PNF Test One Flashcards
(176 cards)
0
Q
Who started the idea of rhythmic movement?
A
Herman Kabat
1
Q
What disease did PNF start to be formed because of
A
POLIO epidemic
patients losing strength and getting contractors –anterior horn cells
post polio syndrome causing issues
2
Q
Who was the former of PNF?
A
Margaret Knott PT
Herman Kabat MD
3
Q
What did Dorathy Voss do
A
helped with education in treatments of patients in Vallejo in 1952
4
Q
what year did Voss teach PNF in vallejo
A
1952
5
Q
When did knott write his first book
A
1956
6
Q
training program in vallejo
what year
A
1952
7
Q
Who wrote a book in 1956
A
Voss and Knott
8
Q
Whose book was published in 1985
A
Voss
third edition
9
Q
What did Voss add to PNF
A
third edition of book in 1985 she added developmental sequence
(like bobath and brunnstrom)
10
Q
Who was Greg Johnson
A
he learned directly from Knott and learned her approach and philosophy
he then developed through the Institute of Physical Art
11
Q
What is learn, earn and return?
A
go to vallejo and work and make money in PNF and then go home and use it at home to spread the philosophy to the world
12
Q
PNF definition
a system of ___ designed to use the ____ system, the ___, to influence the _____ outcome
A
a system of exercise designed to use the neuromuscular system, the proprioceptiors, to influence the movement outcome
(not necessarily facilitate because sometimes we inhibit)
13
Q
Definition of PNF
A
a system of exercise designed to use the neuromuscular system, the proprioceptiors, to influence the movement outcome
(not necessarily facilitate because sometimes we inhibit)
14
Q
Is the goal of PNF to facilitate movement outcomes?
A
NO
NOT necessarily facilitate because sometimes we INHIBIT
It is a system of exercise designed to use the neuromuscular system, the proprioceptiors, to influence the movement outcome
15
Q
What is the purpose of PNF?
A
to improve functional carryover and tap into the patient’s untapped potential
Evaluate the entire patient, not only an extremity or the trunk, and use what they have to get a better outcome
16
Q
The two purposes of PNF
A
to improve functional carryover and tap into the patient’s untapped potential
Evaluate the entire patient, not only an extremity or the trunk, and use what they have to get a better outcome
17
Q
How do we improve functional carryover and tap into the patient’s untapped potential?
A
Evaluate the entire patient, not only an extremity or the trunk, and use what they have to get a better outcome
18
Q
What are the functional principles of PNF
A
- qualitative analysis of normal movement patterns
- integrative approach: memory, musculoskeletal, and physiological
- Keen observation by therapist proceeds problem solving
- set well defined goals and have the intention to reach them, involve the patient
- Goals are function oriented and treatments are goal specific
- facilitate whole skill learning via a learning sequence
- work parts in isolation and as part of a whole skill
- follow the principles of motor learning
- active role of patient and therapist
- address posture and movement
19
Q
PNF is a qualitative analysis of what?
A
PNF is a qualitative analysis of movement patterns
goal of PNF: restore of diagonal smooth reciprocal spiral types of patterns for normal ADL
20
Q
Goal of PNF is to restore what?
A
Goal of PNF is to restore of diagonal smooth reciprocal spiral types of patterns for normal ADL
21
Q
PNF is an integrative approach that uses what three elements?
A
- sensory
- musculoskeletal
- psychological (motivation, relax)
22
Q
Why does PNF require keen observation of PT?
A
keen observation of the therapist proceeds problem solving
every tx is an eval and every eval is a tx and
23
Q
What needs to be set for PNF?
A
set well defined goals and have the intention to reach them, involve the patient
24
What kind of goals are made in PNF? What kind of treatments?
goals are function oriented
treatments are goals specific
25
How does PNF facilitate whole skill learning?
Facilitate whole skill learning via a learning sequence
--start with an isolated part and work towards a full sequence
we can jump to any part we want in this sequence
26
What is the developmental sequence, do we use it in PNF?
the developmental sequence was:
1. baby start head control
2. body control
3. learn roll
4. on hands and knees
5. hold onto couch
6. half kneel
7. stand
8. cruise around furniture
9. walk
IN PNF WE USE LEARNING SEQUENCE
27
Define learning sequence
we can jump into any part we want in the developmental sequence
28
T/F
| PNF works in isolation
PNF works in isolation and as part of a whole skill---incorporate a functional task
need repition to promote motor memory--to self correct
need reciprocation for function
29
PNF works in isolation and as part of a whole skill---incorporate a functional task
what two things does it need?
need reptition to promote motor memory--to self correct
| need reciprocation for function
30
Why does PNF need repetition?
to promote motor memory--to self correct
31
Why does PNF need need reciprocation?
need reciprocation for function
32
How does PNF follow the principles of motor learning?
feedback
| knowledge of performance, tone of voice--relaxed vs recruit motor units
33
Who is active in PNF?
active role of patient and therapist
patient will need to be able to follow command
knowledge of performance and results
34
Does PNF address posture and movement?
we always address the best possible posture
ortho, neuromuscular, cardiopulm
35
Irradiation—
overflow: motor unit recruitment, in response to effort already occurring
a spreading and increased strength of a response that occurs when either the NUMBER OF STIMULI or the STRENGTH of the stimuli is increased.
The response may be either excitation or inhibition.
36
What causes irradiation
a spreading and increased strength of a response that occurs when increase
1. NUMBER OF STIMULI
2. STRENGTH
The response may be either excitation or inhibition.
37
What is response of irradiation
The response may be either excitation or inhibition.
