PNF Patterns & Philosophy
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What is proprioception? | Concerning sensory receptors that give info about body movement & position
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What is neuromuscular? | Involving nerves & muscles
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What is facilitation? | Making easier
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What are hallmarks of PNF? | Spiraling diagonals
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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)
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How is PNF a sensory experience? | Uses visual, auditory, & tactile cues
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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
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When are PNF techniques useful? | From the early phase of tissue healing to the final phase of rehab
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Indications for PNF | Increase strength, flexibility, stability, neuromuscular control, & functional movement
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Contraindications for PNF | Inflammatory arthritis;
Bone fx;
Bone disease;
Malignancy;
Congenital Bone Deformity
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How are diagonals identified? | By the motions occurring at proximal pivot points, either the shoulder or hip
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What are diagonals named by? | The position of the shoulder or hip when the diagonal pattern has been completed
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What are components of each pattern? | Each has a flexion & an extension component which are direct opposites
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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
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In UE D1 flexion what is the shoulder doing? | Flexion
Adduction
ER
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In UE D1 flexion what is the scapula doing? | Elevation
Protraction
Upward rotation
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In UE D1 flexion what is the elbow doing? | Flexion/Extension
Supination
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In UE D1 flexion what is the wrist doing? | Flexion
Radial Deviation
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In UE D1 flexion what are the fingers & thumb doing? | Fingers- flexion, adduction
Thumb- flexion
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In UE D1 extension what is the shoulder doing? | Extension
Abduction
IR
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In UE D1 extension what is the scapula doing? | Depression
Retraction
Downward Rotation
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In UE D1 extension what is the elbow doing? | Flexion/Extension
Pronation
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In UE D1 extension what is the wrist doing? | Extension
Ulnar Deviation
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In UE D1 extension what are the fingers & thumb doing? | Fingers- Extension, Abduction
Thumb- Extension
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In UE D2 flexion what is the shoulder doing? | Flexion
Abduction
ER
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In UE D2 flexion what is the scapula doing? | Elevation
Retraction
Upward Rotation
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In UE D2 flexion what is the elbow doing? | Flexion/Extension
Supination
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In UE D2 flexion what is the wrist doing? | Extension
Radial Deviation
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In UE D2 flexion what are the fingers & thumb doing? | Fingers- Extension, Abduction
Thumb- Extension
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In UE D2 extension what is the shoulder doing? | Extension
Adduction
IR
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In UE D2 extension what is the scapula doing? | Depression
Protraction
Downward Rotation
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In UE D2 extension what is the elbow doing? | Flexion/Extension
Pronation
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In UE D2 extension what is the wrist doing? | Flexion
Ulnar Deviation
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In UE D2 extension what are the fingers & thumb doing? | Fingers- Flexion, Adduction
Thumb- Flexion
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What is the relationship between shoulder & forearm motions? | They rotate in the same direction
Supination with ER, Pronation with IR
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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
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What is the relationship between wrist deviation & forearm rotation? | Ulnar deviation occurs with Pronation (UP)
Radial deviation occurs with Supination (RS)
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What is unique about the elbow in PNF patterns? | It is free to flex or extend
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In LE D1 flexion what is the hip doing? | Flexion
Adduction
ER
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In LE D1 flexion what is the knee doing? | Flexion or Extension
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In LE D1 flexion what is the ankle doing? | DF
Inversion
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In LE D1 flexion what are the toes doing? | Extension
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In LE D1 flexoin what is the pelvis doing? | Protraction
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In LE D1 extension what is the hip doing? | Extension
Abduction
IR
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In LE D1 extension what is the knee doing? | Flexion or Extension
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In LE D1 extension what is the ankle doing? | PF
Eversion
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In LE D1 extension what are the toes doing? | Flexion
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In LE D1 extension what is the pelvis doing? | Retraction
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In LE D2 flexion what is the hip doing? | Flexion
Abduction
IR
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In LE D2 flexion what is the knee doing? | Flexion or Extension
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In LE D2 flexion what is the ankle doing? | DF
Eversion
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In LE D2 flexion what are the toes doing? | Extension
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In LE D2 flexion what is the pelvis doing? | Elevation
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In LE D2 extension what is the hip doing? | Extension
Adduction
ER
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In LE D2 extension what is the knee doing? | Flexion or Extension
