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Dominiek Beckers · Math Buck

PNF in Practice
An Illustrated Guide
Fifth Edition
PNF in Practice
Dominiek Beckers · Math Buck

PNF in Practice
An Illustrated Guide

5th Edition
Dominiek Beckers Math Buck
Maasmechelen, Belgium Beek, Limburg, The Netherlands

ISBN 978-3-662-61817-2 ISBN 978-3-662-61818-9 (eBook)

https://doi.org/10.1007/978-3-662-61818-9

© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer-
Verlag GmbH, DE, part of Springer Nature 1993, 2000, 2008, 2014, 2021
This work is subject to copyright. All rights are solely and exclusively licensed by the
Publisher, whether the whole or part of the material is concerned, specifically the rights
of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction
on microfilms or in any other physical way, and transmission or information storage and
retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology
now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc.
in this publication does not imply, even in the absence of a specific statement, that such
names are exempt from the relevant protective laws and regulations and therefore free for
general use.
The publisher, the authors and the editors are safe to assume that the advice and
information in this book are believed to be true and accurate at the date of publication.
Neither the publisher nor the authors or the editors give a warranty, expressed or implied,
with respect to the material contained herein or for any errors or omissions that may have
been made. The publisher remains neutral with regard to jurisdictional claims in published
maps and institutional affiliations.

Fotonachweis Umschlag: © Math Buck, Dominiek Beckers

Umschlaggestaltung: deblik Berlin

Responsible Editor: Eva-Maria Kania

This Springer imprint is published by the registered company Springer-Verlag GmbH, DE
part of Springer Nature.
The registered company address is: Heidelberger Platz 3, 14197 Berlin, Germany
 V

Preface

Proprioceptive neuromuscular facilitation (PNF) is a philosophy and a

concept of treatment. The PNF philosophy is timeless, and the concept
is a continuous process of growth.
PNF has been one of the most recognized treatment concepts in
physical therapy since the 1940s. Dr. Kabat and Margaret (Maggie)
Knott started and continued to expand and develop the treatment
techniques and procedures after their move to Vallejo, California in
1947. After Dorothy Voss joined the team in 1953, Maggie and Doro-
thy wrote the first PNF book, published in 1956.
At first mostly patients with multiple sclerosis and poliomyelitis
were treated with this method. With experience it became clear that
this treatment approach was effective for patients with a wide range of
diagnoses. Today, patients with neurological, traumatic as well as or-
thopedic symptoms, adults as children are treated with this concept.
This PNF-concept was growing till a universal concept in the Physio-
therapy.
The three- and six-month PNF courses in Vallejo began in the
1950s. Physical therapists from all over the world came to Vallejo to
learn the theoretical and practical aspects of the PNF concept. In ad-
dition, Knott and Voss travelled in the United States and abroad to
give introductory courses in the concept.
When Maggie Knott died in 1978 her work at Vallejo was carried
on by Carolyn Oei Hvistendahl. She was succeeded by Hink Mangold
as director of the PNF program. Tim Josten is the present program
director. Sue Adler, Gregg Johnson, and Vicky Saliba have also con-
tinued Maggie’s work as teachers of the PNF concept. Sue Adler de-
signed the International PNF Association (IPNFA) Instructor course
programs. Developments in the PNF concept are closely followed
throughout the world. It is now possible to take recognized training
courses in many countries given by qualified PNF instructors.
We acknowledge our debt especially to Sue Adler for her big contri-
bution on this book, especially on the first English editions. There are
other excellent books dealing with the PNF method, but we felt there
was a need for a comprehensive coverage of the practical tools in text
and illustrations. This book should thus be seen as a practical guide
and used in combination with existing textbooks.
This book covers the procedures, techniques, and patterns within
PNF. Their application to patient treatment is discussed throughout,
with special attention on mat activities, gait and self-care. The em-
phasis within this book is twofold: developing an understanding of
the principles that underlie PNF, and showing through pictures rather
than with words how to perform the patterns and activities.
VI Preface

In summary, the aim of the authors is:

5 to give a clear presentation of the PNF concept and the in-
structions for the practice of PNF techniques and to support
­physiotherapy students as well as practicing therapists in their PNF
training,
5 to achieve uniformity in practical treatment and
5 to present the latest developments of the PNF concept in words
and pictures

Skill in applying the principles and practices of PNF to patient treat-

ment cannot be learned only from a book. We recommend that the
learner combine reading with classroom practice and patient treatment
under the supervision of a skilled PNF-practitioner.
Movement is our way to interact with our environment. Such inter-
actions are directed by the mechanism of motor learning. Integration
of motor learning principles includes a progression from hands-on to
hands-off treatments; it includes goal-orientated functional activities
and independence. Based on the untapped existing potential of all pa-
tients, the therapist will always focus on mobilizing these reserves to
reach the highest level of function. Especially in the first and cogni-
tive stage of motor control, the therapist’s manual facilitation will be
a helpful tool in reaching this goal. This includes goals on the level of
body structures as well as on the activity level and the participation
level (ICF).
This revised fifth edition includes a description of how the princi-
ples of the International Classification of Functioning, Disability and
Health (ICF), and aspects of motor learning and motor control (from
“hands-on” to “hands-off ” management), are applied in modern PNF
evaluation and treatment.
Several chapters were expanded with new indications and casu-
istry and supported and supplemented with new, more recent scien-
tific ­literature. The design and layout as well as the color ­illustrations
highlight the clearly structured way in which the philosophy, basic
­principles, treatment patterns and activities of the PNF concept are
presented. Thus, this book provides a systematic and easy-to-under-
stand guide to learning and understanding PNF as a practical tool and
application to full effect in treatment.
The authors are indebted to many people. We thank all our
­colleagues, the PNF instructors and members of the IPNFA, for their
cooperation, their exchange of knowledge and experience and further
development of the PNF concept. A special thanks goes to Agnieszka
Stepien from Poland for her contribution abouth pediatrics and scoli-
osis. We are very grateful to Fred Smedes for his contribution to this
edition. He is very active as a “chairman” of the IPNFA research com-
mittee and has helped us intensively with all relevant scientific PNF lit-
erature. We also thank Carsten Schäfer and Frits Westerholt for their
additions.
Preface
VII 
Our thanks also go to our physiotherapy colleagues of Adelante,
Rehabilitation Center Hoensbroek, The Netherlands. In particular we
thank Lisan Scheepers for acting as a model and Ben Eisermann for
editing the drawings.
We would like to thank our colleague Laurie Boston, PNF instruc-
tor in Switzerland, for all her support in correcting the English transla-
tions and contents of the manuscript.
But most of all we are devoted and grateful to our patients; without
them this work would not be possible.