38
Successive Induction:
If have a muscle contracting, using the opposite will have facilitation due to that prior contraction
an increased excitation of the agonist muscle follows stimulation (contraction) of their antagonist.
Techniques involving reversals of agonists make use of this property (induction: stimulation, increased excitability.)
anterior elevation of scapula will help me make a better posterior depression
39
In successive Induction how do we facilitate a muscle contraction?
If have a muscle contracting, using the opposite will have facilitation due to that prior contraction
stimulation (contraction) of antagonist to facilitate increased excitation of the agonist muscle
40
Scapula example of sucsessive induction:
anterior elevation of scapula will help me make a better posterior depression
41
Reciprocal Innervation/Inhibition:
when agonist contracts the antagonist has to relax
contraction of muscles is accompanied by simultaneous inhibition of their antagonists. Reciprocal innervation is a necessary part of coordinated motion.
Relaxation techniques make use of this property.
In Parkinson’s, have them flex elbow, it is difficult because of high tone in biceps and triceps, we want to help with rhythm of movement to help relax overall tone to get the biceps to contract and triceps to relax
42
Types of Muscle Contractions
1. Isotonic
Concentric:
Eccentric:
Maintained isotonic: blocked isotonic, patient does directional movement and therapist resists—pt intention is to be moving
2. Isometric: no movement, intention is to hold
1. Tell patient to match my resistance
43
Concentric contraction
shortening , origin and insertion get closer (pull, push)
44
Eccentric
Eccentric: lengthening, origin and insertion get further apart (lower)
45
Maintained isotonic
Maintained isotonic: blocked isotonic, patient does directional movement and therapist resists—pt intention is to be moving
the intent of the patient is motion, the motion is prevented by an outside force, usually by resistance
46
Isometric
Isometric: no movement, intention is to hold
| --Tell patient to match my resistance
47
Graph isometric:
gradually build force and gradually let off the force—command is “hold”, we are not looking for movement [rhythmic stabilization, hold relax, contract relax, slow reversal hold relax]
48
Graph maintained isotonic
: maintain the resistance, they feel like they are trying to go in a certain direction, and we aren’t allowing it “keep pushing, keep pulling, keep going” [basic technique of timing for emphasis] [special technique combination of isotonic: use concentric, eccentric and maintained isotonic: combination of isotonic, contract relax, slow reversal hold relax]
49
What are the 9 basic techniques?
1. body position and body mechanics
2. manual contacts
3. appropriate resistance
4. verbal commands
5. stretch
6. traction or approximation
7. vision
8. timing
9. pattern
50
Body position and body mechanics:
BASIC TECHNIQUE
the position and body mechanics of therapist and patient
PT proper body positioning an mechanics to provide specific/well-aimed guidance for better control motion, movement, or stability
51
Manual Contacts
BASIC TECHNIQUE
used to increase power and guide motion or movement with proper grip and pressure
- Using lumbrical grip
- TELLS THE PATIENT WHERE TO GO
52
Appropriate resistance:
BASIC TECHNIQUE
appropriate to the task (NOT maximal)
- --Appropriate to patient and appropriate to task
- --Endurance: light resistance, strength: heavy resistance
—ie to do strength building, do a task to train the muscle and add more and more weight with less reps 70% of 1 rep max 5 reps, if building endurance lower resistance so more reps
53
Verbal commands:
BASIC TECHNIQUE
use of words and the appropriate vocal volume to direct the patient
light and easy vs strong and forceful
only use key words, minimal words ie. Hold, push
54
Stretch
BASIC TECHNIQUE
BASIC TECHNIQUE
the use of muscle elongation and the stretch reflex to facilitate contraction and decrease muscle fatigue
quick stretch on a tendon for a spinal cord reflex for a quick response, help initiate a movement, redirect a movement, and sustain a movement.
Stretch must be accompanied by a verbal command—pull into my hand, pull into my hand—needs to be times with a specific verbal command and needs to be followed by a resistance right after the stretch
Tapping into monosynaptic stretch reflex, resistance immediately after the stretch to tap into the alpha motor neuron system—muscle proprioceptive level for alpha motor neuron for the fibers to respond to stretch and for the contraction of the muscle
Initiate movement, redirect movement, help patient get to end of range
55
STRETCH: how do we apply it with verbal command and resistance
Stretch must be accompanied by a verbal command
—pull into my hand, pull into my hand—needs to be timed with a specific verbal command and needs to be followed by a resistance right after the stretch
56
Why do we apply resistance after the stretch basic technique?
Tapping into monosynaptic stretch reflex, resistance immediately after the stretch to tap into the alpha motor neuron system—muscle proprioceptive level for alpha motor neuron for the fibers to respond to stretch and for the contraction of the muscle
57
Purpose of stretch basic techniques (3)
1. Initiate movement
2. redirect movement
3. help patient get to end of range
58
Traction or approximation:
BASIC TECHNIQUE
the elongation or compression of the limbs and trunk to facilitate motion and stability
adding distraction as taking limb through the arc of motion (resisting)-traction (during movement/special technique) increase mobility
stability, set muscle up for isometric contraction-approximation (precede movement/special technique)
59
Traction purpose
adding distraction as taking limb through the arc of motion (resisting)-traction (during movement/special technique) increase mobility
60
Approximation purpose
1. stability
| 2. set muscle up for isometric contraction-approximation (precede movement/special technique)
61
Vision
BASIC TECHNIQUE
BASIC TECHNIQUE
Use of vision for the movement—vision added to the motion enhances the task—ie adding in a weight shift, incorporate trunk, can use a focal point,
use of vision to guide motion and increase force. Visual feedback simplifies motion. This is because patient tracks and controls movement and position with his eyes. By having eye contact the therapist and patient receive feedback about the performed movement.
