Neurofacilitation Techniques

Question 1

What is neuro-facilitation?

Answer 1

To promote normal movement patterns through application of sensory stimulation by the therapist

Question 2

What are the 4 theories of neuro-facilitation?

Answer 2

1. Brunnstorm
2. Bobath (NDT)
3. PNF
4. Rood

Question 3

List 5 similarities between the four theories of neuro-facilitation.

Answer 3

1. Developed in the 1940s and 1950s
2. Based on reflexive and Hierarchical models
3. Augmentation / Manipulation of sensory inputs
4. Emphasize developmental and biomechanical sequence
5. Philosophy to move away from primitive, reflexive or synergistic movement to skilled, volitional, isolated movement

Question 4

What is the basis of Margret Rood’s theory of neuro-facilitation?

Answer 4

Use of sensorimotor stimulation to facilitate muscle activity during movement/attempts to move.

Question 5

What receptors did Rood believe in stimulating for light work? Examples?

Answer 5

Exteroreceptors for light work —upper extremity—open chain such as reaching, wrist extension

Examples: Stimulating afferent nerves through stroking, brushing, icing, warmth, pressure & vibration to increase muscle activation

Question 6

What receptors did Rood believe in stimulating for heavy work? Examples?

Answer 6

Proprioceptors for heavy work—closed chain tasks

Examples: Stretch, resistance, positioning, joint compression & joint distraction used to stimulate reflexes

Question 7

What are Rood’s 4 stages of motor control?

Answer 7

1. Mobility—mass (synergistic) patterns (flexion and extension)
2. Stability (co-contraction) —facilitation postural control
3. Controlled mobility (isolated movement)
4. Skill—stable proximal to allow distal aspect of limb to move

Question 8

Rood’s techniques follow normal ______ patterns and include _____ and ____ techniques to help normalize ______.

Answer 8

1. Neurodevelopmental
2. Facilitation
3. Inhibition
4. Muscle tone

Question 9

What is the normal neurodevelopmental pattern of movement followed by Rood?

Answer 9

Pivot prone> quadraped> kneeling>stance>gait

Question 10

Provide 2 examples of facilitation and inhibition techniques promoted by Rood’s theory of neuro-facilitation.

Answer 10

1. Working out of extensor patterns through full flexion trunk
2. Utilizes rolling to facilitate lateral trunk control to promote movement upper & lower extremity into flexion

Question 11

What did Signe Brunnstrom encourage during early recovery from neurological impairments? What was used to promote movement?

Answer 11

1; Encourages flexor/extensor synergy patterns during early recovery

2. Use of reflexes, associated reactions, and mass synergies to promote movement (any movement is good)

Question 12

Brunnstrom promoted use of ______ to assist in movement of involved limb for desired outcome. This technique preceded _____ techniques.

Answer 12

1. Uninvolved limb

2. Bi-manual techniques

Question 13

What belief is a limitation of the Brunnstrom theory of neuro-facilitation?

Answer 13

Belief that can “break out” of these synergy patterns by then facilitating antagonist of synergy

Question 14

List the 5 techniques that combine to form the Brunnstrom theory of neuro-facilitation.

Answer 14

1. Proprioceptive stimulation (Rood)
2. Exteroceptive stimulation (Rood)
3. Resistance is often applied to uninvolved limb to promote overflow to involved
4. Push/pull technique upper ext/ flex to facilitate trunk and LE extension
5. Emphasis on postural stability

Question 15

What 2 things did Karel and Berta Bobath emphasize in their neurodevelopmental technique (NDT)?

Answer 15

1. Handling techniques to normalize tone, inhibit primitive(reflexive) movement patterns (RIP)
2. Promote normal movement patterns as believes continuous use of primitive movement patterns will become “habit” at the expense of normal pathways

Question 16

The Bobaths emphasized that _____ is key in promoting normal muscle activity.

Answer 16

ALIGNMENT

Question 17

Provide an example using reflex inhibiting postures (RIPs) to inhibit UE flexion synergies.

Answer 17

Inhibiting UE flexor synergy by placing the patient a position of extension/ER

Question 18

What was the treatment emphasis of Bobath (NDT)?

Answer 18

Placing/Holding for co-contraction during early stages of recovery

(Place the patient in specific position and then having the patient hold this position on their own)

Question 19

______ is one way of promoting proximal stability and bilateral symmetry of the limbs.

Answer 19

Weight bearing

Question 20

____ with ____ allows distal joints to stabilize and promote proximal mobility

Answer 20

Weight bearing with Weight shifting

Question 21

PTs should encourage the use of the _____ to prevent compensation.

Answer 21

Affected side

Question 22

True or False: There is fair evidence for the effectiveness of using NDT in balance training in acute, subacute, and chronic stroke pts.

Answer 22

TRUE

Question 23

True or False: There is fair evidence to support NDT for improvement in UE motor function and quality of life in acute and subacute stroke pts.

Answer 23

TRUE

Question 24

There is limited evidence that NDT improves ____.

Answer 24

Quality of gait

Question 25

Who are the 3 founders of PNF?

Answer 25

Herman Kabat
Maggie Knott
Dorothy Voss

Question 26

List 6 things emphasized by the PNF theory of neuro-facilitation.

Answer 26

1. Mass patterns
2. Functionally based
3. Manual contact on muscle
4. Maximum resistance through ROM
5. Use of stretch to facilitate
6. Use of distraction and approximation

Question 27

PNF incorporates Rood’s _____.

Answer 27

4 stages of motor control

mobility, stability, controlled mobility, skill

Question 28

List 3 interventions for which PNF is superior in improving balance, gait and postural control.

Answer 28

1. Planar strengthening exercises
2. Un-resisted static balance training
3. Body weight supported treadmill training (BWSTT)