Maggie Knott
To Maggie Knott, teacher and friend.
Devoted to her patients,
dedicated to her students,
a pioneer in profession

Dominiek Beckers
Math Buck
Autumn 2020
Acknowledgement To Susan Adler

With this new 5th edition of our PNF-book, we particularly wish to

acknowledge the help of Sue Adler, not only as co-author of former
editions of this book, but also because she had so an important influ-
ence on the spread of our PNF-concept worldwide.
Sue Adler has a long-term involvement in our PNF-concept. Sue was
certified as physical therapist at the Northwestern University, Chicago,
Illinois. She became a master in science in physical therapy at the Uni-
versity of Southern California, Los Angeles. She started her PNF edu-
cation in 1962 at the Kaiser Foundation Rehabilitation Center in Vallejo,
California, where she worked and taught together with Maggie Knott.
Beside her big contribution on our first (1993) and second edition
(1999) of this book, Sue Adler designed in the eighties and nineties the
International PNF Advanced and Instructor course programs. She had
diligently monitored the grow and quality during the “young years” of
the IPNFA®.
We also acknowledge our dept to this outstanding person because of per-
sonal reasons. First of all, Sue had an important influence on our PNF-edu-
cation. She led our instructor course in 1984 in Bad Ragaz, Switzerland and
certify both of us as international PNF instructor.
Our first edition of our German PNF-book came out in 1988 and
when we asked Sue in 1992 to join us as co-author for an English trans-
lation and new edition, she directly accepted. As co-author she had a
great contribution to and improvement of the contents of our first Eng-
lish editions in the nighties. Her support certainly lead to the great in-
ternational interest for our work and also for translations. In the mean-
while this work is edited in more than 15 countries and languages.
As pioneer of the IPNFA® and as co-author of the first editions of
this book, Sue Adler had an enormous direct and indirect influence on the
worldwide spread of the PNF-concept.

Dominiek Beckers
Math Buck
 IX

The International PNF-Association®

The objectives of the IPNFA® are as follows

5 To promote further worldwide development of the clinical use of

PNF
5 To maintain continuity and standards of the instructors of PNF
techniques
5 To maintain continuity and standards of PNF course material for
beginning and advanced instructors
5 To educate and train new PNF instructors
5 To promote research into PNF theory and practice
5 To identify further developments in the PNF concept
5 To ensure that developments in neurophysiology and other related
fields (ICF, Neuroplasticity, etc.) are incorporated into PNF clinical
practice
5 To develop peer review in order to maintain the necessary clinical
and educational standards required to teach PNF

The IPNFA® has following possibilities for education

(7 www.IPNFA.org)
X The International PNF-Association®

References
On the website of the IPNFA® (International PNF Association) you
can find actual scientific PNF-literature: 7 www.IPNFA.org.
The authors recommend especially to read the following article and
books which are helpful:
Article:
5 Smedes F, Heidmann M, Schäfer C, Fischer N, Stepien A. (2016)
The proprioceptive neuromuscular facilitation-concept; the state
of the evidence, a narrative review. Physical Therapy Reviews
21(1):17–31

Books:
5 Hedin-Andén S (2002) PNF – Grundverfahren und funktionelles
Training. Urban & Fischer, München
5 Horst R (2005) Motorisches Strategietraining und PNF. Thieme,
Stuttgart
5 Knott M, Voss DE (1968) Proprioceptive Neuromuscular Facilita-
tion, patterns and techniques, 2nd ed. Harper & Row, New York
5 Voss DE, Ionta M, Meyers B (1985) Proprioceptive Neuromuscular
Facilitation, patterns and techniques. 3rd ed. Harper & Row, New
York
5 Sullivan PE, Markos PD, Minor MAD (1982) An Integrated Ap-
proach to therapeutic Exercise, Theory and Clinical Application.
Reston Publishing Company, Reston, VA
5 Sullivan PE, Markos PD (1995) Clinical decision making in thera-
peutic exercise. Appleton and Lange, Norwalk, CT
 XI

Contents

1 Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
1.1 Positioning of the PNF Concept in the Modern Holistic Treatment. . . 2
1.2 PNF: Definition, Philosophy, Neurophysiological Basics. . . . . . . . . . . . . 11
1.3 Test Your Knowledge: Question. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

2 PNF Basic Principles and Procedures for Facilitation . . . . . . . . . 17

2.1 Optimal Resistance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
2.2 Irradiation and Reinforcement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
2.3 Tactile Stimulus (Manual Contact) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
2.4 Body Position and Body Mechanics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
2.5 Verbal Stimulation (Commands). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
2.6 Visual Stimulus. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
2.7 Traction and Approximation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
2.8 Stretch . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
2.9 Timing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
2.10 Patterns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
2.11 Test Your Knowledge: Questions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

3 PNF Techniques. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
3.1 Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
3.2 Rhythmic Initiation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
3.3 Combination of Isotonics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
3.4 Reversal of Antagonists. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
3.5 Repeated Stretch (Repeated Contractions) . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
3.6 Contract–Relax. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
3.7 Hold–Relax. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
3.8 Replication. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
3.9 PNF Techniques and Their Goals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
3.10 Test Your Knowledge: Questions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55