62
what does vision do to a task?
vision added to the motion enhances the task—ie adding in a weight shift, incorporate trunk, can use a focal point,
---use of vision to guide motion and increase force
---visual feedback simplifies motion. This is because patient tracks and controls movement and position with his eyes.
---By having eye contact the therapist and patient receive feedback about the performed movement.
63
what does vision do to motion and force?
---use of vision to guide motion and increase force
---visual feedback simplifies motion. This is because patient tracks and controls movement and position with his eyes.
---By having eye contact the therapist and patient receive feedback about the performed movement.
64
Timing
BASIC TECHNIQUE
Normal timing--in adults normal timing of most coordinated and efficient motions is from DISTAL to PROXIMAL
Timing for emphasis –blocking one part of pattern to get irradiation to facilitate another part of the pattern (can block proximal to get distal or the opposite)
Maintained isotonic is used in timing for emphasis
--In the middle of a contraction motion with resistance and then resist a different component strongly to maintain isotonic, quick stretch with resistance at the same time as the maintained isotonic at another segment: ie blocking movement at ankle with quick stretch to hip to get hip to recruit (irradiation overflow of strong component to weaker component by maintained isotonic and at the same time try to facilitate weaker component)
promote normal timing and increase muscle contraction with proper inputs and through timing for emphasis
65
what direction is normal timing of most coordinated and efficient motions?
Normal timing--in adults normal timing of most coordinated and efficient motions is from DISTAL to PROXIMAL
66
what is timing for emphasis
Timing for emphasis –blocking one part of pattern to get irradiation to facilitate another part of the pattern (can block proximal to get distal or the opposite)
67
How is maintained isotonic is used in timing for emphasis?
In the middle of a contraction motion with resistance and then resist a different component strongly to maintain isotonic, quick stretch with resistance at the same time as the maintained isotonic at another segment:
ie blocking movement at ankle with quick stretch to hip to get hip to recruit (irradiation overflow of strong component to weaker component by maintained isotonic and at the same time try to facilitate weaker component)
68
what is the purpose of timing for emphasis
promote normal timing and increase muscle contraction with proper inputs and through timing for emphasis
69
Pattern
BASIC TECHNIQUE
BASIC TECHNIQUE
synergistic mass movements, components of functional normal motion
anterior elevation and posterior depression motion without stopping at neutral
70
What makes special techniques special?
- special because they treat a specific problems
- require the continued use of basic techniques
- goal is smooth and coordinated movement with normal postural control.
72
how are special techniques used
use basic techniques with a specific
1. purpose
3. strength
4. endurance
5. stretch.
6. Smooth coordinated movement with normal postural control.
Task specific training in the good posture. Learn with best possible posture.
73
Special techniques
purpose
what do they require
what is the goal
treat specific problems
require the continued use of basic techniques
goal is smooth and coordinated movement with normal postural control
74
SPECIAL TECHNIQUE:
Rhythmic Initiation
purpose
1. EVALUATE:
- arc of motion
- tone
- patients ability to complete arc
2. GIVE PATIENT THE SENSE OF THE
3. MOVEMENT
4. RELAX THE PATIENT
5. MUSCLE REEDUCATION
- successive unduction
75
SPECIAL TECHNIQUE:
Rhythmic Initiation
definition
PASSIVE
ACTIVE ASSISTIVE
APPROPRIATE RESISTANCE
76
SPECIAL TECHNIQUE:
Rhythmic Initiation
when is it useful
RI helps PT EVALUATE the movement and helps the PATIENT TO KNOW what the movement is.
A good TEACHING tool.
With successive induction can REEDUCATE the muscles.
Should be as SMOOTH TRANSITION as possible.
1. Passive
2. Active assistive
3. Appropriate resistance
77
SPECIAL TECHNIQUE:
Rhythmic Initiation
purpose
1. Evaluate arc of motion, tone, and patients’ ability to complete arc
2. Give patient the sense of the movement.
3. Relax patient.
4. Muscle reeducation-successive induction (agonist-antagonist)
78
What do we do in Rhythmic Initiation?
Passive
Active assistive
Appropriate resistance
79
Rhythmic Initiation: Body position, body mechanics:
1. patient lie on side in proper postural alignment, straight spine, rotate pelvis (may use towel roll if small space)
fold pillow under head, elbow, shoulder, pelvis alignment. Relax. Her arm/elbow on her waist to set scapula, make sure scapula positioned onto thorax with minimal gap to the thorax.
2. My knees at back of her butt, by her pelvis, my knee line in the diagonal parallel with middle of their ear and middle of their pelvis. We use our bodies not our arms to make the movement. My elbow should go in between my knees down to the mat as I come down.
80
Rhythmic Initiation: Manual Contact
lumbrical grip: on acromion, divot grip on inferior angle
1. PASSIVE:
-anterior elevation anterior acromion (fingers on anterior acromion, palm not touch anything), and put inferior angle in divot of my other palm: push up to ear
bring down into posterior depression
2. Do this active assistive
3. Resistive
- anterior elevation: can reinforce hand with other hand—patient pulls me up and I take passive down
- posterior depression: uses bottom hand as resistance at inferior angle with no hand on acromion
- resistance should be equal—CONSISTENT through the arc of motion
81
Rhythmic Initiation: Verbal Cue
1. just relax and I am going to move you up and forward, down and back…
2. now this time I want you to help me up and forward down and back…bring your shoulder to your ear: up and forward, down and back…
3. now I am going to resist you at the top. Pull up into my hand, pull up, pull up, pull up
4. wait I’m putting my hand at the bottom
5. now push down and back, down and back
6. now wait until I switch my hands
7. push up and forward...(tell them to increase effort, louder vc..)
