PNF

Question 1

what is PNF?

Answer 1

proprioceptive neuromuscular facilitation

combines the function based diagonal patterns with techniques to facilitate the neuro motor units to improve muscle control and function

Question 2

PNF can be used to improve/develop:

Answer 2

1. Muscular strength
2. Muscular endurance
3. Stability
4. Mobility
5. Neuromuscular control
6. Coordinated movement
7. Foundation for restoration of function

Question 3

how can PNF be modified for various levels of difficult?

Answer 3

Beginning with PROM → isometrics → active assisted movement → higher velocity resisted movements

Question 4

Define overflow (irradiation)

Answer 4

spread of a muscle response from stronger to weaker muscles

primarily achieved through applying resistance

Question 5

what is the role of manual contact in PNF?

Answer 5

stimulates the muscle to reinforce the movement AND guide the direction of the movement

Question 6

where should the PT be positioned during PNF?

Answer 6

directly in line with the desired motion

should be facing the direction of the desired movement

Question 7

what are the component of cueing in PNF?

Answer 7

1. Verbal cues → both preparatory as well as energetic, strong and active verbal cues during movement when requiring strong recruitment
2. encouraging visual attentiveness by the patient → watching distal segment in mirror
3. timing → encouraging movement of distal segment first, then moving proximal; rotation occurs throughout the entire movement
4. resistance → facilitates the contraction by recruiting motor units

Question 8

List several specific PNF techniques

Answer 8

1. Diagonals
2. Lifts
3. Reverse lift
4. Chop
5. Reverse Chop
6. Quick stretch
7. Rhythmic initation
8. Alternating isometrics
9. Rhythmic stabilization
10. Dynamic reversals

Question 9

what are the different diagonal PNF patterns?

Answer 9

D1 flexion and extension

D2 flexion and extension

(for both UE and LE)

Question 10

describe D1 UE flexion

Answer 10

starting in D1 extension, then “the seatbelt”

1. shoulder flex, add, ER
2. forearm supination
3. wrist radial deviation
4. fingers flexed

Question 11

describe D1 UE extension

Answer 11

start in D1 flexion then:

1. shoulder ext, ABD, IR
2. forearm pronation
3. wrist ulnar deviation
4. fingers extended

Question 12

describe D2 UE flexion

Answer 12

start in D2 extension then “pull sword out”

1. shoulder flex, ABD, ER
2. forearm supination
3. Wrist radial deviation
4. fingers extended

Question 13

describe D2 UE extension

Answer 13

Start in D2 flexion then “put sword back in sheath”

1. shoulder ext, ADD, IR
2. forearm pronation
3. wrist ulnar deviation
4. fingers flexed

Question 14

describe D1 LE flexion

Answer 14

Start in D1 LE extension and think “kicking soccer ball”

1. Hip flex, ADD, ER
2. DF
3. Inversion
4. Toes extended

Question 15

Describe D1 LE extension

Answer 15

Start in D1 flexion and think “winding up to kick”

1. Hip ext, ABD, IR
2. PF
3. Eversion
4. Toes flexed

Question 16

Describe D2 LE flexion

Answer 16

Start in D2 LE Extension, think “dog peeing on hydrant”

1. Hip flex, ABD, IR
2. DF
3. Eversion
4. Toes extended

Question 17

Describe D2 LE extension

Answer 17

start in D2 LE flexion, think “ballerina pose”

1. Hip ext, ADD, ER
2. PF
3. Inversion
4. Toes flexed

Question 18

When are lifts, reverse lifts, chops, reverse chops used?

Answer 18

when you want the patient to perform the motion but their involved limb is too weak so they need to use their other arm to perform the motion (AAROM)

Question 19

what pattern is the involved limb going through when performing a lift and reverse lift?

Answer 19

1. Lift
   
   • involved limb → D2 extension to D2 flexion
2. Reverse lift
   
   • involved limb → D2 flexion to D2 extension

Question 20

what pattern is the involved limb going through during a chop and reverse chop?

Answer 20

1. Chop
   
   • involved limb → D1 flexion to D1 extension
2. Reverse chop
   
   • involved limb → D1 extension to D1 flexion

Question 21

what is rhythmic initiation, when is it used and what are it’s goals?

Answer 21

1. used to promote the ability to initate a movement pattern
2. utilized for trx of dysfunctions which affect initiation, speed, direction, or quality of contraction
3. Goals → allow the pt to become familiar w/sequence of movement and the rate at which movement is to occur

Question 22

Describe the technique for rhythmic initation (the 4 steps)

Answer 22

1. therapist moves pt passively through pattern
2. therapist asks pt to perform active assisted movement
3. active movement
4. active movement against manual resistance

Question 23

list some indications for rhythmic initation

Answer 23

1. improve coordination
2. potentially used to “break up tone”
3. improve motor planning
4. beneficial to ppl who respond better to tactile than verbal cues

Question 24

Describe alternating isometics

Answer 24

Manual resistance is applied in a single plane on one side of a body segment and then on the other

• pt instructed to “hold” his/her position as resistnace is alternated from one direction to the opposite direction
• no joint movement should occur
• Procedure isometrically strengthens agonist and antagonist
  
  • can be applied to one/both extremities simultaneously, or to trunk
• can be applied in WB or nonWB positions

Question 25

how is rhythmic stabilizations different from alternating isometrics?

Answer 25

alternating isometrics only applies force from one direction and the pt knows which direction it will be coming from. rhythmic stabilizations apply forces from all directions quickly (like perturbations) this is way more challenging as the force is multi-directional

Question 26

Describe the technique for rhythmic stabilizations

Answer 26

co-contractions of agonist and antagonist performed by placing hands on opposite sides of body and applying simultaneous resistance no motion is allowed shift hand placement opposite to the muscles you were just recruiting

Question 27

List some indications for rhythmic stabilization

Answer 27

1. progression from alternating isometrics 2. impaired strength and coordination 3. pt can work through limited ROM 4. appropriate for pts who have issues with postural stability and balance 5. appropriate for pts with decreased stability at a given joint 6. can provide PT info on pt's ability to reinforce and maintain contractions

Question 28

what are dynamic (slow) reversals?

Answer 28

agonist → antagonist contractions eliciting bidirectional movement from patient switch hands at the end of each movement

Question 29

List other PNF techniques

Answer 29

1. Fast/quick stretch 2. Repeated contraction/stretch 3. Dynamic (slow) reversal hold 4. Agonist reversals

Question 30

what are agonist reversals?

Answer 30

reversing the type of contraction and always working concentrically, isometrically, or eccentrically. you work the same muscle in both directions but switch the type of contraction