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PNF1: Techniques
| Question | Answer |
|---|---|
| 4 levels of motor control | Mobility Stability Controlled mobility skill |
| Mobility | the ability to initiate movement through a functional range of motion |
| stability | the ability to maintain a postion or posture through contraction and tonic holding around a joint--i.e. unsupported sitting with midline control |
| controlled mobility | the ability to move w/in a WB position or rotate around a long axis-i.e. activities in prone on elbows or WS in quadruped |
| skill | the ability to consistently perform functional tasks and manipulate the environment w/ normal postural reflex mechanisms and balance reactions--i.e. ADLs and community locomotion |
| Mobility increase ROM includes what techniques | Rhythmic Rotation Rhythmic Stabilization Joint distraction Contract-relax Hold-relax |
| Mobility to initiate movement includes what techniques | rhythmic rotation rhythmic initiation joint distraction hold-relax active mvmt Repeated contractions |
| What techniques are for stability | Alternating Isometrics Rhythmic Stabilization Slow reversal slow reversal hold |
| What techniques are for controlled mobility | Agonistic reversals slow reversal slow reversal hold |
| What techniques do distal functional movement skill | normal timing slow reversal slow reversal hold |
| what techniques do proximal dynamic stability | agonistic reversals resisted progression |
| what techniques are for strength | alternating isometrics repeated contractions timing for emphasis resisted progression |
| Rhythmic rotation is for what | mobility |
| What is rhythmic rotation indications | relaxation of excess tension in mm (hypertonia) combined w/ PROM of the range limiting mm |
| What is rhythmic rotation | relaxation is achieved with slow, repeated rotation of a limb at a point where limitation is noticed. As mm relax, the limb is slowly and gently moved into the range. -As new tension is felt, RR is repeated. |
| Rhythmic Initiation (RI) is for what | mobility |
| Rhythmic initiation indications | inability to relax, hyerptonicity;difficulty initiating mvmt, motor planning deficits, motor learning deficits, communication deficits (aphasia), mvmt too fast or too slow |
| How is rhythmic initiation (RI) performed | voluntary relaxation followed by passive movements progressing to active-assisted and activeresisted mvmts to finally active movements -light, graded tracking resistance is used during the resistive phase to facilitate mvmt |
| Rhythmic initiation (RI) verbal commands | -used to set the speed an rhythm of mvmt -"let me move you"-->"help me move you"-->"move against the resistance"-->"move on your own" |
| Alternating isometrics (AI) are used for what? | Stability and strength |
| What are the indications for Alternating isometrics | Weakness, decreased ability to change direction of motion, exercised mm begin to fatigue |
| How is Alternating isometrics (AI) performed | Manual resist is applied in a single plane on one side of body, then on the other to improve isometric strength and stability of postural mm of trunk or prox stabilizing mm of shld girdle and hip -applied to both extrem at once, one at a time, or to trun |
| Instructions during alternating isometrics (AI) | pt is instructed to "hold" his/her position as the direction of resistance alternates |
| Rhythmic stabilization (RS) is used for what | mobility and stability |
| Rhythmic stabilization (RS) indications | impaired strength and coordination limitations in ROM impaired stabilization, control, and balance |
| Rhythmic stabilization (RS) is used as a progression of what | Alternating isometric (AI) |
| Rhythmic stabilization (RS) is designed to do what | promote stability (preparing for mvmt) through co-contraction of the proximal stabilizing musculature of the trunk shoulder, and pelvic girdle |
| Rhythmic stabilization often incorporates what | joint approximation to further facilitate co-contraction |
| How is rhythmic stabilization applied | PT applies multidirectional, rather than unidirectional , resistance using manual contacts as the pt holds the selected position--multiple mm groups around jts must contract including rotators, to hold the position |
| Normal timing (NT) is used for level of motor control | skill |
| Normal timing is used to do what | to improve coordination of all components of a task |
| Normal timing (NT) is performed in what sequence | distal to proximal--proximal components are restricted until the distal components are activated and initiate movement -repetition of the pattern produces a coordinated mvmt of all components |