82
SPECIAL TECHNIQUE:
Isotonic Reversal:
what we do to apply it (3)
1. Appropriate resistance—maintain through the range
2. quick stretch in opposite of direction going timed with a command and immediately followed by resistance—myotatic reflex and resistance for the spindle
3. can add traction
83
SPECIAL TECHNIQUE:
Isotonic Reversal:
1. what kind of pattern
2. what kind of contractions
3. can we use quick stretch
4. when can we use maintained isotonic?
5. when can we used maintained isometric
1. reciprocal pattern
2. ISOTONIC contractions through arcs with appropriate resistance
3. use quick stretch as needed
4. can do maintained isotonic or isometric at any point in the range
(can use traction too)
84
Isotonic Reversal
purpose (5)
hers
1. facilitate coordinated reciprocal movement
2. improve smooth reversal of movement direction
3. facilitate contraction of agonist-antagonist pairs
4. prevent or relieve fatigue/increase endurance
5. increase ROM
85
Isotonic Reversal
purpose (5)
1. facilitate coordinated reciprocal movement
2. Improve smooth reversal of direction (ie from agonsits to antagonist)
3. Facilitate contraction of agonist antagonist pairs
4. For less fatigue and more endurance with repetitions
5. Get more AROM as get stronger throughout the motion, now they will have more scapular contribution when do pattern actively and reach for something after having done this scapular elevation
86
Isotonic Reversal
How to apply isotonic contractions through arcs with appropriate resistance
* Make sure consistent through the arc
* Patients need a sense of effort that is the same throughout the arc of motion
* Follow the resistant all the way to anterior elevation down to posterior depression
87
Isotonic Reversal
How can a quick stretch be used in
Isotonic Reversal
Use quick stretch as needed
* A little bit of a pull into the opposite pattern
* Push into my hand immediately after quick stretch
* Has to be timed with the command and immediately followed by resistance
* Monosynaptic stretch reflex (quick stretch) and spindle (resistance)
* can do quick stretch throughout range so that they stay in the direction you want them to go
* ex: anterior elevation, patient wants to shrug forward
88
Isotonic Reversal
When may you use maintained isotonic or isometric?
* Can do maintained isotonic or isometric at any point in the range
* if they are having trouble getting through the range
89
Isotonic Reversal
what are we doing?
reversing concentric contractions:
Active resisted and concentric motion change direction (agonist to antagonist) without pause/relaxation
We did the anterior elevation and posterior depression of the scapula
90
ISOTONIC REVERSALS
how do we do it
Reversing concentric contractions
---Up into anterior elevation, down into posterior depression
---You choose agonist and antagonist
Ex: ant elevation as agonist, antagonist would be posterior depression
Only time we’re specific about agonist antagonist is stretching techniques
1---Reciprocal pattern
2---Isotonic contractions through arcs with appropriate resistance
!!!Make sure consistent through the arc
▪ Patients need a sense of effort that is the same throughout the arc of motion
▪ Follow the resistant all the way to anterior elevation down to posterior depression
3---Use quick stretch as needed
▪ A little bit of a pull into the opposite pattern.
Push into my hand immediately after quick stretch
Has to be timed with the command and immediately followed by resistance
▪ Monosynaptic stretch reflex (quick stretch) and spindle (resistance)
▪ can do quick stretch throughout range so that they stay in the direction you want them to go
● ex: anterior elevation, patient wants to shrug forward
4---Can do maintained isotonic or isometric at any point in the range
● if they are having trouble getting through the range
o Good time to add traction if you’re looking for movement
91
ISOTONIC REVERSALS
purpose
1. Always – facilitated coordinated, reciprocal movement
2. Improve smooth reversal of movement direction
● Transition from agonist to antagonist
● Difficult for some people
3. Facilitate contraction of agonist – antagonist pairs
4. Prevent or relieve fatigue, increase endurance
5. Increase AROM
● Facilitating the ROM
● Ex: doing scap elevation and then ask them to reach for something, elevation will be much greater after having done this
**Exact same thing as the last thing of rhythmic initiation – skip passive and active and go straight to resistive
92
SPECIAL TECHNIQUES
Combination of Isotonics
definition
use of ECCENTRIC, CONCENTRIC and MAINTAINED ISOTONIC contractions in ONE DIRECTION of a given diagonal
▪ Ex: just anterior elevation – apply eccentric, concentric, and maintained isotonic
93
use of eccentric, concentric and maintained isotonic contractions in one direction of a given diagonal
Combination of Isotonics
94
SPECIAL TECHNIQUES
Combination of Isotonics
use of _________, _________ and _________ contractions in one direction of a given diagonal
use of eccentric,
concentric and
maintained isotonic contractions in
ONE DIRECTION OF A GIVEN DIAGONAL
95
SPECIAL TECHNIQUES
Combination of Isotonics
purpose (2)
1. mimic ADL
2. train patients ability to transition among 3 types of contractions
It is only one direction of a given diagonal—ie just for anterior elevation for concentric, eccentric, and maintained isotonic
96
Why would a therapist use
| COMBINATION OF ISOTONICS
Purpose:
▪ Mimic ADL
This carryover well to ADL: i.e. lift sugar to the shelf, and be able to transition between the three types of contractions
▪ Train patient’s ability to transition among all three types of contractions
--might be able to great concentric or eccentric but the transition is difficult
97
SPECIAL TECHNIQUES
Combination of Isotonics
--what part is evaluation
First few reps is evaluation, go all the way through arc concentrically and then ask patient to lower slowly, assess where weak and where strong and where did they have trouble
98
SPECIAL TECHNIQUES
Combination of Isotonics
--what do you do if you see patient has trouble in a point of the range
When they have trouble apply maintained isotonic to give them time to recruit
99
SPECIAL TECHNIQUES
Combination of Isotonics
--what are my body mechanics
Always lean into the contraction: feel the concentric transition to eccentric—hands on ischial tuberosity, knees by feet, lean into ischial tuberosity pushing them to anterior elevation:
patients concentrically push into posterior depression against the resistance and then let up slowly into anterior elevation with the resistance still there from the therapist. (we don’t ever stop)
100
SPECIAL TECHNIQUES
Combination of Isotonics
how is it an evaluative tool? how does this apply to treatment?
