PNF! Proprioceptive neuromuscular facilitation! Methods of promoting or hastening the response of the neuromuscular mechanisms through stimulation of proprioceptors!

s! ! Pattern - model! ! Facilitation means:! 1. Promotion or hastening of any natural process, the reverse of inhibition! 2. The effect produced in nerve tissue by the passage of an impulse! ! Proprioceptive means:! Receiving stimulation c in tissues of body! ! Neuromuscular - pertaining to nerve or muscles! ! Dr. Herman Kabat, MD, Ph.D. - originator of the PNF! Margaret (Maggie) Knott - was the rst PT to be employed by Dr. Kabat! ! The method! PNF method was developed by working with px! Motions were combined to ascertain the effectiveness of maximal resistance and stretch in facilitating the response of weak distal muscle by irradiation from stronger proximal muscle! Mass movement patterns was then developed! Techniques were also developed based on Sherrington's principles of! Successive induction! Reciprocal innervation! Process of irradiation! ! Principles of PNF! The N neuromuscular mechanism becomes integrated and efcient without awareness of individual muscle action! The decient neuromuscular mechanism is inadequate to meet the demands of life, in proportion to the degree of the deciency! Responses may be limited as a result of faulty development, trauma or disease of the nervous or musculoskeletal system! Deciencies as evidenced by weakness, incoordination, immobility of joints, muscle spasm or spasticity !

 It is the decient neuromuscular mechanism that becomes the concern of the medical profession and the PT! The facilitation effect is the means used by the PT to reverse the limitations of the patient! ! Patterns of motion! The patterns of motion are mass movement patterns! Mass movement is characterized of N motor activity! Beevor's axiom - research! The mass movement pattern are spiral and diagonal in character and closely resemble the movements used in sports and in work activities! The spiral and diagonal character is in keeping with the spiral and rotatory characteristics of the skeletal systems of muscles, bones, joints and ligaments! ! Diagonals of motion! Upper extremity! D1 ex! D1 ext! D2 ex! D2 ext! Lower extremity! D1 ex! D1 ext! D2 ex! D2 ext! ! Motion components UE shoulder! D1 ex! Flex ! Add! ER! D1 ext! Ext! Abd! IR! D2 ex! Flex! Abd! ER!

 D2 ext! Ext! Add! IR! ! Consistency of motion (UE)! ER is consistent c ex! IR is consistent c ext! Supination and radial deviation is consistent c ex and ER of the shoulder! Pronation and ulnar deviation is consistent c ext and shoulder abd! Wrist ex is consistent c shoulder add! Wrist ext is consistent c shoulder abd! Finger ex c add occurs c wrist ex and shoulder add! Finger ext c abd occurs c wrist ext and shoulder abd! Flex of thumb is consistent c add of shoulder! Ext of thumb is consistent c shoulder abd! ! Consistency of motion (LE)! Hip add is consistent c ER! HIP abd is consistent c IR! PF is consistent c hip ext! DF is consistent c hip ex! Inv is consistent c hip add and ER! Ev is consistent c hip abd and IR! ! Basic procedures! Manual contacts! Deep pressure but no painful, applied to parts and muscle groups where response is desired! To stimulate proprioceptors in muscles, tendons and joints! May be used c or s resistance or in isotonic or isometric muscle contraction! Pressure may be used as a sensory cue to help the patient to understand the direction of the anticipated movement! ! Traction! Separation of jt surfaces by manual contact of PT! To stimulate proprioceptors related to stretch! To separate jt surfaces in order to make jt motion less painful! To promote movement!

Helpful means of stimulation! Approximation ! Joint compression by manual contact of PT! To stimulate joint proprioceptors related to compression! Synonymous to COMPRESSION! To promote stability or maintenance of posture! ex. ! ! Sitting balance! ! Apply pressure in a downward direction!

! Quick stretch ! Maximal stretch of a major muscle components in lengthened range of pattern! To demand increased response where response is inadequate to initiate active motion in lengthened range of pattern! Indicated in conditions where inner action is inadequate to produce active motion! ! Timing for emphasis! Sequence of contraction of major muscle components from distal to proximal! To develop coordinated movements! To make possible outow and reinforcement when resistance is superimposed! ! Maximal resistance! Graded according to patient's abilities and needs! May be slight amount for weak components and a great amount for stronger components! Patient must be allowed to move if command is for active motion. Must not be excessive that it prevents the patient from holding when the command is to hold! To obtain overow from stronger components to weaker components! To develop power, endurance and coordination! To correct imbalances! To demand relaxation! ! Reinforcement! Accomplished by resisted motion in stronger part of range of reinforcing components of pattern! Patterns selected as reinforcement must be related stronger...!

 To stimulate weaker components or weaker patterns! To establish coordination between combination of patterns! ! SPECIFIC TECHNIQUES! Agonist! Repeated contractions! Hold-relax-active motion! Rhythmic initiation! Antagonist! Slow reversal! Slow reversal hold! Rhythmic stabilization ! Quick reversal! Relax! Contract-relax! Hold-relax! Slow reversal-hold-relax! Rhythmic rotation! ! AGONIST! ! Repeated contractions! Sustained and repeated effort in one direction! To stimulate gains in range of active motion of agonistic pattern! To demand relaxation or lengthening reaction of antagonistic pattern! To improve endurance, coordination, and strength in a given pattern or in a specic part of ROM of a specic pattern! ! Hold-relax-active motion! Isometric, followed by voluntary relaxation, followed by isotonic contraction! Repeated effort s sustained effort ! Performed from shortened range to lengthened range! To stimulate response in a lengthened range! To improve endurance, strength and coordination of the agonistic pattern! Indicated in weakness in the lengthened range and where marked imbalance exists in favor of antagonistic pattern! ! Rhythmic initiation! Voluntary relaxation - assisted isotonic contraction - resisted isotonic

contraction! Promote ability to initiate movement! Indicated where rigidity or spasticity prevents initiation of movement! ! ANTAGONIST! ! Slow reversal! Isotonic contraction (antagonist) - isotonic contraction (agonist)! Stimulate active motion of agonist! Develop the N reversal pattern of antagonist! Indicated where weakness is primary factor and reversal...! ! Slow reversal hold! Isotonic - isometric of antagonist - isotonic - isometric of agonist! To develop stability and ability to perform isometric in specic range of pattern! Indicated where the ability to perform isometric contraction is decient! ! Rhythmic stabilization! Isometric (agonistic pattern) - isometric (antagonistic pattern)! Develop stability in specic part of pattern! Stimulate circulation through isometric contraction! Stability is the goal of the tx! Indicated where active motion is not permitted or impossible because of pain! ! Quick reversal! Isotonic (antagonist) - reversed isotonic (agonist) - isometric (agonist)! Facilitate agonist by resistance to antagonist followed by reversal of agonist! ! RELAX! ! Contract relax! Isotonic (antagonist) - passive motion (agonist)! Performed at where limitation by antagonist presents itself! To archive relaxation of antagonistic pattern! Indicated where stability is primarily a factor! ! Hold relax! Isotonic (antagonist) - free active motion of agonist! Performed where limitation presents itself as a result of pain or muscle spasm!

 To achieve relaxation of antagonist! ...! ! Slow reversal-hold-relax! Isotonic - isometric (antagonist) - voluntary relaxation - isotonic (agonist)! Performed where limitation of antagonist present itself! To achieve relaxation if antagonist! To stimulate agonist contraction! ! Rhythmic rotation! Repeated rotation of a segment! To achieve relaxation of range-limiting muscles! Stimulation of rotation components! ! Intermediate joint! From exed -> extended! From extended-> exed! From straight -> straight!