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Pt Management '11


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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