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PNF

Proprioceptive Neuromuscular Facilitation

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what is PNF?

A number of neuromuscular patterns that can be applied using specific techniques that are based on a set of neurophysiological principles

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PNF definition

• Definition: ‘To facilitate or make easy a response of the neuromuscular mechanism to the demands of functional activity in the initiation, achievement and holding of a movement or position.’

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why use?

Primarily used for strengthening/lengthening, improving coordination and motor skills, facilitating/inhibiting muscle activity

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Impairments that can be treated using PNF:

• Muscle weakness (disuse or nerve damage)
• Decreased muscular endurance
• Muscle imbalance
• Increased muscle tone (spasticity / rigidity)
• Dyspraxia (impairment of ability to execute purposeful, voluntary movement)
• Incoordination
• Decreased sensation / proprioception
• Decreased range of movement

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integration of:

PATTERNS
TECHNIQUES
NEUROPHYSIOLOGICAL PRINCIPLES

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summary

x2 Head and Neck
X2 Scapular
X2 Pelvis patterns
Lower limb pattern 1
Lower limb pattern 2
Upper limb pattern 1
Upper limb pattern 2
* The patterns of mvmt are composed of multijoint, multiplanar, diagonal and rotational movements.

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Head & Neck patterns:

Fl. with Rot. to (R) < > Ext. with Rot. to (L) Fl. with Rot. To (L)<>Ext. with Rot. To (R)

Patient lying on back, knees bent and head over bed
Have patients head in hands
Have bed height without flexion
Start crouched: ext. and rot. > stand: flx and R rot.

start in extension

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Scapular patterns:

Anterior Elevation <>Posterior Depression Posterior Elevation <>Anterior Depression

Side lying, pillow in between legs and pillow under head
Ant. Elevation > posterior depression
Thumbs on shoulder with fingers under arm pit
Resistance: up and out backwards
- Forwards; fingers on front
Ant. Elevation > post. Depression. = align back hand on border of scap
Women –put pillow under waist cause of waist difference

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Pelvis Patterns:

Anterior Elevation<>Posterior Depression (walking forwards)
Anterior Depression<>Posterior Elevation
(walking backwards)

Pelvis 2: don’t expect lot’s of movement – small movements but more up and down
Stand on diagonal and lunge/squat for up down
Bottom leg bent and top extended to help with stabilisation
Down with iliac crest, up with ischial tuberosity

Opposite = anterior depression > posterior elevation (like stepping backwards)

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Lower Limb Pattern 1

* like kicking a ball when going down
Fl. Add. Ext Rot.<>Ext. Abd. Int Rot.
(Knee remains in extension unless noted as below)
Fl. Add. Ext Rot. (With knee Fl.)<>Ext. Abd. Int Rot. (With knee Ext.) OR
Fl. Add. Ext Rot. (With knee Ext.)<>Ext. Abd. Int Rot. (With knee Fl.)
Distal components are always:
Toe Ext. DF. Inv.<>Toe Fl. PF. Ev.

L1: controlling knee with left arm, controlling rotation with right
Up and across into dorsiflexions > point down and out
With resistance = change hands

When knee flx = right hand on inside, hand on top of foot
Resit extension on side, up and under knee , hand on sole of foot

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Lower Limb Pattern 2

Fl. Abd. Int Rot.<>Ext. Add. Ext Rot. (Knee remains in extension unless noted)
Fl.Abd.IntRot.(With kneeFl.)<>Ext.Add.ExtRot.(WithkneeExt.) OR
Fl.Abd.IntRot.(With kneeExt.)<>Ext.Add.ExtRot.(With kneeFl.)
Distal components are always:
Toe ext. DF. Ev.<>Toe Fl. PF. Inv.

