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PNFpresentation
PNFpresentation
Elham Attari, SPT Joseph Jemera, SPT Bryce Stavness, SPT Angela Corchado, SPT Michael Sterken, SPT Jennifer Ferguson, SPT
Learning Objectives
At the completion of this presentation the student will be able to: 1. Define proprioceptive neuromuscular facilitation (PNF). 2. Discuss the treatment philosophy that serves as the framework for using PNF intervention techniques. 3. List the theoretical explanations for the effectiveness of PNF techniques on increasing muscle length. 4. Discuss the current use of PNF in adult neurorehabilitation.
History of PNF?
Developed by: Dr. Herman Kabat and Maggie Knott in the late 1940s and early 1950s as a means of rehabilitation for neurological disorders such as multiple sclerosis, cerebral palsy and poliomyelitis.
PNF Definition
y Definition: A motor learning approach used in
neuromotor development training to improve motor function and facilitate maximal muscular contraction.
y Kabat (1951): The basis of the PNF philosophy is the
idea that all human beings, including those with disabilities have untapped existing potential.
PNF Philosophy
1.
Positive approach: no pain, achievable tasks, set up for success, direct and indirect treatment, strong start. 2. Highest functional level: functional approach, ICF, include treatment on body structure level and activity level. 3. Mobilize potential by intensive training: active participation, motor learning, self training.
PNF in practice 2007
Philosophy cont
4. Consider the total human being: whole person with his/her environmental, personal, physical, and emotional factors. 5. Use of motor control and motor learning principles: repetition in a different context; respect stages of motor control, variability of practice.
patterns are used to improve ADLs, functional mobility, and athletic performance.
PNF in practice 2007
PNF Stretching
y Sherrington (1900): Developed
concepts of neuromuscular facilitation and inhibition. y Kabat: Clinical PNF stretching techniques. y Types: Contract relax, hold relax, agonist contract, and hold relax with agonist contract. y Proposed Mechanisms: autogenic inhibition, reciprocal inhibition, passive properties of the musculoskeletal unit, and stretch perception.
Research Reviews
(n = 131)
Conventional Treatment Exercises (57) PNF Techniques (36) Bobath NDT Techniques (38)
Conclusion: No substantial advantage could be attributed to any one of the three therapeutic approaches.
Results/Conclusion: 50% improved on 8 gait variables (not clinically sig.) at first posttest. NO subjects demonstrated carryover 30 mins after treatment!
Wang RY (1994)
y Testing efficacy of resisted pelvic motions using PNF
Results/Conclusion: After first treatment, Group 1 saw immediate improvements in gait speed and cadence. After 12 sessions, both groups had similar treatment effects, resulting in increased gait speed and cadence.
Trueblood et al. (1989) & Wang (1994) both used the same PNF techniques for pelvic motion to improve gait
Wang RY (1994)
y Treatment Time: 30 minutes y Dosage:
(n = 22)
EMG-initiated E-stim of wrist extensors (6) Low intensity E-stim with voluntary contraction (8) Proprioceptive Neuromuscular Facilitation Exercises (3) No Treatment (5) Results/Conclusion: Fugl-Meyer scores improved 42 % for EMG-stim, 25% for B/B, 18% for PNF, and negligible for no treatment.
admission to study. y Many patients won t tolerate a max contraction induced by E-stim.
y In 2001, the Heart and Stroke Foundation of Ontario
found that when the data was recalculated after combining the PNF group with the control group, the EMG-stim group did not have significantly different improvements in Fugl-Meyer scores!
Management of the Post Stroke Arm and Hand 2001 HSFO recommendations
y http://profed.heartandstroke.ca/ClientImage
s/1/PostStrokeArmAndHandFinal2002%5B1 %5D.pdf
Techniques Weight Training Conclusion: After 8 weeks, total UE strength improved in both groups with no sig. difference between groups. UPPER EXTREMITY FUNCTIONAL LEVEL DID NOT CHANGE FOR PATIENTS IN EITHER GROUP !!
Other Research
y Several studies were omitted due to weak evidence:
- poor research designs (lack of reproducibility) - small sample sizes (case reports) - poor generalizability (e.g. healthy, athletic subjects) -unsubstantiated conclusions (lack of causality)
reeducating normal movement patterns AND facilitating adaptation to function are both important treatment aims!
Nearly all respondents that use Brunnstrom/PNF or Bobath/NDT reported practicing these techniques, despite the lack of evidence to
According to Natarajan et al. (2008)
Current literature does NOT favor either Bobath/NDT or Brunnstrom/PNF methods over other treatment options [in stroke rehabilitation].
y
Though clinicians recognize there is limited evidence, PNF provides: Time efficient treatment Treatment of multiple joints/muscles Movement through functional patterns Safe motion
PNF Stretching
yThe most effective PNF technique combines
concentric contraction of agonist, and static contraction of the antagonist muscle (target muscle)
yRecommendations for Augmented ROM: - 3 second contraction holds (20% max)
References
y Adler, S.S., Beckers, D., & Buck, M. (2008) PNF in Practice: An Illustrated Guide (3rd ed.). Germany: Spinger. y Colby, L.A., Kisner, C. (2007) Therapeutic Exercise: Foundations and Techniques (5th ed.). Philidelphia: F.A. Davis Company. y Dickstein R, Hocherman S, Pillar T, & Shaham R. Stroke Rehabilitation: Three Exercise Approaches. Physical Therapy. August 1986; 66 (8): 1233-1238. y Kraft GH, Fitts SS, & Hammond MC. Techniques to Improve Function of the Arm and Hand in Chronic Hemiplegia. Archives of Physical Medicine and Rehabilitation. 1992; 73 (3): 220-227. y Natarajan P, Oelschlager A, Agah A, et al. Current clinical practices in stroke rehabilitation: Regional pilot survey. Journal of Rehabilitation Research & Development. 2008; 45(6):841-850.
References (cont.)
y Sharman MJ, Cresswell AG, & Riek S. Proprioceptive Neuromuscular Facilitation Stretching: Mechanisms and Clinical Implications. Sports Medicine. 2006; 36 (11): 929-939. y Trueblood PR, Walker JM, Perry J, & Gronley JK. Pelvic Exercise and Gait in Hemiplegia. Physical Therapy. January 1989; 69 (1): 18-26. y Wang RY. Effect of Proprioceptive Neuromuscular Facilitation on the Gait of Patients with Hemiplegia of Long and Short Duration. Physical Therapy. December 1994; 74 (12): 1108-1115. y Yamashiro, K.M. Proprioception Neuromuscular Facilitation Level 1. y Yildirim SA, Erden Z, & Kilinc M. Comparison of the Effects of Proprioceptive Neuromuscular Facilitation Techniques and Weight Training in Patients with Neuromuscular Diseases. [Abstract.] Fizyoterapi Rehabilitasyon. August 2007; 18 (2): 65-71.