Presentation on theme: "Proprioceptive Neuromuscular Facilitation"— Presentation transcript:
1Proprioceptive Neuromuscular Facilitation National Rehabilitation CenterKim, Seok-Hwan
2Proprioceptive Neuromuscular Facilitation (PNF) Methods of promoting or hastening the response of the neuromuscular mechanism through stimulation of the proprioceptor.Major Goal – Restore or enhance postural responses or normal patterns of motion.
3Basic Neurophysiologic Principles of PNF Diagonals of Movement Innate path in which maximal response of the trunk and extremities can be facilitated.Components associated withantagonistic motion:Flexion versus extension.Abduction versus adduction in extremities and lateral movement of trunk.Internal vs. external rotation.
4Reflects functional relationship of trunk Normal coordinated patterns of motion are diagonal in direction with spiral components – Facilitate strongest output.Reflects functional relationship of trunkand extremities.Diagonals may be used to identify:Quality of contractionsRange of motionFunctional impairments/limitations
5Motor Development PNF is based on 11 principles drawn from: NeurophysiologyMotor learningMotor behavior
6Examination and Evaluation Assessed Areas: Impaired ROM and muscle lengthImpaired muscle powerImpaired muscle enduranceImpaired balanceImpaired postureImpaired motor controlPain
7Factors Included During the Evaluation Patient’s short-term and long-term goals.Patient’s receptive potential for language, vision, and manual contacts to promote cuing.Patient’s strengths.Patient’s weaknesses.
8Treatment Implementation Treatment interventions may include:Modification of environmentEducation and compensation for the impairmentTreatment directed at changing the patient’s neuromuscular capabilities
9Patterns of Facilitation Manually resistive exercises that create the diagonals of movement by coupling pairs of antagonistic patterns, providing a path for reversing motions, and using the agonist–antagonist relationship of the nervous system as techniques are applied.
10Procedures Body positioning and mechanics Manual contacts Manual and maximal resistanceIrradiationVerbal and visual cuingTraction and approximationStretchTiming
11Body Positioning and Mechanics Be positioned in the diagonal plane or treatment plane whenever possible.Shoulders and hips face toward direction of movement.Forearms in this plane is important.
13Manual ContactsUse contacts overlying agonist muscle group to strengthen contractions and/or direction of movement.Use lumbrical grip to provide contact.Contact the target group (direct effect) or synergist or antagonist (indirect).
14Manual and Maximal Resistance Resistance to motion enhances muscle activation.Direction, quality, and quantity of resistance are adjusted according to treatment goals.Resistance should be no greater than the resistance that allows full ROM.
15Irradiation (Overflow) Spread of energy from agonist to complimentary agonists and antagonists within a pattern.Irradiation is stimulated through clinician’s use of resistance.Weaker muscle groups benefit while working in synergy with more normal partners.
16Verbal Cuing Should be clear and concise. Begin by detailing a particular patient response.Change to more simple cues for subsequent repetitions.Alter tone according to goal (e.g., soft voice for inhibition)
17Approximation and Traction Stimulates receptors to facilitate co-contraction and stability around the joint.Employed through the use of weight-bearing developmental postures.Traction is commonly used with pulling movements to inhibit compression.
18StretchOften performed at the starting position of a pattern or movement.Result – Reflex activation.Resistance through entire range provides continued stretch through tension.Stretch can be repeated at start of range or superimposed during a pattern.
19Techniques of Facilitation Rhythmic initiationRepeated contractionsReversals of antagonistsDynamic reversals of antagonistsStabilizing reversals6. Rhythmic stabilization7. Hold and relax8. Contract and relax9. Combination of isotonics (dynamics)
20Uses of Rhythmic Initiation Initiate movement.Define the direction or pattern of movement.Set the appropriate rate of movement.Improve coordination and sense of motion.Promote general relaxation.
21Uses of Repeated Contractions Help to initiate movement.Strengthen agonist movement pattern from lengthened range.Strengthen agonist movement pattern within available ROM.Redirect motion within pattern or task.
22Use of Reversals of Antagonists To facilitate agonist.Improve balance between agonist and antagonist.
23Use of Dynamic Reversals of Antagonists Increase active ROM.Improve strength in the available ROM.Improve balance and coordination of antagonist.Improve endurance of antagonistic patterns.
24Use of Stabilizing Reversals Improve balance and stability.Improve strength.Integrate a new posture or ROM into function.
25Use of Rhythmic Stabilization Improve strength of antagonists.Improve balance of antagonists.Improve stability.Increase active and passive ROM following technique.Decrease pain.
26Use of Hold and RelaxImprove PROM.Provide relaxation.Reduce pain.
27Use of Contract and Relax Improve passive ROM.Provide relaxation.
28Use of Combination of Isotonics Increase strength of agonist.Increase active ROM.Teach functional control.
29SummaryPNF is a manual therapy approach that applies postures, movement patterns, contacts, cues, and goals. All = Maximally facilitating.Treatment is based on improving function, and using functions that are possible to reach those are attainable goals.PNF lends itself to use as an adjunct to other treatment approaches.