o Evaluative tool for therapist for first repetitions
▪ Go through full arc concentrically and ask patient to lower slowly (coming down into posterior depression) but will still be contracting their anterior depressors – look at where they are strong, where they were having trouble
▪ At points of trouble – apply maintained isotonic – give them time to recruit, and then continue with the task
101
SPECIAL TECHNIQUES
Combination of Isotonics
how to apply resistance?
o Concentric or eccentric – apply resistance in the same direction
▪ Say “keep pushing”
o Smaller arc to larger arc repetitions
o Where they are good – apply concentric resistance
o Where they are having trouble - maintained isotonic
o Want to know how they are with making and breaking actin and myosin connections
ex: scapular posterior depression
on vertebral border, cupping inferior border
push into my hand and go up slowly
always pushing into scap – always engaging the posterior depression
where you feel weakness, tell them to push
every once in a while do a concentric and eccentric and see where you need to work
102
Characteristic of:
1. Isotonic reversals
2. Combination of isotonics
Stabilization
● Stabilizing reversal
● Rhythmic stabilization
Isotonic reversals – talking about an agonist going to an antagonist
o Dynamic reversal – agonist to antagonist without stopping
● All of them are the same
Combination of isotonics – taking one movement of interest (ex: posterior depression)
● Hand placement, body position never changed. Do eccentric, concentric of the same motion. Body part going in both direction, but its because one is concentric and one is eccentric
Stabilization
● Stabilizing reversal – isotonic reversal without applying movement = maintained isotonic
● Rhythmic stabilization – just isometric
103
SPECIAL TECHNIQUES
How is hand placement and body position changed in Combination of Isotonics?
Hand placement, body position never changed.
104
SPECIAL TECHNIQUES
What contraction type are we using in Isotonic reversal when they are good? When they are having trouble?
o Where they are good – apply concentric resistance
| o Where they are having trouble - maintained isotonic
105
Traction
for stiffness or high tone
---Use when you want to increase mobility and separate joint surfaces
---Can do it during any part of rhythmic initiation
Ex: anterior depression
Resistive forces are opposite – as they’re going down, we pull back up
● 1 Force vector
Add traction – adding a lift to resistance force
● Hold until the end
Patient is experiencing a combination of resistive effort with the traction
When you add vectors you get a resultant vector:
● Combination of the multiple resistance vectors with the traction vectors
106
SPECIAL TECHNIQUES
Repeated Quick Stretch (contractions)
(5)
Get a contraction going in the muscle and do repeated quick stretch through the arc of motion
● Purpose:
1. Initiating motion
▪ Useful if initiation is their problem
2. Midrange – encourage movement vs. fatigue
3. Improve patient’s awareness of movement
▪ Re-direct motion
4. Increase AROM
5. Increase endurance
▪ Keep the contraction going when you see them start to fatigue
107
SPECIAL TECHNIQUES
Repeated Quick Stretch
purpose
1. Initiating motion
2. Midrange-encourage movement vs. fatigue
3. Improve patients awareness of movement—redirect motion
4. Increase AROM
5. Increase endurance
108
Isometric Reversals
purpose (5)
1. develop co-contraction around a joint
2. develop ability to stabilize against a
reversing force
3. develop strength in fixed part of ROM
4. promote relaxation and pain reduction
5. maintain muscle tone
109
Isometric Reversals
robyn
● Alternating isometric contractions against resistance, no motion intended
```
● Purpose:
○ Develop con-contraction around a joint
○ Develop ability to stabilize against a resisting force
○ Develop strength in fixed part of ROM
○ Promote relaxation and pain reduction
○ Maintain muscle tone
--Can help with posture
```
● Always start with approximation
● Command: “Hold”
● Trunk= pt sitting and alternating lumbrical grip on acromions and inferior angle of scapula
110
Repeated Quick Stretch
robyn
● Applying quick stretches repeatedly in a diagonal during an active contraction
● A little pulse in the opposite direction of the movement
● Purpose:
○ Initiating motion
○ Midrange- encourage movement vs. fatigue: Endurance and strength
○ Improve patients’ awareness of movement re-direct motion
○ Increase AROM
○ Increase endurance
○ End range- more active end range
● Goal: get more of a contraction
111
Combination of Isotonics
robyn
Use of eccentric, concentric and maintained isotonics contractions in one direction of a diagonal
*Purpose:
○ Mimic ADLs- allow pt to do useful contraction
○ Train pt’s ability to transition among all three types of contractions
● Do maintained isotonics when you feel there is a weakness in the range
● PT controls speed with concentric and maintained isotonics
● Patient controls the speed of the eccentric
● When finished: nice, strong isotonic concentric and eccentric movements throughout the range
● Progress after feeling smooth, solid contractions for a few reps.
