Activity Portfolio Submission #2

Facilitation Technique Category: Therapeutic Use of Exercise

Activity Title: Flexibility training via PNF Pattern and Manual Static Stretching
(hamstring and iliopsoas)
Source: Kisner, Carolyn & Colby, Lynn A. (2002) Therapeutic Exercise Foundations
and Techniques, Fourth Edition. Philadelphia, PA: F.A. Davis Company.
Equipment: Comfortable clothes, Plinth table, belt, towel, pillow
Activity Description: The word mobility is said to be the ability of structures or
parts of the body to move or be moved to allow the presence of range of motion for
functional activities. It is that ability of an individual to initiate control or sustain
active movements of the body to perform simple to complex motor skills. It is
associated with joint integrity as well as the flexibility or extensibility of soft tissues
that cross or surround joints, such as muscles, tendons, fascia, joint capsules and
skin, which are necessary for unrestricted, pain free movements of the body during
functional tasks of daily living. Stretching is designed to increase mobility of soft
tissues and subsequently improve ROM by elongating or lengthening structures that
have adaptively shorted and have become hypomobile over time (Kisner, 2002).
The duration of static stretch should be 30-60 seconds for effective elongation of
the structures. To stretch the hamstrings to increase flexion of the hip with knee
extended; the CTRS 1) with the participants knee fully extended, support the
participants lower leg with your arm or shoulder, 2) stabilize the opposite extremity
along the anterior aspect of the thigh with your other hand or a belt or with the
assistance of another person, 3) with the knee at 0 degrees extension, and the hip
in neutral rotation, flex the hip (lift the leg) as far as possible. To increase hip
extension, have the participant close to the edge of the treatment table so that the
hip being stretched can be extended beyond neutral. The opposite hip and knee
are bent toward the participants chest to stability the pelvis and spine. The CTRS
may, 1) stabilize the opposite leg against the participants chest with one hand, or if
possible have the participant assist by grasping around the thigh and holding it to
the chest to prevent the hip from tilting during stretching, 2) move the hip to be
stretched into extension or hyperextension by placing a downward pressure on the
anterior aspect of the distal thigh with their other hand. Allow the knee to extend
so that the quadriceps muscle does not restrict the range of motion. Proprioceptive
neuromuscular facilitation (PNF) is a therapeutic exercise that combines functionally
based diagonal patterns of movement techniques of neuromuscular facilitation to
evoke motor responses and improve neuromuscular control and function. PNF
techniques can be used to develop muscular strength and endurance; facilitate
stability, mobility, neuromuscular control, and coordinated movements; and lay a
foundation for the restoration of function. The patterns of movement associated
with PNF are composed of multi-joint, multi-planar, diagonal and rotational
movements of the legs (Kisner, 2002). The CTRS should have the participant lie on
their back on the treatment table involved side (right or left leg), 1) position the legs
(hip and knees) straight the involved leg out to the side knee rotated in toward the
other leg and toes pointed down and foot turned outward, 2) to complete pattern
with verbal commands have the participant, bend hip and knees, bring leg in

Activity Portfolio Submission #2

towards other leg and rotated outward, foot pointing up towards the face with toes
straight up. CTRS should provide necessary handout with examples of stretches
and PNF pattern and demonstrate them as well. Finish the session by reviewing
stretches and PNF pattern, discuss benefits, difficulties and have participant return
demonstration for teach back method to ensure understanding.
Leadership considerations: The CTRS functions as the instructor or therapist for
this activity and is actively performing the stretching and giving manual resistance
with slight over pressure for stretching to end feel. It is recommended that the
CTRS possess certification in functional training, sports conditioning, personal
training or exercise therapy. Depending on the medical history, precautions,
contraindication and flexibility of the participant, the staff to participants ratio
should be 1:1 or 1:2. Prior to flexibility training the CTRS should provide instruction
and do a quick assessment on the participants medical history to avoid
contraindications of flexibility training any bony blocks limiting ROM, recent
fractures or surgery, acute inflammation or infection, sharp acute pain with
stretching, osteoporosis and hematoma. Instruct the participant to breath during
stretching to avoid Valsalva maneuver. The CTRS will demonstrate and explain
stretching prior to performing on the participant.
Adaptations: Participants with Parkinsons Disease: Parkinsons Disease is a
disorder that effects central nervous system and the production of dopamine.
Parkinsons disease symptoms include muscle rigidity, tremors, and change in
walking patterns and speech. For participants with Parkinsons Disease the CTRS
may need to perform the stretching in an alternative position or add pillows for
positioning due to the decreased mobility and stiffness. When stretching the
hamstring the CTRS may, 1) kneel on the mat and place the participants heel or
lower leg against their shoulder, 2) place both of their hands along the top of the
lower thigh to keep the knee extended, 3) the other leg is stabilized in extension by
a belt or towel and held in place by the CTRSs knee. When stretching the hip to
increase hip extension the CTRS may, have the participant lie on their stomach if
possible, 1) support and grasp the front of the participants lower thigh, 2) stabilize
the participants buttocks to prevent movement of the pelvis, 3) hyperextend the
participants hip by lifting the thigh off the table. For PNF pattern to reduce rigidity
the CTRS may need to assist the participant, use a pillow for comfort following the
description above. The CTRS should have the participant lie on their back on the
treatment table involved side (right or left leg), 1) position the legs (hip and knees)
straight the involved leg out to the side knee rotated in toward the other leg and
toes pointed down and foot turned outward, 2) to complete pattern with verbal
commands have the participant, bend hip and knees, bring leg in towards other leg
and rotated outward, foot pointing up towards the face with toes straight up. The
therapist may need to assist the participant, their hand placement if performing on
right leg 1) place right hand on the top and inside surface of the foot and toes, 2)
left hand on the inside of the thigh just above the knee, 3) give verbal commands
while assisting with the quick stretch to the ankle to push it upward toward face
rotate the foot inward and stretch the toes and say foot and toes up and in; bend
your knee; pull your leg over and across (Kisner, 2002).