4 Patient Assessment and Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59

4.1 Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
4.2 Assessment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
4.3 Hypothesis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
4.4 Tests for Causal Impairments and Activity Limitations
Adjust to the Treatment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
4.5 Treatment Goals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
4.6 Treatment Planning and Treatment Design. . . . . . . . . . . . . . . . . . . . . . . . . . . 63
4.7 Re-Test for Causal Impairments and Activity Limitations. . . . . . . . . . . . . 65
4.8 Treatment Examples . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
4.9 Indications and Contraindications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
4.10 Test Your Knowledge: Questions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
XII Contents

5 Patterns of Facilitation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
5.1 Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74
5.2 PNF Patterns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74
5.3 Test Your Knowledge: Questions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78

6 The Scapula and Pelvis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79

6.1 Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80
6.2 Applications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80
6.3 Basic Procedures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80
6.4 Scapular Diagonals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82
6.5 Pelvic Diagonals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
6.6 Symmetrical, Reciprocal, and Asymmetrical Exercises. . . . . . . . . . . . . . . . 96
6.7 Test Your Knowledge: Questions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99

7 The Upper Extremity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101

7.1 Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
7.2 Basic procedures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
7.3 Flexion–abduction–external rotation (Fig. 7.2). . . . . . . . . . . . . . . . . . . . . . . 105
7.4 Extension–Adduction–Internal Rotation (Fig. 7.5). . . . . . . . . . . . . . . . . . . . 112
7.5 Flexion–Adduction–External Rotation (Fig. 7.8) . . . . . . . . . . . . . . . . . . . . . . 118
7.6 Extension–Abduction–Internal Rotation (Fig. 7.11). . . . . . . . . . . . . . . . . . . 124
7.7 Thrust and Withdrawal Combinations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
7.8 Bilateral Arm Patterns. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133
7.9 Changing the Patient’s Position. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135
7.10 Therapeutic Applications of Arm Patterns. . . . . . . . . . . . . . . . . . . . . . . . . . . . 139
7.11 Test your Knowledge: Questions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139

8 The Lower Extremity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141

8.1 Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143
8.2 Basic Procedures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143
8.3 Flexion–Abduction–Internal Rotation (Fig. 8.2). . . . . . . . . . . . . . . . . . . . . . . 145
8.4 Extension–Adduction–External Rotation (Fig. 8.5). . . . . . . . . . . . . . . . . . . . 151
8.5 Flexion–Adduction–External Rotation (Fig. 8.8) . . . . . . . . . . . . . . . . . . . . . . 157
8.6 Extension–Abduction–Internal Rotation (Fig. 8.11). . . . . . . . . . . . . . . . . . . 162
8.7 Bilateral Leg Patterns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168
8.8 Changing the Patient’s Position. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168
8.9 Therapeutic Indications for Leg Patterns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 172
8.10 Test Your Knowledge: Questions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179

9 The Neck. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181

9.1 Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 182
9.2 Basic Procedures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 182
9.3 Indications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187
Contents
XIII 
9.4 Flexion to the Left, Extension to the Right (Fig. 9.1) . . . . . . . . . . . . . . . . . . 187
9.5 Neck for Trunk . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189
9.6 Test Your Knowledge: Questions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 194
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 194

10 The Trunk. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195

10.1 Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 196
10.2 Treatment Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 196
10.3 Chopping and Lifting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197
10.4 Bilateral Leg Patterns for the Trunk. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203
10.5 Combining Patterns for the Trunk . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209
10.6 Test Your Knowledge: Question. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213

11 Mat Activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215

11.1 Introduction: Why Do Mat Activities?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 216
11.2 Basic Procedures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 216
11.3 Techniques. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217
11.4 Mat Activities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217
11.5 Patient Cases in Mat Activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 254
11.6 Therapeutic Applications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 258
11.7 Test Your Knowledge: Question. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 259
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 259

12 Gait Training. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 261

12.1 Introduction: The Importance of Walking. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 262
12.2 Basics of Normal Gait. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 262
12.3 Gait Analysis: Observation and Manual Evaluation. . . . . . . . . . . . . . . . . . . 266
12.4 The Theory of Gait Training. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 267
12.5 The Procedures of Gait Training . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 268
12.6 Practical Gait Training. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 270
12.7 Patient Cases in Gait Training. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 292
12.8 Test Your Knowledge: Questions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 298
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 298

13 Vital Functions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 301

13.1 Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 302
13.2 Stimulation and Facilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 302
13.3 Facial Muscles. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 302
13.4 Tongue Movements. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 312
13.5 Swallowing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 314
13.6 Speech Disorders. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 314
13.7 Breathing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 315
13.8 Test Your Knowledge: Questions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 318
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 318
XIV Contents

14 Activities of Daily Living . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 321

14.1 Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 322
14.2 Transfers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
323
14.3 Dressing and Undressing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 325
14.4 Test Your Knowledge: Question. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 328
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 328

15 Test Your Knowledge: Questions and Answers. . . . . . . . . . . . . . . . 331

Supplementary Information
Glossary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 338
Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 341
 XV

About the Authors

Dominiek Beckers
5 M
 aster of Physical Therapy, Movement Science and
Rehabilitation at the University of Leuven, Belgium,
in 1975
40 years Physical Therapist in Adelante, the Rehabili-
5 
tation Center of Hoensbroek, The Netherlands
5 International PNF senior instructor of the IPNFA
5 Instructor SCI Rehabilitation
5 Co-author of numerous books and article