● Aides in: Gait, climb stairs, gain control in mvmt, bed mobility
112
Isotonic reversals (AKA: Reversal of Antagonists)
robyn
Isotonic contractions through reciprocal PNF diagonals with appropriate resistance
```
*Purpose:
○ Increase AROM
○ Develop coordination (smooth reversal of motion)
○ Prevent/relieve fatigue
○ Increase endurance
○ Decrease muscle tone
```
*Physiological principle: Successive induction- “contraction of the antagonists is followed by an intensified excitation of the agonist.”
```
*Indications:
○ Decreased AROM
○ Weakness in the agonist muscles
○ Decreased ability to change direction of motion
○ Exercised muscles begin to fatigue
○ Relaxation of hypertonic muscle groups
○ Ataxia
○ Coordination problems
```
*Looks like the last part of Rhythmic initiation
*Embellishments:
○ Quick stretch (as needed)
○ Maintained isotonic or isometric at any point in the range---Timing for emphasis
○ Reverse motion prior to hitting the end range
○ Variable speed
113
Rhythmic initiation
robyn
Rhythmic motion of limb/body through the desired ROM
*3 steps:
○ Start with PROM
○ Progress through AAROM
○ End with appropriate resistance
```
*Purpose:
○ Evaluate ROM, tone, pt’s ability to complete arc
○ Give pt sense of the mvmt
Teach or re-teach
Muscle re-education
○ Relax the pt- smooth, no yelling
```
*Physiological principle:
○ Successive induction- “contraction of the antagonists is followed by an intensified excitation of the agonist.”
```
*Indications:
○ Difficulties in initiating motion
○ Movement too fast or too slow
○ Uncoordinated or dysrhythmic motion (i.e. ataxia, rigidity)
○ Regulate or normalize muscle tone
○ General tension
```
114
Traction
GOALS
robyn
*Goals:
○ Facilitate movement (esp. pulling and antigravity mvmts)
○ Aid in elongation of muscle tissue when using the stretch reflex
● Applied during a movement
● Adds an upward and outward vector to the pattern
● Can make movement easier for patient
115
Approximation
GOALS
robyn
Compression
*Goals:
○ Promote stabilization
○ Facilitate weight-bearing and the contraction of anti-gravity muscles
○ Facilitate postural sets
Adds a down and inward vector to the pattern
116
Learning Sequence
robyn
Set of postures and movements that progressively develop motor skills as the nervous system heals or matures
*Purpose:
○ Increase variety of movement
○ Reduce fear and improve learning environment
----↓degrees of freedom= ↓ fear= better learning environment
○ Allow integration of basic and advanced motor patterns
○ ↑postures= ↑ patient movement repertoire
*Sets to Progress/Eval:
1. Maintain posture within the sequence (stabilize)
2. Move head/limbs/trunk within posture
3. Transition to next lower posture and next higher posture in sequence
---Be Aware of pt’s bodies
○ Ex: elderly in prone may not be comfy
○ Ex: watch patient with stroke’s shoulder
---Can encourage weight bearing by doing PNF on non-weight bearing extremity
---Remember to cue the head where to look
117
Scapula: Anterior elevation, posterior depression
Scapula: Posterior elevation, anterior depression
a. Up and back, down and forward (lunge forward onto knees, lunge back onto heels bring elbows down to the ground between my knees)
b. Neutral position, fold of grip on spine of scapula
c. Ulnar border on coracoid process
d. Scapula between two hands, bring like loaf of bread, up and back, down and forward
e. Tuck acromion behind ear (up and back), Front pocket (down and forward),
f. Resist: lean back, elbows down, heel of hand on back of acromion and push into my hand as my elbows come back and down
g. Hypothenar eminence on coracoid process (not humerus) and palm of hand has spine of scapula
h. Resistance: squish bread and have them bring you down and forward, (lean back to give more resistance)—then heel of hand on posterior of acromion and say push up into my hand for posterior elevation (this should push me down onto my feet and drop my elbows)
118
Pelvis: anterior elevation, posterior depression
a. My knees by their feet, behind and below their butt
b. Their hip and knees 90-90
c. Rhythmic initiation: take right hand with ridge of lumbrical grip on anterior rim of right ilium (their right leg) (posterior to ASIS), fingers pointing posterior relative to patient, other hand finds the ischial tuberosity facing posterior of patient or to the ceiling, and use my body to push up coming up onto knees and come down as squat down to pull up and pull down in the passive phase with my arms locked. My midline just a little ahead pointing to space between their nose and their ear.
d. Should feel the pelvis is coming up to the rib cage and not that they are rotating through the trunk
e. For rhythmic initiation: PROM, AROM asking them to help you, then apply resistance
Anterior elevation: make a double lumbrical grip onto the pelvis at the anterior brim of crest and lean onto it with whatever space can get, lean back with them in posterior depression and ask them to bring you up
Posterior depression: Knees by their feet to be able to dig into the mat, follow the arc pushing with elbows coming between my knees, make them push me down dropping my elbows to the mat.
119
Which muscle contraction has gradual resistance if build up and come off and which has a quick peak in resistance?
MAINTAINED ISOTONIC: peak in resistance quickly. Patient goal is to move
ISOMETRIC: gradually build up and come off the resistance. Patient goal is to HOLD
120
Is Quick stretch appropriate in Isometric Reversals?
