Chapter 22 PNF Head and Neck, Scapular, and Trunk Patterns P. J.

Waddington Head and Neck Patterns As with the limb patterns, each head and neck pattern has three components resul ting in a diagonalmovement. These are rotation either to the right or left, most of which takes place at the atlanto-axial jointand either flexion or extension at two levels, i.e. at the atlanto-occipital joint only, a nodding movement of the head on the neck, and the second a large movement involving in addition the whole of the cervicalvertebrae.Care must be taken to ensure that rotation occurs throughout the whole movement. If full rotation is allowedto occur too soon, extension and flexion will be limited and the movement will not be in a diagonal direction.This diagonal is in line with the oblique muscles of the trunk. The therapist may ask the patient to look at thehand in the extension/adduction /medial rotation position to give the inner range position of the flexed androta ted head and neck and may ask the patient to look at the hand in the flexion/abduct ion/lateral rotationposition to give the inner range position of the extended an d rotated head and neck. The chin will be seen tomove in a straight line in a dia gonal direction. Extension with Rotation to the Right Starting Position (Fig. 22.1) PATIENT Supine with the shoulders level with the end of the plinth. Flexion of t he head with rotation to theleft. THERAPIST Stance The therapist stands at the head end of the plinth in the lunge position with th e right leg forwards. Grip The therapist places the thumb of her right hand on the lateral surface of the r ight half of themandible. The rest of the hand and fingers are kept well away from contact with the patien t.The left hand is placed, thumb abducted with fingers down, on the occiput. The temptation to put this han dnear to the nape of the neck must be resisted as the wrist will be placed in an uncomfortable position whenthe patient moves into extension.

Page 232 starting position forextension with rotation to the right Fig. 22.1Neck patterns . Commands. 'Now' 'push and look to the right' . Movement Extension of the head and neck with rotation to the right (Fig. 22.2). Flexion with Rotation to the RightStarting Position (Fig. 22.3) PATIENT Lying with the shoulders level with the edge of the plinth. Extension of the head and neck withrotation to the left.THERAPIST Stance As for extension with rotation to the right, but with the left foot forward. Grip The therapist may choose to use either hand on the chin and vice versa on the oc ciput but it isconvenient to use the left hand on the mandible so that

the slow reversal technique (Chapter 23) may beused.

Fig. 22.2Neck patterns finishing for extension withrotation to the right.Fig. 22 .3Neck patterns starting position forflexion with rotation to the right. The little and ring fingers of the left hand are placed on the inferior border o f the right half of the mandible. If more fingers are used there is a tendency to press on the patient's larynx and cause discomfort.The right hand is on the o cciput as for extension with rotation to the left. Commands 'Now' 'pull your chin up towards your breast pocket' . Movement Flexion of the head and neck with rotation to the right (Fig. 22.4).Head and nec k patterns can usefully be done with the patient in forearm support prone lying either on theplinth or on the mat. It may also be found to be of value to use the extensor patterns with the patient in thesitting position. This will as sist the patient to gain a good position of the head and thus will favourably affectp osture in general.Using the timing for emphasis technique (Chapter 23) and the head and neck as the 'handle', the strong neck muscles can be used to obtain a contraction of the abdominal muscles (flexion with rotation) and the erectorspinae (extension with rotation). Fig. 22.5Diagram showing the diagonal movementsof the scapula.