PTA 202- PNF Techniques

Facilitates muscle co-contraction All joints, including the spine must be properly aligned Enhances function in weight bearing postures Enhances stabilization

Approximation

Synergist patterns are _________ and _________ rather than straight plane to mirror normal movement

rotational, diagonal

Contraindications to PNF include ____________________ or any other unstable medical condition.

significant pain, unstable joints, fractures,

Alter normal ________ using resistance to enhance a more localized contraction and to ___________ a particular component within the pattern

timing emphasize

Rhythmic Initiation: 4 Phases of training 1. ________________ Relax "let me move you" Establish appropriate speed and rhythm using verbal commands 2. __________ "now help me move you" 3. ________ "Now move on your own" 4. ________________ Resistance is used to enhance movement....not prevent it! Transitions between phases are smooth and continuous

1- Passive ROM 2- AAROM 3-AROM 4-Resisted Movement

Verbal Cues and Commands: ______________ Action VCs: guide the patient through the movement Corrective VC: provide augmented feedback to help the patient modify movements Summary VCs

Associative

_____________ refers to a reduction in excitability of a contracting or stretched muscle, that in the past has been solely attributed to the increased inhibitory input arising from Golgi tendon organs (GTOs) within the same muscle.

Autogenic inhibition

Verbal Cues and Commands: Clear, concise, well timed to the patient's movements Cues and commands ______________ stage: Preparatory VCs: Ready the patient for movement

Cognitive

Utilizes concentric, isometric, and eccentric contractions of agonist muscles without loss of tension Transition with resistance from concentric to isometric Cues like "push" or "pull" to "don't let me move you" Progress to "now slowly let me win.." as you move into eccentric

Combination of Isotonics

-Patient actively moves into pattern. -If range restriction is present (tight antagonist), therapist resists a strong contraction of the limiting musculature. -The antagonist contraction is held for 5-8 seconds -Then return to movement into the agonist pattern into the new range -Autogenic inhibition will cause the antagonists to relax and decrease range restriction -Moving into the agonist pattern further enhances relaxation of antagonists via reciprocal inhibition

Contract-Relax

Reversals of Antagonists: Two techniques that allow for agonist contraction followed by antagonist contraction without pause or relaxation

Dynamic Reversals Stabilizing Reversals

Reversals of Antagonists: Smooth reversals of antagonists -FIRST: the therapist resists contraction of one pattern (i.e. UE D1 flexion). At the end of the range, a preparatory command is given to reverse direction. -The therapist switches hand placement to resist the opposite pattern (in this case UE D1 extension). -If an imbalance exists, the stronger pattern is performed first. -If there is difficulty with transition from agonist to antagonist (by pt...not therapist), you can incorporate a hold at the end of the pattern and progress to decrease time and smooth transition -Indications: Impaired strength, range, and coordination, inability to easily reverse directions between patterns, and fatigue

Dynamic Reversals (Isotonic Reversals)

Appropriate Resistance: Resistance is applied manually to contracting muscles Light resistance to weaker muscles Used to promote relaxation of antagonists by ______________

Reciprocal inhibition

Performed in a position of comfort and below the level that causes pain Patient actively moves the limb in the pattern to the end of pain-free ROM (Agonist contraction) A strong isometric contraction of the restricting muscles (antagonist) is resisted (providing autogenic inhibition . Follow with voluntary relaxation and passive movement into the newly gained range of agonist pattern

Hold-Relax

The following are __________ for PNF techniques: Decrease tone Relax Increase initiation of movement Uncoordinated movement Motor planning or motor learning deficits

Indications

______________ and reinforcement is more commonly known as overflow. Stronger motor units facilitate weaker units. This occurs ipsilaterally, and contralaterally, from the extremities to the trunk, from the trunk to the extremities. It requires an appropriate level of resistance to produce the overflow response. *Important*: Enhances strength or contraction and synergistic muscle activity

Irradiation

Appropriate Resistance: Resistance used in PNF can be __________ (concentric or eccentric) or ___________ depending on the needs of the patient, the strength of the muscles at any given portion of the pattern.

Isotonic Isometric

__________ uses functionally based diagonal patterns of movement with special techniques of facilitation to improve ______________ and learning and ultimately improve ____________.

PNF motor control function

Prolonged Holds: Irradiation achieved through the application of _______________ involves a sustained prolonged hold of phasic muscles leading to a spread of activation of tonic (stabilizing) muscles. Prolonged hold results in shaking of the phasic muscle as it fatigues. When this occurs, core stabilizers will engage (related to irradiation)

Phasic Shakes

Verbal Cues and Commands: ____________ instructions are given to the patient, helping them know what they are to do, these are accompanied by demonstration and guided movement to make sure that the patient knows what is expected. These cues are teaching the patient the pattern. Additional cues are given as the patient moves through the patterns to help them learn how and when to move, correcting their performance as needed.

Preparatory

Overall goal ________________ for distal controlled mobility Patterns can be unilateral or bilateral

Proximal stability

Use of the stretch reflex to facilitate muscle activity, initiate movement __________________ tends to increase motor unit recruitment and response Also used to facilitate existing contractions to increase motor unit recruitment Prolonged stretch tends to decrease motor activity *Note*: Usually begins in an elongated position and is used to facilitate the pattern.

Quick Stretch

_______________ describes the process of muscles on one side of a joint relaxing to accommodate contraction on the other side of that joint. ... Joints are controlled by two opposing sets of muscles, extensors and flexors, which must work in synchrony for smooth movement.