NO
o Quick stretch not appropriate because we’re allowing muscle time to activate
121
Purpose of repeated quick stretch
1. initiating motion
2. midrange: encourage movement vs fatigue
3. improve patient awareness of movement: redirect motion
4. increase AROM
5. increase endurance
122
Contract Relax
Definition:
Technique which employs ____ inhibition to stretch a limitation within a ____
Technique which employs reciprocal inhibition and GTO inhibition to stretch a limitation within a pattern
Purpose:
1. lengthen muscle or muscle groups
2. relax in muscle spasms
123
Contract Relax:
Purpose (2)
1. lengthen muscle or muscle groups
| 2. relax in muscle spasms
124
Contract Relax:
Technique
1. Take the body part to end or range IN PATTERN *actively or passively
2. ask patient to contract agonists OR antagonists while therapist resists all components of pattern (slight rotation allowed)
3. patient relaxes completely (PT body supports body part temporarily)
4. patient lifts into new range against therapist resistance OR therapists moves it passively into new range
125
Technique which employs reciprocal inhibition and GTO inhibition to stretch a limitation within a pattern
contract relax
126
Hold Relax
Definition
use of ______ to lengthen a muscle or muscle group _____
use of isometric contraction to lengthen a muscle or muscle group IN PATTERN
127
Hold Relax
purpose
to relax muscles
128
Hold Relax
technique
1. take part to end point of range in pattern
2. ask patient to isometrically contract agonists or antagonists while therapist resists all components of pattern (no rotation allowed)
3. patient relaxes completely (PT supports body part)
4. patient lifts into new range against PT resistance or therapist moves it passively into new range
VC: "Hold"
129
Options for Hold Relax
1. Take body part to end range
2. contract muscles in pattern against PT resistance "HOLD"
3. go into new range
1. Take body part to end range"
- -active with appropriate resistance
- -passive
2. contract muscles in pattern against PT resistance "HOLD"
- -agonist group
- -antagonist group
3. go into new range
- -active with lighter resistance
- -passive
130
Options for Contract Relax
1. Take body part to end range
2. contract muscles in pattern against PT resistance "PUSH"
3. go into new range
1. Take body part to end range
- -active with appropriate resistance
- -passive
2. contract muscles in pattern against PT resistance "PUSH"
- -agonist group
- -antagonist group
3. go into new range
- -active with lighter resistance
- -passive
131
Options for Slow Reversal Hold Relax
1. Take body part to end range
2. contract muscles in pattern against PT resistance "PUSH"..."HOLD"
3. go into new range
1. Take body part to end range
- -active with appropriate resistance
- -passive
2. contract muscles in pattern against PT resistance "PUSH"..."HOLD"
- -agonist group
- -antagonist group
3. go into new range
- -active with lighter resistance
- -passive
132
Slow Reversal Hold Relax
technique (4 parts)
1. push = maintained isotonic at end range
2. hold = isometric at end range--same direction as above (ramp up and ramp down)
3. relaxation
4. isotonic with light resistance into new range
133
Hold Relax Active Motion
purpose-3
(relaxation technique)
1. strengthen at end range
2. decrease muscle imbalance
3. improve endurance
134
Hold Relax Active Motion
techniue
1. HOLD: isometric at end range [ramp up, ramp down]
2. PT passively take part to start of the diagonal [relax]
3. pt Isotonic contraction with appropriate resistance through the full diagonal [goes through the range against appropriate resistance] (using the same muscle group as step 1)
135
Rhythmic Rotation
(relaxation technique)
like counterrotation
relax and decrease overall tone of body and extremities
joint receptor reaction to relax surrounding muscle
can be active or passive
136
Learning Sequence
set of ___ and ____ that progressively develop ______as the nervous system _____
set of postures and movements that progressively develop motor skills as the nervous system matures or heals
137
Purpose of Learning Sequence
1. increase variety of movement
2. reduce fear and improve learning environment
3. allow integration of basic and advanced motor patterns
138
4 steps of evaluation in the learning sequence
1. Handling and observation
2. determine the missing components
3. train the missing components
4. recheck the task
139
Planning the intervention
1. concepts for preogressing intervention
2. home program integrating PNF
3. using free weights, theraband, etc
140
Bilateral Patterns
Symmetrical and Simultaneous
Same Diagonal and Same Motion
D1-D1
F-F
141
Bilateral Patterns
Symmetrical and Alternating
Same Diagonal and Different Motion
D1-D1
F-E
142
Bilateral Patterns
Asymmetrical and Simultaneous
Different Diagonal and same motion
D1-D2
F-F
143
Bilateral Patterns
Asymmetrical and Alternating
Different Diagonal and different motion
D1-D2
F-E
144
Lift
Up
145
Chop
Down
146
Learning sequence
What we do
attain, maintain, transition to higer level
147
Learning sequence is a
Set of ______ and _______ that progressively develop motor skills as the nervous system heals or matures
● Set of postures and movements that progressively develop motor skills as the nervous system heals or matures
148
Learning sequence is a
Set of _____ and ______ that progressively develop _____ as the nervous system heals or matures
Set of postures and movements that progressively develop motor skills as the nervous system heals or matures
149
Learning sequence is a
Set of ____ and ____ that progressively develop____ as the _________ heals or matures
Set of postures and movements that progressively develop motor skills as the nervous system heals or matures
150
Learning sequence is a
Set of ____ and ____ that progressively develop____ as the _________ _____ or _____
Set of postures and movements that progressively develop motor skills as the nervous system heals or matures
151
What is the learning sequence?