Math Buck
Certified as Physical Therapist at the Hoge School in
5 
Heerlen, The Netherlands, in 1972
Since 1984 IPNFA instructor and “Fachlehrer” for
5 
PNF in Germany
5 S
 ince 2002 senior instructor and in 2004 honorary
member of the IPNFA
More than 37 years practical working with patients
5 
with mainly spinal neurological diseases in a rehabili-
tation center. Many post graduate education which he
uses in his courses
Co-author of some books of treatment of spinal cord
5 
patients and articles with different topics
 1 1

Introduction
Contents

1.1 Positioning of the PNF Concept in the Modern

Holistic Treatment – 2
1.1.1 The ICF Model – 2
1.1.2 Treatment and the PNF Concept: Basic Principles
and Techniques – 5
1.1.3 Learning Phases – 6
1.1.4 Motor Control and Motor Learning – 7

1.2 PNF: Definition, Philosophy, Neurophysiological

Basics – 11
1.2.1 Definition – 11
1.2.2 PNF Philosophy – 11
1.2.3 Basic Neurophysiological Principles – 12

1.3 Test Your Knowledge: Question – 13

References – 13

© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer-Verlag
GmbH, DE, part of Springer Nature 2021
D. Beckers and M. Buck, PNF in Practice,
https://doi.org/10.1007/978-3-662-61818-9_1
 2 Chapter 1 · Introduction

1.1  Positioning of the PNF

1 Concept in the Modern Holistic
Treatment

In this chapter, we illustrate the position of the

PNF concept within the current holistic treat-
ment spectrum. Furthermore, we show how
the PNF concept works in conjunction with
the assessment and treatment of our patients.
On the one hand, a detailed assessment
of the clinimetry findings (measurements)
and the experience and expertise of the ther-
apist are necessary for making clinical deci-
sions. On the other hand, scientific knowl-
edge about motor learning and motor con-
trol plays an important role in determining
the treatment goals. A patient treatment plan
is established from the results of the assess- . Fig. 1.1 Factors determining the choice of therapy
and their integration into the PNF concept
ment and from following the criteria of “ev-
idence-based practice.” (Sacket et al. 1996,
1998, 2000). ­lassification of Functioning, Disability
C
In addition, social norms and cultural and Health 2007) formulated by the World
models also influence the treatment. We will Health Organization (WHO 2007, Chap. 4)
briefly describe the factors determining the is recommended as a framework for organ-
choice of therapy and their integration into izing and directing patient treatment. The
the PNF concept (. Fig. 1.1). goal is to develop a common international
and standard language to simplify the com-
munication between different professions
1.1.1  The ICF Model within the health sector.
The ICF is a model of understanding
Assessment and Evaluation (Suppé 2007) (. Fig. 1.2) comprising the fol-
Before a treatment can be started, the ther- lowing five dimensions:
apist must perform a detailed patient eval- 5 Body structures and body functions
uation. The ICF model (International 5 Activities