Activity Portfolio Submission #2

Adaptations: Participants with Cerebral Vascular Accident (CVA/Stroke): A
stroke occurs when blood flow to a part of the brain stops, rupturing of a blood
vessel or is blocked. For participants with a stroke the CTRS may need to perform
the stretching in an alternative position or add pillows for positioning due to the
decreased mobility and stiffness. When stretching the hamstring the CTRS may, 1)
kneel on the mat and place the participants heel or lower leg against their
shoulder, 2) place both of their hands along the top of the lower thigh to keep the
knee extended, 3) the other leg is stabilized in extension by a belt or towel and held
in place by the CTRSs knee. When stretching the hip to increase hip extension the
CTRS may, have the participant lie on their stomach if possible, 1) support and
grasp the front of the participants lower thigh, 2) stabilize the participants
buttocks to prevent movement of the pelvis, 3) hyperextend the participants hip by
lifting the thigh off the table. For PNF pattern to reduce rigidity the CTRS may need
to assist the participant, use a pillow for comfort following the description above.
The CTRS should have the participant lie on their back on the treatment table
involved side (right or left leg), 1) position the legs (hip and knees) straight the
involved leg out to the side knee rotated in toward the other leg and toes pointed
down and foot turned outward, 2) to complete pattern with verbal commands have
the participant, bend hip and knees, bring leg in towards other leg and rotated
outward, foot pointing up towards the face with toes straight up. The therapist may
need to assist the participant, their hand placement if performing on right leg 1)
place right hand on the top and inside surface of the foot and toes, 2) left hand on
the inside of the thigh just above the knee, 3) give verbal commands while assisting
with the quick stretch to the ankle to push it upward toward face rotate the foot
inward and stretch the toes and say foot and toes up and in; bend your knee; pull
your leg over and across (Kisner, 2002).

Adaptations References
Dattilo, J., & McKenney, A. (2016) Facilitation Techniques in Therapeutic Recreation.
Third edition. State College, PA: Venture Publishing, Inc.
Kisner, Carolyn & Colby, Lynn A. (2002) Therapeutic Exercise Foundations and
Techniques, Fourth Edition. Philadelphia, PA: F.A. Davis Company.
Parkinsons Disease. Retrieved September 15, 2016. From
http://www.parkinson.org/.
Stroke. Retrieved September 15, 2016. From
https://medlineplus.gov/ency/article/000726.htm .

Activity Portfolio Submission #2

Facilitation Technique Category: Therapeutic Use of Sports

Activity Title: Competitive Swimming Backstroke Technique
Source: Backstroke Technique Australian Swimming Club
Equipment: swimming cap, ear plugs
Activity Description: The thrill of competition aside, swimming offers many
benefits including strengthening the cardiovascular systems and the major muscle
groups of both the upper and lower body. It also develops flexibility in the muscles
and joints as the swimmer performs a wide range of motion against the waters
resistance. It is an activity that keeps your heart rate up but takes some of the
stress that is common in impact sports off the body; injuries dont occur as easily.
The waters buoyancy evenly distributes and supports the weight of the body; there
is no danger of falling, and there are no impact forces on the residual limb.
Swimmers who have disabilities endorse the sport because it gives them a sense of
freedom. They dont have to rely on any supportive device, such as a wheelchair, to
assist them. They are independent. They are only judged on their times and
whether those times are dropping (www.disabledsportsusa.org). The purpose of
this activity is to teach participants the skills of backstroke. First, keep the body flat
like a board/plank of wood. Make sure that the participants body (trunk and hips)
lays as flat on the surface of the water as possible. The smaller the profile in the
water, the less resistance they will feel and its easier to go faster in the water.
Second, make sure the participants head sits semi-submerged in the water, it
should almost cover the ears completely but the mouth, nose and eyes should be
above the water. Third, while on your back hips and chest up, start kicking like a
flutter kick the participants legs should be straight and close together using
short kicking motions by raising one leg up and kicking the other leg down to help

