PNF uses
Frequency & repetition are used to promote & retrain motor learning & strength development / endurance.
Goal directed activities are used by applying facilitation techniques with ADLs.
-multisensory approach: cues brief/clear. Strong/sharp tone used when max stim of motor response desired. Use soft tone when encouraging smooth movement.
Visual stimuli: pt visually track in direction of movement. Help pt initiate and coordinate movement.
Tactile: use to guide & reinforce pattern of movement desired, keeping it normal as possible.
Practice for speed/accuracy.
PNF (proprioceptive neuromuscular facilitation)
- normal motor development proceeds orderly pattern, but not step by step
- early motor behavior is dominated by reflex activity
- establish a balance between antagonists
- improvement in motor ability depends on motor learning
- use facilitation tech applied to ADLs to improve fun
PNF Common Techniques
-Traction: gentle pull to separate jt surfaces; promotes jt movement. IE: carry briefcase
*contraindication:, subluxation.
- Approximation: Compress jts (WB),
promotes stability & postural control. Can do WB with subluxation. WB is resistive activity.
- Max resistance: apply greatest resistance to an active contraction while still allowing full ROM
- Stretch: hold at max lengthened position but avoid pain then relax.
- Rhythmic initiation: passive then progressive to active, to resistive.
- Diagonal patterns: require crossing midline, strengthening, rotation is facilitated
NDT (Neurodevelopmental Treatment)
Goals:
- Normalize tone
- Inhibit primitive patterns of mvmt.
- Facilitate automatic reactions
- Quality more important than quantity, if abnormal quality of mvmt seem, stop pt & reposition properly
- Positioning
- Bilateral activities
- Discourages compensatory techniques
- Focus on relearning normal tone
- Guide affected UE in activities
NDT facilitative techniques
Quick stretch Resistance Light touch Traction Vestibular stim
NDT inhibiting techniques
Prolonged stretch
Compression
Firm pressure
Rhythmic rocking
NDT Proper Positioning
Good alignment: normalize, prevent deformity, promotes function.
- Position in bed on affected side, bottom leg extended, top leg flexed, pillow between, bottom affected arm flexed at elbow up under head pillow area
- If sitting, both feet flat on floor, pelvis anterior tilt, head in midline.
- If standing: weight should be symmetric and head should be in midline
- Scapula should be in protraction prior to raising affected arm or hand
NDT positioning techniques
Weightbearing over affected side helps normalize tone in arm. Do not use with pain or edema.
Prepare shldr for WB with scap mobilization.
Separation of upper trunk and lower trunk: promotes weight shift to affected side, introduces activities that involve rotation, elongation/ shortening both sides
Scap protraction: glide into forward protraction b/f raising arm.
Ant pelvic tilt is for proper alignment of pelvis, shldr, head. Poor pelvic alignment increases flexor synergy. Must reposition pelvic tilt properly prior to any activity
PNF: difference between Traction & Approximation
Traction: promotes movement
Approximation: compresses jt to promote stability