Set of postures and movements that progressively develop motor skills as the nervous system heals or matures
152
Purpose of the learning sequence
1. Increase variety of _____
2. Reduce ____ and improve learning environment
3. Allow integration of basic and advanced ____
○ Increase variety of movement
○ Reduce fear and improve learning environment
○ Allow integration of basic and advanced motor patterns
153
Purpose of the learning sequence
1. Increase variety of _____
2. Reduce ____ and improve ________
3. Allow integration of ____ and ______ ____
○ Increase variety of movement
○ Reduce fear and improve learning environment
○ Allow integration of basic and advanced motor patterns
154
Purpose of the learning sequence
1. Increase variety of _____
2. Reduce ____ and improve ________
3. Allow ____ of ____ and ______ ____
○ Increase variety of movement
○ Reduce fear and improve learning environment
○ Allow integration of basic and advanced motor patterns
155
learning sequence
Planning your intervention:
Concepts for progressing intervention
1) Add resistance
2) Stable to unstable surface
3) As doing the basics think forward about how getting them ready for more advanced skills (we want strength, ROM, endurance)
156
learning sequence
Home program integrating PNF
i. Add a weight
| ii. Do in kneeling to add a balance component into the learning sequence to add to the challenge
157
learning sequence
Using free weights, theraband™ etc.
i. Can use for UE and LE PNF
ii. Cable column with the weights and the handle or hook person at ankle cuff and work LE water
in the pool give a floaty and push against it
iii. A mit and push against it in water
iv. Flippers to work against in water
158
Learning Sequence Evaluation
1. Handling and Observation
2. Determine Missing Components
3. Train the missing components
4. Recheck the task
1) Handling and observation
2) Determine missing components
- --Focus in on the missing components
- --It may be ROM, that they have good strength but loss of range in GHJ—have them be able to do good D2 reciprocal flexion extension patterns
- ---Contract relax or hold relax or hold relax active motion to fix the missing component and then come back to the bi skill
- ---Use the PNF to train the missing components and put them back to the whole task
3) Train the missing components
4) Recheck the task
159
Learning Sequence Evaluation
1. Handling and _____
2. Determine ____ Components
3. Train the _____ components
4. Recheck the ____
1. Handling and Observation
2. Determine Missing Components
3. Train the missing components
4. Recheck the task
160
Learning Sequence Evaluation
1. _____ and Observation
2. _____ Missing Components
3. ____ the missing components
4. _____ the task
Learning Sequence Evaluation
1. Handling and Observation
2. Determine Missing Components
3. Train the missing components
4. Recheck the task
161
Learning Sequence Evaluation
| 4
Learning Sequence Evaluation
1. Handling and Observation
2. Determine Missing Components
3. Train the missing components
4. Recheck the task
162
Symmetrical
Same PNF Diagonal
163
Assymetrical
Different PNF diagonal
164
Simultaneous
Flexion Flexion
or Extension Extension
165
Alternating
Flexion-Extension
or Extension-Flexion
166
What is the three things we do for learning sequence
attain
maintain
transition to a higher level
167
Hold Relax Active Motion
technique
goals
1) ISOMETRIC at endrange with appropriate resistance
2) therapist takes patient to beginning of diagonal
3) Patient performs ISOTONIC contraction with appropriate resistance through the full diagonal (same muscle group as step 1)
Goals
1. strengthen at end range
2. decrease muscle imbalance
3. improve endurance
168
Goals of hold relax active motion
3
1. strengthen at end range
2. decrease muscle imbalance
3. improve endurance
169
D1 Flexion UE
SCAPULA: Anterior elevation
GH: Flexion, adduction, external rotation
ELBOW: Variable
WRIST: Flexion and radial deviation with supination
FINGERS: Flexed and adducted
Bend your wrist, close your fingers, up and across
170
D1 Extension UE
D1 Extension
SCAPULA: Posterior depression
GHJ: Extension, abduction, internal rotation
ELBOW: variable
WRIST: Extension and ulnar deviation with pronation
FINGERS: Extension and abduction
Push down and out
171
D2 Flexion UE
SCAPULA: Posterior Elevation
GHJ: Flexion, Abduction, External Rotation
ELBOW: Variable
FOREARM: Supination
FINGERS: Extension, Abduction, Radial Deviation
Open fingers, extend the wrist, push up and out
172
D2 Extension UE
SCAPULA: Anterior Depression
GHJ: Extension, Adduction, Internal Rotation
ELBOW: Variable
FOREARM: Pronated
WRIST: Flex, adduction, ulnar deviate
Close the fingers, bend the wrist, pull down and across
173
D1 FLexion LE
Position patient near the end of the table in supine, one leg bent up and resting on the table
PELVIS: Anterior elevation
HIP: Flex, Add, ER
KNEE: Variable
ANKLE: DF & inverted
Toes: Extend and abduct
“Toes up, foot up, knee up & heel in”
174
D1 Extension LE
PELVIS: Posterior depression
HIP: Ext, Abd, IR
KNEE: Variable
ANKLE: PF & everted
“Point your toes & push down & out”
175
D2 Flexion LE
PELVIS: Posterior elevation
HIP: Flex, Abd, IR
KNEE: Variable
ANKLE: DF & everted
Toes: Extend and Abduct
“Toes up, knee up & heel out”
176
D2 Extension LE
PELVIS: Anterior depression
HIP: Ext, Add, ER
KNEE: Variable
ANKLE: PF & inverted
“Point your toes & push down & in”