Activity Portfolio Submission #2

move forward. Make sure the kicks are coming from the hips and not the knees for
efficiency in power. Fourth, the arm motion should be long and fluid, keeping arms
close to their sides should be key. Reach one up toward the ceiling and up in front
of them, bring it up over their head near their ear then down back into the water.
Now that the arm is in the water bring it down and outward to propel forward. Make
sure you have a steady and even rhythm with your arms and legs for speed. Fifth,
follow the path of least resistance for hand position. The hands should enter and
exit the water with their edges first, not the palms. When you lift your arm out of
the water, lead with your thumb. When it enters the water, lead with your thumb as
well (www.wikihow.com). It reduces resistance, make sure that when the hand is in
the water to turn the palm facing the feet, again this helps with propel you forward.
Seventh, keep your movement in your shoulders and hip loose and flexible for
efficiency. As you raise each arm, rotate your shoulder upwards and the other
downwards, also slightly twist your hips with each kick, when one leg kicks that hip
should go down a little. Special considerations with swimming, is breathe every
cycle as an arm enters and exits the water breathe in and out. Use flip turns to turn
around quickly and use the ceiling or clouds to help keep a straight path. Finish the
session by review stroke performance, while also discussing steps, benefits, and
difficulties with backstroke.
Leadership considerations: The CTRS is the instructor for this activity, the
instructor is in the pool with the participants. The CTRS should be CPR/First Aid
certified and also have a certification for Water Safety Instructor or Aquatic Therapy.
There should be at least one lifeguard present during the session. The staff to
participants ratio should be 1:1, 1:3, 1:4, 1:5. Before starting the session the CTRS
should discuss water safety in and around the pool, pool rules, review what to do in
an emergency. Prior to the participants the CTRS should check the pool
temperature and chemical level of the chlorine. The CTRS should demonstrate the
techniques to each participant.
Adaptations: Participants with Upper Extremity Amputation: Upper
extremity amputations are generally a result of a traumatic injury or congenital
disorder. The level of the amputation depends on the location of the injury but the
goal is to preserve as much of the limb as possible. The swimmer may need to
remove the prosthetic prior to swimming. Some may need to wear a buoyancy suit,
if this is the case encourage the participant to streamline the body position as much
as possible. The participant may also need steps to enter and exit the pool. But
most swimmers will use the diving block to enter/exit the pool. Depending on the
length of the amputation, some participants may not have full use of their arms or
hands. One modification that may occur is that instead of a flutter kick a participant
may demonstrate a dolphin kick underwater. This is how many swimmers initially
start the back stroke. The trick is to concentrate on streamlining the upper body as
much as possible during the dolphin kicks. The thighs produce the strength for the
dolphin up kick while the hamstrings work the down kick (www.swimclub.com). The
participant may need assistance into the water but plan and prepare ahead of time
for this.

Activity Portfolio Submission #2

Adaptations: Participants with Auditory Impairment: Auditory impairment
are generally the result of inner ear or nerve damage. Causes of auditory
impairment range from congenital defect, injury, disease, medications, exposure to
loud noise or age related. Auditory impairment can range from loss of pitch,
reduction of hearing in a noisy area or when they remove their hearing aids to total
deafness or loss of hearing. To ensure a successful swim with participants who have
an auditory impairment, may need the following adaptations. Use clear and
accurate demonstrations, also photos or videos may help break the stroke
technique down into simpler form for the participant. Some participants with
auditory impairments may be able to read lips so make sure to face them when
talking or position take a lower position on the pool side. Make sure the participant
removes the hearing aid to avoid damage to it. The CTRS may need an instructor
who is ASL certified to translate communication with the participant.
Adaptations References
Barclay, Gary. Backstroke Technique. Retrieved September 15, 2016. From
http://www.swimclub.com.au/resources/articles/coaches/backstroke_technique.htm
How to Swim the Backstroke Perfectly. Retrieved September 15, 2016. From
http://www.wikihow.com/Swim-Backstroke-Perfectly
Inclusion of Swimmers with a Disability. Retrieved September 16, 2016. From
http://www.swimming.org/assets/uploads/library/Inclusion_of_swimmers_with_a_disa
bility.pdf
Swimming. Retrieved September 15, 2016. From
http://www.disabledsportsusa.org/sport/swimming/?gclid=Cj0KEQjwjem-BRC_isGJlJ0h-MBEiQAbCimWIaPJXZ4l49clCBZIlAsJuDj2sUXXzUWgFEwRk60e6QaAkj08P8HAQ
Water Safety. Retrieved September 15, 2016. From http://www.redcross.org/gethelp/prepare-for-emergencies/types-of-emergencies/water-safety .