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PNF Lecture 1

PNF Patterns & Philosophy

QuestionAnswer
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
Created by: 1190550002