| Joint distraction is used for what level of motor control | Mobility |
| Joint distraction: indications | inability of flexor mm to function in mobilizing or antigravity patterns |
| joint distraction: a distraction force is used to do what | facilitate mm contraction and motion, esp in flexion patterns or pulling motion |
| Joint distraction: how is it performed | consistent manual traction is provided slowly and usually in combination with mobilization techniques to reduce pain and relieve mm spasm -can also be used in combo w/ quick stretch to elongate mm tissue and facilitate mvmt via stretch reflex |
| Agonistic Reversals (AR) is used for what level of motor control | Controlled mobility Skill |
| Agonistic Reversals (AR): indications | weak postural mm inability to eccentrically control body weight during movement transitions por dynamic postural control |
| What is Agonistic reversal (AR) also called | "combination of isotonics) |
| What is Agonistic reversals (AR) | a resisted isotonic concentric contraction of agonist mm is followed by a stabilizing/isometric contraction and then an eccentric contraction as the body segment is moved slowly back to start position |
| During agonistic reversals (AR) are there relaxation periods? How is the therapists hand position? | there is no relaxation between the types of contractions -the therapists hands remain on the same surface |
| Agonistic reversals (AR) are typically used when | in antigravity activities or the assumption of postures (i.e. bridging, sit-to-stand transitions) |
| Contract-relax (CR) is used for what level of motor control | mobility |
| contract-relax (CR) indications | limitations in ROM |
| What is Contract-Relax (CR) | after the extremity reaches the point of limitation the pt performs a strong, small range isotonic contraction of the restricted mm |
| Contract-relax (CR): what mvmts may be resisted? Which ones should be allowed to occur? | All linear mvmts of the antagonistic pattern may be resisted, but rotation should be allowed during CR |
| Contract-Relax (CR) therapist role | The therapist resists mvmt for 5-8 seconds w/ relaxation to follow -technique is repeated until no further gains in ROM are noted |
| Hold-Relax (HR) level of motor control | mobility |
| Hold-Relax (HR) indications | limitations in PROM w/ pain |
| What is Hold-relax (HR) | isometric contraction is performed at the limiting point in the ROM and resisted for 5-8 secs -relaxation then occurs and the extremity is moved through the newly acquired range to the next limitation point until no further increases |
| Hold-relax (HR) is usually used with which patient group | pts that present with pain |
| Hold-Relax Active mvmt (HRAM) level of motor control | mobility |
| Hold-relax active mvmt is used to do what | improve weak mm's ability to initiate mvmt and sustain mvmt throughout the range |
| Hold-relax active mvmt indications | marked weakness inability to sustain a contraction in the shortened range |
| How is Hold-relax active mvmt performed | isometric contraction is performed once the extremity is passively placed into a shortened range w/in pattern -upon relax extremity is immediately moved into lengthened position of pattern w/ a quick stretch -pt isotonic contraction to shortended positi |
| Repeated contractions (RC) level of motor control | mobility strength |
| repeated contractions (RC) indications | impaired strength initiation of mvmt fatigue limitations in AROM |
| Repeated contractions is used to do what | initiate mvmt and sustain a contraction through the ROM |
| How is repeated contractions (RC) performed | repeated isotonic contractions from the lengthened range, induced by quick stretches and enhanced by resistance - repeated (3-4 stretches) during one pattern or until contraction weakens |
| what range is repeated contractions performed in | through the range or part of the range at a point of weakness |
| Timing for emphasis (TE) level of motor control | strength |
| timing for emphasis (TE) indications | weakness and/or incoordination |
| How is timing for emphasis performed | strong mm are resisted isometrically wile motion is allowed in the weaker mm. |
| timing for emphasis (TE) does what to normal sequencing | changes it to emphasize a particular mm or a desired activity |
| Timing of emphasis is sometime used with what other technique | Repeated contractions |
| Timing for emphasis: max resistance is used for what | to elicit a strong contraction and allow irradiation/overflow to occur from strong to weak components w/in a synergistic pattern |
| Resisted progression (RP) level of motor control | skill strength |
