is; we can use this to retrain movements |
| Plasticity | the concept that we can change neurofiber patterns and recruitment |
| Types of input used in PNF | 1. touch 2. stretch 3. resistance 4. traction 5. approximation 6. visual 7. verbal |
| touch | tactile cue (a response between the touch and the skin/nerve endings) |
| stretch | provides stimulus to spindle to contract muscle |
| resistance | provides an overload that can stretch or increase tension of muscle fibers of joint surfaces; causes receptors in joint to react a certain way |
| traction | separation- response of contraction (flexors want to contract more) |
| approximation | compression (extensors want to contract more) |
| visual | using motor control center to establish eye/body part coordination and promotes muscle control |
| verbal | -we respond differently to different tones, volumes, speeds, etc -use this to either relax a patient or tense up that patient depending on how much contraction the PT wants |
| Treatment Philosophy | -patient potential -integrative -positive approach -functional -strong assists weak -maximal response -repetition |
| UE D1 Flexion | -scapular: elevation, ABD, UR -shd: flexion, ADD, LR -forearm: suppination -wrist/finger: flexion, radial dev -thumb: ADD |
| UE D1 Extension | *exact opp of the flexion pattern |
| UE D2 Flexion | -scapula: elevation, ADD, UR -shd: flexion, ABD, LR -forearm: suppination -wrist/finger: extend, RD -thumb: ABD |
| LE D1 Flexion | -hip: flexion, ADD, LR -ankle: DF, inversion |
| LE D2 Flexion | -hip: flexion, ABD, MR -ankle: DF, eversion |
| Scapular Patterns | -Anterior Elevation/ Posterior Depression (1&7) -Posterior Elevation/ Anterior Depression (5&11) |
| Pelvic patterns | -only Anterior Elevation/ Posterior Depression (1&7) -hands placed on the ischial tuberosity and ASIS |
| PNF techniques for Mobility | -rhythmic initiation -slow reversal -hold relax |
| PNF techniques for Stability | -slow reversal hold -alternating isometrics -rhythmic stabilization |
| PNF techniques for Controlled Mobility | agonistic reversal |
| PNF techniques for Skill retraining | resisted progression |
| Rhythmic Initiation Definition | the movement is first passive, then progress to assistive, then active motion through increments of range |
| Applications of Rhythmic Initiation | -unable to initiate movement -limited active or passive ROM -to teach an activity |
| Slow Reversal | an isotonic contraction of one pattern followed by an isotonic contraction of antagonist pattern (occurs once RI progresses to using resistance) |
| Applications of Slow Reversal | -to teach an activity -muscle weakness which limits ability to initiate or complete a movement -when there is muscle weakness in any compnent of an activity -if someone is strong in shd muscles but weak in elbow and wrist muscles, promote strengthening |
| Applications of Slow reversal Hold | -to increase strength in an activity when all components are weak -to increase strength when any component is weak |
| Alternating Isometrics | therapist resists an isometric contraction of one pattern and immediately follows with an isometric contraction of the opposite pattern. Resistance is built up within each shift and over the entire sequence (shorten range gradually until essentially zero) |
| Applications for Alternating Isometrics | -to balance tone -pts who are unable to part/joint with RS |
| Rhythmic Stabilization | simultaneous isometric contractions (co-contraction) of antagonistic patterns. it is performed by therapist alternating antagonistic pattern resisted with each hand -eventually take out verbal & visual cues adding random touches |
| Applications for Rhythmic Stabilization | -to develop stability in a posture, especially in the proximal joints of the extremities and in trunk, neck and head |
| Agonstic Reversal | -uses both concentric and eccentric -most often used in developmental movements/positons -concentric first then hold isometrically, followed by an eccentric then hold |
| Applications of Agonistic Reversal | -to promote control through full range of lengthening contraction -to strengthen muscle groups which function frequently or primarily in an eccentric manner, especially in developmental postures |
| Resisted Progression | therapist resists isotonic movement in a pattern of locomotion (manual cues i& resistance in direction of movement |
| Applications of Resisted Progression | -teach an actvity -develop endurance -promote motor learning of an activity -develop/increase strength -promote/reinforce use of appropriate sequence or control of movement |
Created by:
CWestrick
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