LL 2:
Up and out (DF) > down and in (point)
Resitance: switch hands up – hands on outside > going down (hands on inside of knee)

For knee flexion, come further down bed so leg is flexed over bench

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Upper Limb Pattern 1:

Fl. Add. Ext Rot.<>Ext. Abd. Int Rot. (Elbow remains in extension unless noted)
sweeping up and in > down and out

Fl. Add. Ext Rot. + Elbow Fl.<>Ext. Abd. Int Rot. + Elbow Ext. OR
Fl. Add. Ext Rot. + Elbow Ext.<>Ext. Abd. Int Rot. + Elbow Fl.

Distal components are always:
Finger & thumb flexion, wrist flexion & radial deviation, forearm supination<>Extension of fingers & thumb,extension and ulnar deviation of wrist, forearm pronation.

Think driver grabbing seatbelt
Resistance: flexion on hand (grab more resistance with hand closer to head) and hold elbow
Opposite: switch hands - push into flexion
• DIRECTION MOVING INTO IS HAND YOU WILL USE

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Upper Limb Pattern 2:

* putting on seatbelt
Fl. Abd. Ext Rot.<>Ext. Add. Int Rot. (Elbow remains in extension unless noted)
Fl. Abd. Ext Rot. + Elbow Fl.<>Ext. Add. Int Rot. + Elbow Ext. OR
Fl.Abd.ExtRot.+ElbowExt.<>Ext.Add.IntRot. +ElbowFl.
Distal components are always:
Finger and thumb extension, wrist extension with radial deviation and forearm supination<>finger and thumb flexion, wrist flexion and ulna deviation, forearm pronation.

closes at bottom, opens at top
Hand on trunk and palm – hand closer to head reach across body to start
At top: flx
In flexion – extend wrist
Going up – say push up
Going down – say pull

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PNF patterns

• Patterns of movement combine rotational (spiral) and diagonal components.
• It is believed that the stretch reflex is more effective when an entire pattern (rather than an individual muscle) is stretched
• Directions of movement within patterns are referred to as AGONIST and ANTAGONIST:
– Agonist = weak muscle groups or direction lacking range
– Antagonist = the opposite side of the pattern
* In the upper and lower limbs, the pattern is named and recorded in the chart by the movements occurring at the PROXIMAL joint i.e. hip or shoulder.

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PNF pivots

Remember that rotation occurs in PNF patterns around pivots.
• In the trunk and neck patterns, the pivot is the vertebral column.
• In the limbs, the pivot occurs at multiple points:
– Proximal (hip, shoulder)
– Intermediate (elbow, knee)
– Distal (wrist / hand or ankle / foot)

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Recommended method for learning patterns

1) Actively DO the movement yourself and NAME all of the components out loud.
2) Passively take the patient through the movement.
3) Ask your ‘patient’ to actively perform the movement (to ensure they have understood and are performing correctly, make any corrections as appropriate).
4) Practice the footwork (i.e. stride stance, lunging / squatting, pivoting as required) – note do this WITHOUT any hands on the patient.
5) Now you can add manual contact and work out your hand positions on the patient.

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Requirements to Achieve Normal Movement

• An INTACT neuromusculoskeletalsystema and Sensori-motorintegration
• Core (central) stability
• Coordination
• Rhythm and speed of movement
• Timing of recruitment
• Patterns of recruitment
• Ability to hold position
• Ability to control lengthening of a muscle against an extrinsic force (such as gravity) i.e. eccentric strength
Skilled motor function relies on the integration of sensory – motor systems to achieve motor control and to acquire any level of skill in moving.

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Central stability is vital to communicate, eat & live

WORK FIRST ON HEAD AND TRUNK THAN INCORPORATE PERIPHERY
• Head control
– Communication – Breathing
– Eating
• Trunk stability
– Ventilation
– Digestion
– Enabling controlled limb movement
• Basis for dynamic and peripheral movement

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Patterns of Movement

• All normal movement incorporates ROTATIONAL and DIAGONAL elements.
• There is always a pivot point.
Therefore PNF suggests that EXERCISE should incorporate rotational (spiral) and diagonal components.