| Resisted progression (RP) indications | impaired timing and control of lower trunk/pelvic segments during locomotion impaired endurance |
| Resisted progression (RP) is used to emphasize what | coordination of proximal components during gait |
| Resisted progression (RP) is performed how | stretch, approximation, and tracking resistance are applied manually to facilitate pelvic motion and progression during locomotion |
| What is the level of resistance during resisted progression | it is light so as to not disrupt the pt's momentum, coordination and velocity. |
| Reversal of antagonists is based on what | Sherrington's law of successive induction |
| what 2 techniques involve stimulation of a weak agonist pattern by first resisting static or dynamic contractions of the antagonist pattern | Slow reversal (SR) SR hold (SRH) |
| Many functional activities involve what | quick direction reversals such as: throwing, swinging a racquet/club/bat, or grasping and releasing object |
| Slow reversal (SR) levels of motor control | stability controlled mobility skill |
| Slow reversal (SR) indications | impaired strength stability balance |
| Slow reversal (SR) is performed how | a technique of slow and resisted concentric contractions of agonists and antagonists around a joint w/out rest between reversals |
| Slow reversal (SR) promotes what | rapid, reciprocal action of agonists and antagonists, useful for improving control of mvmt and posture |
| Slow reversal: what pattern is selected first | Contraction of the stronger patterni s selected first w/ progression to the weaker pattern |
| Slow reversal: is the limb moved through very limited ROM or full ROM | may be moved through full ROM or very limited ROM depending on the tx objectives |
| SR Hold (SRH) level of motor control | Stability controlled mobility skill |
| SR hold (SRH) indications | impaired strength stability balance |
| SR hold (SRH) hold is what | slow reversal with the addition of an isometric contraction performed at the end of each movement in order to gain stability |
| Shortened held resisted contraction (SHRC) level of motor control | stability |
| What is shortened held resisted contraction (SHRC) is performed how | graded isometric contractions in a shortened range in non-WB postures -postural extensors are isometrically contracted (< 10 seconds) in their shortened range |
| Shortened held resisted contraction (SHRC): is the pt actively or passively involved | Pt can be actively or passively moved into the shortened position |
| Slow reversal hold through decrements of range (SRHDR) is what level of motor control | stability |
| Slow reversal hold through decrements of range (SRHDR) is used for what | when pts have increased mobility--as in ataxia or athetosis--to help move into mid-line for stability -idea is to gradually ask for holds closer and closer to mid-line |
| Slow reversal hold through increments of range (SRHIR) is what level of motor control | controlled mobility |
| how is slow reversal hold through increments (SRHIR) is done how | slow reversal movements are done between agonists and antagonists w/out relaxation b/t patterns -holds are applied farther and farther from mid-line -Quick stretch may be applied to facilitate movement into more range |
| Mass movements | -all joints flex or extend -These mvmts are seen early in the developmental sequence- mass withdrawal from danger (flexion) and protective supporting reflex (extension) |
| Advanced movements | the same mvmt is seen at the proximal and distal joint while the intermediate joint does the opposite mvmt -This type of mvmt is more advanced than the mass mvmts |
| Associated reactions | involuntary limb movements on the hemiperetic side of a CVA patient elicited when tension is developed in another part of the body |
| What are the associated reactions | -contralateral reflex response -homolateral limb synkinesis -Raimeste's phenomenon -souque's phenomenon |
| Contralateral reflex response | isolated to flexion/extension mvmts. In the UEs, resisted mvmt evokes the same mvmt that was resisted from the contralateral UE. In the LEs, resisted mvmt evokes the opposite mvmt that was resisted |
| Homolateral limb synkinesis | Flexion of the affected UE evokes flexion of the LE on the affected side |
| Raimiste's phenomenon | isolated to add/abd. Reistance to adduction of thehip on one side will evoke adduction in the opposite hip. Same is true of resisted ABD. This also occurs at the shld |
| Souques phenomenon | raising the involved upper extremity above 100 degrees w/ elbow extension will produce extension and abduction of the fingers |
Created by:
Amusch21