. Fig. 1.2 The five

dimensions of the ICF
model
1.1 · Positioning of the PNF Concept in the Modern Holistic Treatment
5 Participation
5 Personal factors
5 Environmental factors
The patient evaluation documents which an-
atomical structures (joint, muscle, tone, sen-
sation etc.) and functions are involved and
which motor skills are possible for the pa-
tient (positive approach) (Smedes et al. 2016;
Horst 2008); it also lists any existing defi-
cits. This examination gives guidelines on the
specific activities that the patient more than
likely can or cannot perform. The PNF phi-
losophy of a “positive approach” entails
questioning first those activities that the pa-
tient can still perform, and later the activities
linked to difficulties.
After this, we examine which limitations
of the body structures and body functions
(Causal Impairments) can be responsible for
the limitations of activities (Activity Limita-
tion) and participation (Restriction of Partic-
ipation).
Patient Example: Mr. B.
Mr. B, a 60-year-old man, has worked as a
supervising engineer in a multinational com-
pany and has suffered from a severe form of
Guillain–Barré syndrome (his second epi-
sode). After a long stay in the intensive care
unit (ICU) with intubation, we note at the
level of body function and structure good
joint mobility, muscle strength (MFT 4), and
stability in the trunk. He is very motivated.
There is proximal 4 and distal 3 muscle
strength in the lower extremities. There are
no vegetative disturbances (we refer to these
as autonomic disorders). There have been no
autonomic disorders. Psychologically, he is
clear and oriented. He is apprehensive about
his future. As impairments, we note serious
problems: general loss of strength through-
out the body including his face, severe limi-
tations in joint movements of the upper ex-
tremities, sensory disturbances (primarily
in the hands), pain, extensive edema in the
hands, and breathing problems. At the level
of activities, he can propel a wheelchair us-
3 1
Finally, the existing capabilities of the pa-
tient’s level of participation (work, hobbies)
as well as the problems that may be encoun-
tered in his/her social life are documented.
Personal factors (age, culture) and environ-
mental factors (stairs, accessibility) must also
be considered.
Treatment Goals
After documenting the existing capabilities
and problems, a discussion begins with the pa-
tient (Cott 2004) to determine the treatment
goals. It is not just the medical team/therapist
(supply-driven) or only the patient (demand-dri-
ven) who formulates the treatment goals. To-
gether, through consultation, the team/thera-
pist and the patient determine and agree on set
goals (dialog-driven). Ultimately, the goal is to
achieve the highest level of participation that
the patient desires and is realistically able to
achieve. Besides these factors, environmental
(social environment) and personal factors (in-
dividual background) also play a role.
ing his legs and he can transfer himself inde-
pendently from the wheelchair to the bed.
Limitations on the level of activity are, in-
itially, a loss of gait functions; within the ac-
tivities of daily living (ADLs), he is almost to-
tally dependent on assistance. His speaking is
difficult to understand because of bilateral fa-
cial paralysis. Eating and drinking are difficult.
Driving and gardening are not possible.
At the level of participation, Mr. B can go
to his own home on weekends where his chil-
dren and grandchildren can visit him. Restric-
tions on the level of participation are that he is
not able to work, he cannot visit his children
or grandchildren because of the long drive,
and under his current circumstances he avoids
dining in restaurants. The following personal
factors hinder him from attaining his goals: his
social status, his character, his age, and the fact
that this is the second episode of the disease.
The external factors such as his social status,
his work, and his hobbies determine what is re-
quired to restore his physical functional ability.
 4 Chapter 1 · Introduction
The treatment goals that were formulated
1 together with the patient are adjusted and re-
defined on an ongoing basis. Thus, the pa-
tient is an active member and a fully fledged
discussion partner within the team, which
consists of the rehabilitation doctor, the phy-
sician, speech and occupational therapists,
the nurse, the psychologist, social workers,
and others.
After the jointly defined treatment goals
have been clarified, an objective should be
formulated for each goal using the SMART
analysis.
SMART (Oosterhuis-Geers 2004; Scager
2004) stands for:
5 S = specific: the objective is directed to-
ward the patient’s individual target goal.
5 M = measurable: progress is documented
by the improvement of the activity as well
as by clinimetry.
5 A = acceptable: the objective should be
accepted by the patient as well as by the
treatment team.
5 R = realistic: the objective should always
be an attainable goal.
5 T = time related: the objective should be
achievable within a realistic time frame.
SMART Analysis of Mr. B.
The treatment goal is for Mr. B. to be to-
tally independent.
S: goal setting of Mr. B. is to become to-
tally independent in his ADLs.
M: Mr. B. should wash, dress, and undress
himself independently.
A: Mr. B. and the treatment team expect
that Mr. B. will ultimately be doing all his
ADLs on his own.
R: it is realistic that despite the loss of mo-
tor function and sensation, Mr. B. will be-
come totally independent in all of his ADLs.
T: the time for achieving the intermediate
and the final goals will be discussed. Mr. B.
should be totally independent after 4 months.
The achievable treatment goals that have
been determined should comprise a logical
and structured process based on clinical rea-
soning.
Clinical Reasoning
This is a clinical process for achieving opti-
mal treatment results combining therapeutic
knowledge, skills, and empathy.
The therapist proposes a hypothesis re-
garding which limitations at the level of body
structure and body function can hypothet-
ically be responsible for the cause of the re-
strictions on the level of activity. To create
the hypothesis, the therapist needs sufficient
professional knowledge and clinical prac-
tice. At the same time, the therapist should be
open to other ideas that refute these hypoth-
eses and he should not ignore others in ad-
vance (unbiased). The hypothesis will be re-
viewed regularly during the treatment and
amended when necessary.
The therapist should be able to complete
the next steps at the right time so as to make
optimal use of the total treatment time.
Combining the different steps, determin-
ing a physical therapy diagnosis, establishing
a treatment plan, executing it, and adjusting
it if necessary is a cyclical process.
Clinimetry
Clinimetry is used to measure and objec-
tify the results of the treatment. When using
tests the therapist should be clear that these
tests really test what he/she wants to test (Va-
lidity, Reliability, Sensitivity, and Specificity)
By testing the results of the therapy offered,
changes in the results become clear. This is
necessary in order to demonstrate the effec-
tiveness of the treatment.
The following overview lists examples of
measurements and tests.
Objective Results of Treatment
Measurements at the level of body struc-
ture and function:
5 Muscle strength (Manual Muscle Test-
ing and Dynamometer)
5 Mobility (i.e., goniometer)
1.1 · Positioning of the PNF Concept in the Modern Holistic Treatment