Reciprocal inhibition

Repeated isotonic contractions directed to the agonist muscles, initiated by a quick stretch and enhanced by resistance Dynamic The technique is used throughout the motion at weak places to increase motor recruitment Strengthens weak agonist components of a pattern BE CAREFUL and alert to allow sufficient time for a patient response

Repeated Stretch (Repeated Contraction)

Position patient in the end position (shortened range) of the agonist Have patient hold and perform an isometric contraction with resistance "Don't let me move you" Have patient relax and move the patient passively into lengthened position "now let me move you back" Finish with patient performing active range into end position with quick stretch and tracking resistance throughout. Repeat with increasing ROM each time

Replication (Hold Relax-Active Motion)

Promote learning of a new movement, improve intra and intermuscular coordination, promote relaxation and independent movement

Rhythmic Initiation

Passive or active Rotation of a limb or body segment Start with available range and gently increase the range as the muscles relax Rotations should be performed with slow, rhythmic motion Indications Relaxation of spastic or rigid muscles

Rhythmic Rotation

Reversals of Antagonists: Improve stability (co-contraction), strength, endurance, ROM, intra and intermuscular coordination, promote relaxation and decrease pain Isometric contractions of antagonist patterns, focusing on co-contraction of muscles Apply resistance in opposing directions to 2 segments simultaneously (Posterior resistance to anterior shoulder and Anterior resistance to pelvis)

Rhythmic Stabilization

Prolonged Holds: ________________ is the strong or efficient segment where resistance is applied to facilitate increased neuromuscular output elsewhere (i.e. irradiation, overflow)

Source Segment

Reversals of Antagonists: Use alternating isometric contractions with stabilizing holds of first agonists ("hold this position, and don't let me move") against resistance. A LOW load resistance is applied SLOWLY Build the resistance (can incorporate traction or approximation) Once a stabilizing contraction is achieved by the patient, the therapist slowly reduces resistance load on agonist side while increasing on antagonist side If an imbalance exists, the stronger side is performed first

Stabilizing Reversals (Isometric Reversals)

Prolonged Holds: _______________ is the segment with an inefficient muscular response that will benefit from irradiation from another segment of the body

Target Segment

Prolonged Holds: Uses irradiation from the stabilizing muscles of one segment to tonic stabilizing muscles of a different segment (I.E. Irradiation from the pelvic/hip tonic stabilizers to the trunk) Initial resistance to the source segment must be applied SLOWLY and with a LOW load. As the therapist perceives a building muscular response at the source segment, resistance is slowly increased. Leads to improved dynamic stability through the direct facilitation of tonic stabilizing muscles

Tonic Spread

____________ can be applied throughout the arc of motion. It facilitates muscle response. Carrying a heavy object causes distraction of the glenohumeral joint and ___________ on the cuff muscles. This stimulates a reflex contraction of the rotator cuff. Similarly __________ of the extremity causes joint receptors to fire and reflex contraction of proximal stabilizers.

Traction

Prolonged Holds: True or false: Phasic Shakes are more commonly used with orthopedic population because its challenging and requires prolonged holds

True

Both intrinsic and extrinsic feedback is essential to motor learning. ______________ has been shown to improve performance, enhance contraction of muscles and ultimately improve motor control and function. The patient should be taught to follow the distal segment throughout the pattern with their eyes and head.

Visual Input

Manual Contacts: Generally, hands are placed over the __________ muscles to facilitate and promote movement. It requires coordination, smooth transitions of hand placement by the therapist.

agonist

It is absolutely imperative that the therapist be positioned appropriately. -Positioned Along Diagonal Planes - in line with the desired motion -Maintain wide Base of Support (BOS) -Resistance applied through _________________

body weight, not upper extremity

Key Components Emphasis on functional outcomes Techniques to facilitate and enhance _________________

coordinated muscle activity

Sequencing of muscle activity to ensure smooth coordinated movement Proximal stability for distal mobility - thus _____ stability of the trunk is a basic requirement

core

People need to be able to perform synergistic movements which require proximal stability for ______ ___________________________________.

distal controlled mobility

For extremity patterns, normal timing is from _________________. Distal segments like the hand or foot begin the movement, followed by rotation and then the proximal component. Rotation continues smoothly throughout the pattern.

distal to proximal

Patient Position Change in position to enhance segments of the pattern and facilitate ________________ demands

increased postural

Patient Position If the therapist is attempting to achieve greater contraction of the muscles by using a quick stretch, placing them in a ___________ position first provides the best stretch responses. Various positions can be used to make it easier or harder for the patient or to work on specific segments of a pattern or proximal stability.

lengthened

Manual Contacts: -Therapist uses a "__________ grip"

lumbrical

Patient Position It is important to position the patient in good alignment with support based on deficits. Muscle positioning at optimal ranges of function for _________________ will enhance the outcomes of the therapy.

maximal contraction

Patient Position Good alignment and support Length tension relationships Greatest muscle tension generated in ______________ Weak contractile forces in shortened ranges Lengthened ranges provide optimal stretch responses

mid-range

When used correctly, especially in the *developmental or foundation positions*, approximation facilitates _________________. It enhances function and stabilization. When applied through the spine, it can facilitate stabilization and co-contraction of muscles of the trunk promoting extension and proximal stabilization at the hips.

muscle co-contraction around a joint

Selecting the appropriate patterns of movement for your patient. These patterns are used for higher level patients with both __________ and __________ impairments. Which patterns are seen here?

orthopedic neurologic D1 Flexion and Extension

Key Components Use of developmental postures and transitions to facilitate and enhance coordinated muscle activity Use of _____________ patterns of movement

synergistic