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 |