5 Sensitivity (i.e., two-point discrimina-
tion, dermatomes)
5 Spasticity (Modified Ashworth Scale)
5 Pain (Visual Analog Scale)
5 Vital capacity
Tests at the Level of Activity:
5 FIM (Functional Independence Meas-
ure)
5 Barthel Index (index for testing ADL
skills)
5 Timed Up and Go test
5 10-m walk test
5 COPM (Canadian Occupational Perfor-
mance Measure, client-oriented test in
occupational therapy)
5 Berg Balance Scale (test to objectify
balance)
5 Jebsen test or the Van Lieshout test,
both for hand function
1.1.2  Treatment and the PNF
Concept: Basic Principles
and Techniques
z Structures and Body Function
At the level of impairments, the PNF con-
cept gives us an excellent opportunity to treat
the resulting limitations. PNF can also be
easily combined with other treatment con-
cepts. There are manifold applications of the
basic principles and techniques of the PNF
approach, as we can see in the following ex-
amples.
► Example
1. Insufficient Coordination
a) If the deficit is at the level of impairments,
the following basic principles can be imple-
mented:
– Guidance resistance
– Visual and auditory (feedforward) input
– Approximation
– Body position of the patient
b) Techniques to improve or to guide the co-
ordination:
5 1
– Rhythmic initiation
– Combination of isotonics
– Replication
2. Muscle Weakness
a) To improve muscle weakness, the following
basic principles can be used:
– Optimal resistance
– Approximation
– Stretch
– Verbal stimulus
– PNF pattern
b) Useful techniques are:
– Dynamic reversals
– Combination of isotonics◄
z Activities
Working on the limitations of activity in-
volves improving the ADLs), such as stand-
ing up, sitting down, walking, climbing stairs,
toileting, brushing teeth, shaving, dress-
ing, and undressing. Improved speaking and
training activities to be carried out and prac-
tical training of hobbies are also examples of
working at the level of activities.
The task of the therapist is to analyze the
functional limitations and to logically choose
which PNF principles and techniques can be
used to efficiently treat these problems. The
PNF concept offers many possibilities. One
can deviate from the standard PNF patterns.
If the functional activities do not fit within
a conventional PNF pattern as described in
this book, the activity should be practiced ac-
cording to the patient’s needs. One can use
the basic principles such as resistance, ver-
bal and visual input, timing, approximation,
stretch, etc., in order to achieve the desired
goal (Horst 2008).
> Important
In training a patient to bring a glass to his
mouth, the PNF patterns of
5 Flexion–adduction–external rotation
with elbow flexion
5 Flexion–abduction–external rotation
with elbow flexion are not adequately
problem-oriented
The reversal of radial thrust (see . Fig. 7.18a,
b) is probably the pattern that best matches
this activity. One would not facilitate
 6 Chapter 1 · Introduction
. Fig. 1.3 a Phases of motor learning (Fitts and Posner 1967). b Facilitation and PNF in the phases of motor
learning
c­ omplete flexion–abduction–external rotation
in the shoulder. The pronation of the fore-
arm in this pattern and palmar flexion (con-
centric–eccentric alternately) are identical to
those of functional activity.
The choice of the position of the patient
during treatment depends on the treatment
goals and on the capabilities of the patient.
One does not always follow normal mo-
tor development when choosing starting po-
sitions. If the patient is already able to walk
but is not able to come to a side-lying posi-
tion, to sit up, or to transition from a sitting
to a standing position (which we see with
many neurological patients), we should treat
this patient in the positions where improve-
ments are needed, for example, treating also
in a side-lying position (for turning), stand-
ing (for walking), sitting, standing up, etc.
z Participation
The aim of the therapy is for the patient to
achieve optimal functional ability at the level
of participation. Problems at the level of
body function and structure are solved as far
as possible and the activities that are impor-
tant for the patient are practiced. In the end,
the patient should be able to perform all the
activities needed in his/her everyday environ-
ment, and without the presence of the thera-
pist. To prepare for this, everyday situations
are created that simulate closely the activities
that are needed. This is practiced both within
the hospital setting as well as outside the fa-
cility. The possibilities for facilitation with
the PNF concept at this level (participation)
can be the same as those used for ­treating
the patient at the level of activities. Walk-
ing in the clinic is very different than walking
outside the clinic or at home, where the pa-
tient performs other activities simultaneously
(dual task). The therapist should bring the
patient into a situation that resembles the fu-
ture situation or into his own social situation.
1.1.3  Learning Phases
Fitts and Posner (1967) described three learn-
ing phases (. Fig. 1.3):
1. Cognitive phase: the patient has to think
about every action and cannot do another
task at the same time.
2. Associative phase: the patient tries to find
a solution to the problem. The therapist
should allow the patient to make mistakes
so that he can learn from them. He may,
however, help the patient to find the right
solution.
3. Autonomic phase or automatic phase: the
patient no longer needs to think about
solving the problem and can even simulta-
neously fulfill other tasks (dual tasks).
Patients who have suffered an illness or have
had a severe accident must often go through
these learning phases multiple times. It is
role of the therapist to identify which phase
the patient is in and to set up the therapy ac-
cordingly, so as to treat the patient optimally.
Therefore, the basic principles and tech-
niques are suitable options.
There are several possibilities for relearn-
ing an activity.
1.1 · Positioning of the PNF Concept in the Modern Holistic Treatment
Declarative Learning
Every action is analyzed exactly and then
practiced. This form of learning is applied,
for example, in sports, where one needs to
learn a specific movement pattern perfectly.
This requires almost 3000 repetitions. New
activities that we want to teach our patients
require a high intensity and great number
of repetitions (repetition without repetition,
Bernstein 1967).
Procedural Learning
It is not necessary to think consciously. Ac-
tivities are learnt by practicing them under
constantly changing circumstances (jumping,
cycling, etc.).
1.1.4  Motor Control and Motor
Learning
Applying the principles of motor control and
motor learning challenges the treating team
to solution-oriented thinking for the indi-
vidual limitations of the patient. These prin-
ciples are helpful in the subsequent steps of
treatment, integrating the process of clinical
reasoning and improving the multidiscipli-
nary teamwork.
Motor Control
Motor control is the study of postures and
movements that are controlled by central
commands and spinal reflexes, including the
functions of mind and body that govern pos-
ture and movement (Brooks 1986). Motor
control organizes activities that are already
present in the patient or have already been
learned. Furthermore, in motor develop-
ment, motor control proceeds in progressive
processes or planned steps. There are four
progressive phases of motor control, each
having specific characteristics (see overview
