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PNF Patterns & Philosophy

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Question
Answer
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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