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In LE D2 extension what is the ankle doing? | PF
Inversion
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In LE D2 extension what are the toes doing? | Flexion
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In LE D2 extension what is the pelvis doing? | Depression
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What is the relationship between the hip and the ankle? | ER is associated with inversion
IR is associated with eversion
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What does the ankle do (in general)? | Follows the direction of the diagonal
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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
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What is unique about the knee in LE diagonal patterns? | It is free to flex or extend
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What is occurring with a symmetrical bilateral pattern? | Same direction, Same diagonal
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What is occurring with an asymmetrical bilateral pattern? | Same direction, Different diagonal
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What is occurring with a reciprocal bilateral pattern? | Different direction, Same diagonal
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What is occurring with a crossed diagonal bilateral pattern? | Different direction, Different diagonal
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What is the relationship between flexion/extension patterns & trunk motion? | Flexion results in trunk extension
Extension results in trunk flexion
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Bilateral asymmetrical patterns results in what trunk motion? | Rotation
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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).
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Bilateral asymmetrical chop | 1 UE performs D1 extension while assisting arm performs a D2 extension pattern (facilitates trunk flexion, rotation, weight shifting).
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Bilateral Reciprocal Patterns results in what? | Co-contraction of trunk musculature, promiting stability
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With what common activities does bilateral reciprocal motion occur? | Walking, Running
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Crossed Diagonal (asymmetrical reciprocal) pattern requires? | Highest level of trunk & extremity control
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Normal timing | Ensures smooth, coordinated movement
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What way does normal timing move? | Distal to proximal
Rotaiton occurs throughout the pattern
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Differences between babies & adults with timing | Infants- arm determines where hand goes
Adults- hand directs arm
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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.
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Resistance Principles | Light resistance applied to weak mm in combination with light stretch to facilitate mm contraction.
Strong resistance used to generate max effort.
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What types of contractions are used in PNF? | Concentric
Eccentric
Isometric
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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
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Which types of contraction are the most efficient? | Eccentric > Isometric > Concentric
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Which grip is used most often in PNF? | Lumbrical Grip
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Where should manual contacts be placed if possible? | Over agonist muscle groups or their tendinous insertions to facilitate underlying mm.
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In extremity patterns, where should manual contacts be placed? | One placed distally & other more proximally
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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.
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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.
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What kind of cues enhance motor output? | Auditory
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Preparatory Commands | Clear, concise, & ready the pt for movement
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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
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Corrective Commands | Use after the motion is finished
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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.
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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"
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What is good about "winding up the part" or "taking up the slack"? | Increases excitability & responsiveness of the agonist muscles
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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.
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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
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Approximation of Joint Surfaces | Gentle compression of joint surfaces stimulates co-contraction of agonists & antagonists by activating joint mechanoreceptors, & enhances dynamic stability & postural control.
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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.
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Joint Traction | Distraction force facilitates mm contraction & motion esp in flexion patterns or pulling motions.
Helpful when treating pts with joint pain.
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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.
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Temporal Summation | Weak stimuli applied in succession, one after another in a short time period, they combine to cause excitation
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Spatial Summation | Weak stimuli applied simultaneously to different areas, different space, they erinforce each other to cause greater excitation
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Irradiation | aka Overflow;
Spread of mm response from stronger mm in a pattern, when resisted, to weaker mm
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How is irradiation applied to PNF patterns? | Isometrically resisting the stronger mm while allowing the weaker mm to move
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Successive Induction | Stimulation/contraction of antagonist intensifies the excitation/contraction of agonists
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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
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