below). The therapist should adjust his/her
goals and exercises within these phases. Thus,
if the patient lacks the necessary mobility or
stability for a particular activity, then these
are trained first before the actual activity can
be performed (patient example: Mr. B.).
7 1
Patient Example: Mr. B.
After receiving many treatments, the active
and passive motion in Mr. B.’s shoulder in-
creased. Actively raising his right shoul-
der is possible, but he can hold this posi-
tion only briefly. Therefore, the activities of
putting his glasses on and off, eating, and
drinking are not yet possible. The central
trunk stability is sufficient. Sequence of
treatment: phase 2 should be treated first:
stability of the shoulder in the desired po-
sition. Principles that are applicable are ap-
proximation, resistance, verbal command,
and manual contact. Techniques that can
be applied are Stabilizing Reversals, Com-
bination of Isotonics, and Rhythmic Sta-
bilization. Phase 3: controlled mobility can
be achieved by controlling the stability in
the proximal joints, and then moving the
distal joints. Phase 4: finally, a skill can be
practiced. At the end of the rehabilitation,
the patient is able to trim a tree standing
on a ladder.
The therapist can use the following possi-
ble phases to recognize the patient’s problems
and to structure the treatment:
1. Mobility: the ability to assume a posture
and to start a movement
2. Stability: stabilizing a new position and
controlling gravity
3. Controlled mobility/mobility on stability:
the movement can be controlled at each
point in a stable position
4. Skill: all movements are possible, all parts
of the body can move and be controlled
in all directions
During the treatment, the therapist
adapts to the capabilities and needs of the
patient.
On the basis of the analysis of the scope of
possibilities and problems of the patient, the
therapist chooses a problem-oriented exer-
cise and a patient position. The phase of mo-
tor control is taken into consideration and a
 8 Chapter 1 · Introduction
. Fig. 1.4 a, b Activity: bringing a cup to the mouth
s­pecific exercise in a specific body position is
chosen that the patient is not yet able to achieve
or do alone. Feedforward can be used (Mulder
1991, Mulder and Hochstenbach 2004). The
therapist gives the patient the goal of the activ-
ity, so that the patient can think about a move-
ment plan to qualitatively carry out the activity.
The execution of this activity is determined by:
5 The goal or target
5 The task of the activity
5 The patient himself
5 The situation in which the activity happens
The movement is facilitated by using PNF
principles and techniques:
5 To improve the stability, we can use re-
sistance, approximation, and verbal com-
mand and the techniques Rhythmic Stabi-
lization and Stabilizing Reversals.
5 To improve the execution of the mo-
vement, we can use resistance, verbal com-
mand, visual input, manual contact, trac-
tion, and timing. As techniques we can
use Rhythmic Initiation, Combining of
Isotonics and Replication.
Determining which facilitation is to be ap-
plied depends not only on the actual patient
assessment findings (before treatment began),
but also on the reactions during the treatment
of the patient, which play an important role.
After practicing, one can give the patient
feedback about the end result of the activity
(knowledge of results). Additionally, tactile
and verbal feedback during the execution of
the activity focused on the quality of the per-
formance (knowledge of performance) can
be stimulating.
Motor Learning
Motor learning is not a treatment ap-
proach, such as the PNF concept, but
rather a model of how the therapist plans
his method of treatment. Motor learning is
a set of processes associated with practice
or experience leading to relatively perma-
nent changes in the capability for respond-
ing (Schmidt and Wrisberg 2004). This pro-
cess consists of: perception–cognition–ac-
tion (Shumway-Cook and Woollacott 1995)
(. Fig. 1.4 and 1.5).
1.1 · Positioning of the PNF Concept in the Modern Holistic Treatment
. Fig. 1.5 The process of motor learning: interaction
between the individuum, the goal or the task, and the
situation
Patient Example: Mr. B.
Mr. B is still not able to drink or to eat
without help. The required mobility in the
upper extremity is present, as is the stabil-
ity of the trunk. He is unable to stabilize
his shoulder in the position long enough to
bring a fork to his mouth.
Sequence of treatment: to train the shoul-
der to stay in a desired position (stability),
the basic principles of approximation, re-
sistance, and verbal command can be ef-
fectively implemented. After Mr. B. has
trained by himself to maintain this po-
sition for long enough, he can work on
bringing the fork to his mouth (skill). Re-
sistance, verbal instructions, visual input,
and the technique of the combination of
isotonics and replication can be used to fa-
cilitate this skill (. Fig. 1.4).
Each task that the patient is given should
have a specific goal and a specific function.
Performing the task is determined by the ca-
pabilities and limitations of the patient and
by the given situation in which the task is to
be fulfilled. The way of completing a task,
and the capability to do so, depend on bio-
mechanical, psychological, and neuropsy-
chological factors. For a positive outcome of
therapy, the activities must be practiced by
the patient (Weinstein 1991) and the activi-
ties have to be meaningful for the patient (law
of effects). Only then will the patient main-
tain his motivation. These activities should
9 1
. Fig. 1.6 Activity: garden work
be repeated many times under ever-chang-
ing circumstances (Bernstein 1967, repetition
without repetition) and should ultimately be
implemented in everyday activities (participa-
tion) (. Fig. 1.6).
The learning process is more effective
if the therapist allows the patient to make
­mistakes, so that the patient can learn from
these errors. This method of learning gives
the ­patient the minimal amount of input and
guidance so that he can perform the activity
optimally.
Therapists who work with the PNF con-
cept often apply tactile and verbal input,
but this should not always be the case. Ulti-
mately, patients should learn to perform this
task by themselves. In the treatment at the
level of body structure and function, “hands
on” work can be very useful. If the patient
still has difficulty in performing the activities,
hands on work in the cognitive and associa-
tive phase can still be useful. It helps the pa-
tient to perform this activity more easily. The
basic principles such as (guiding) resistance,
verbal instruction, approximation, movement
patterns (traditional as well as adapted to the
functional activity), and techniques are avail-
able. Ultimately, the goal is for the patient to
be able to carry out the activity without facil-
itation (hands off).
 10 Chapter 1 · Introduction
Proprioceptive information and sen-
1 sory input by using hands on or other tactile
means of information are more appropriate
when they are integrated in a motoric activity
(Horst 2005).
Manual Guidance:
5 Makes the learning process easier for ade-
quately conducting a motoric strategy
5 Gives the patient security
5 Increases the patient’s self-confidence
5 Provides sensory feedback
Children also learn new motoric activities
such as walking, cycling, or swimming, at
least in the beginning, with manual facilita-
tion given by their parents. In a study in 2007
about “hands on” versus “hands off,” Hache
and Kahlert showed that therapists find it use-
ful to apply manual facilitation in treatment at
the level of body structure and function as well
as in the cognitive phase of a­ ctivities (Hache
and Kahlert 2007). However, at the level of
participation or in the autonomic phase, a
sensory input is usually not needed.
In addition to the learning phase, there
are other areas where manual facilitation can
be useful in patients:
5 Problems in performing a task
5 Cognitive, communication, or sensory
problems
5 Treatment of spasticity
5 Balance problems
5 Insecurity
Patient Example: Mr. B.
Mr. B. has great difficulties in tucking his
shirt into the back of his pants after visit-
ing the bathroom, an activity that is very
important for him (target). This problem is
very much at the level of impairments: not
only because mobility is decreased in the
shoulder, but more so because of inade-
quate fine motor skills as well as a distur-
bance of sensation in the hands. In this ac-
tivity he is also missing visual control (in-
dividuum), which plays an important role
too. With this in mind, the treatment is ini-
tially at the level of impairments.
Sequence of Treatment
When the biomechanical prerequisites are
fulfilled, then the training on tucking the
shirt into the pants can begin (. Fig. 1.7a,
b). Guided resistance, manual contact, ver-
bal instruction, rhythmic initiation, combina-
tion of isotonics and replication can be used
as possibilities to learn this skill. Ultimately,
Mr. B. will learn to do this activity by himself
and not only with his jogging pants but with
a pair of pants that he wears for work (situa-
tion). The training situation is adapted to the
daily life situation.
Evidence-Based Medicine
Today we live in a society where the ther-
apy that we offer our patients should meet
the requirements of evidence-based med-
icine (EBM) and should be explained by
evidence-based practice (EBP). This means
­
that evidence for the effectiveness of treat-
ment should be given. For EBP, Sackett and
colleagues (1996, 1998, 2000) describe a five-
rank order with decreasing conclusiveness
(and evidential value).
Studies are differentiated as being either
fundamental research or experimental re-
search.
5 In fundamental research, general princi-
ples such as anatomy, physiology, etc., are
assessed.
5 In clinical experimental research, the ef-
fects of the interventions are evaluated.
In physical therapy, many studies have been
conducted to document the effectiveness of
strength, mobility, coordination, etc., as well
as at the level of activity, such as getting up,
walking, etc. Unfortunately, only a few studies
have described the exact treatment form that
was effective for a typical p ­ roblem (­Smedes
2009). Furthermore, even fewer studies have
been conducted in which the patient has been
treated with the PNF concept only.
Smedes et al. published an extended lit-
erature study (Smedes et al. 2006 (IPNFA);
Smedes 2016) as well as a literature list Sme-
des et al. 2007; 2008–2018). This list will be
constantly updated.
As mentioned earlier, there have been
only a few concrete treatment studies us-
1.2 · PNF: Definition, Philosophy, Neurophysiological Basics
. Fig. 1.7 Activity: tucking the shirt into the pants
ing purely the PNF concept. Mostly, a PNF
method (part of the concept) has been used
but not the overall concept of PNF. This
makes it difficult to compare the results of
treatments (Smedes et al. 2016).
To promote scientific research is one of
the targets of the IPNFA (International
PNF Association, 7 www.IPNFA.org; IP-
NFA 2005, 2006, 2007a, b, c, d, 2008), with
more and more studies now being pub-
lished.
1.2  PNF: Definition, Philosophy,
Neurophysiological Basics
1.2.1  Definition
Proprioceptive neuromuscular facilitation
(PNF) is a concept of treatment. Its under-
lying philosophy is that all human beings, in-
cluding those with disabilities, have untapped
existing potential (Kabat 1950).
Proprioceptive – having to do with any of
the sensory receptors that give information
concerning movement and position of the
body.
11 1
Neuromuscular – involving the nerves and
the muscles.
Facilitation – making things easier.
1.2.2  PNF Philosophy
In keeping with this definition, there are certain
basics that are part of the PNF philosophy:
PNF is an integrated approach: each treat-
ment is directed at the total human being,
not just at a specific problem or body seg-
ment.
Mobilizing reserves: based on the un-
tapped existing potential of all patients, the
therapist will always focus on mobilizing the
patient’s reserves.
Positive approach: the treatment approach
is always positive, reinforcing and using what
the patient can do, at a physical and psycho-
logical level.
Highest level of function: the primary goal
of all treatments is to help patients to achieve
their highest level of function.
Motor learning and motor control: to
reach this highest level of function, the ther-
apist integrates principles of motor control
and motor learning. This includes treatment
 12 Chapter 1 · Introduction
at the level of body structures, at the activity
1 level, as well at the participation level (ICF,
International Classification of Functioning,
WHO 1997).
The PNF philosophy incorporates certain
basic thoughts, which are anchored in the
treatment concept shown below.
Overview
The philosophy of the PNF treatment con-
cept:
5 Positive approach: no pain, achievable
tasks, set up for success, direct and indi-
rect treatment, start with the strong
5 Highest functional level: functional ap-
proach and use ICF, include treatment
of impairments and activity levels
5 Mobilize potential by intensive active
training: active participation, motor
learning, and self training
5 Consider the total human being: the en-
tire person with his/her environmental,
personal, physical, and emotional fac-
tors
5 Use motor control and motor learning
principles: repetition in different con-
texts, respect of the stages of motor
control, variability of practice
Movement is our way to interact with our
environment. All sensory and cognitive
processes may be viewed as input that de-
termines motor output. There are some
aspects of motor control and learning
that are very important for rehabilitation
(Mulder and Hochstenbach 2004). A key
element of any interactive situation is the
exchange of information. This also applies
to every type of therapy. Without an ex-
change of information, patients are severely
limited in mastering new tasks. This is par-
ticularly important in the first stages of
motor learning (. Fig. 1.3) as well as in the
rehabilitation process when, because of the
damage, the patient can no longer trust his
or her internal information. In these cases,
the therapist using PNF as facilitation pro-
vides an important source of external in-
formation.
According to the authors, this positive
functional approach is the best way to stim-
ulate the patient to attain excellent treatment
results.
1.2.3  Basic Neurophysiological
Principles
The work of Sir Charles Sherrington was im-
portant in the development of the procedures
and techniques of PNF. The following use-
ful definitions were abstracted from his work
(Sherrington 1947):
5 Afterdischarge: the effect of a stimulus
continues after the stimulus stops. If the
strength and duration of the stimulus in-
crease, the afterdischarge increases as
well. The feeling of increased power that
comes after a maintained static contrac-
tion is the result of afterdischarge.
5 Temporal summation: a succession of
weak stimuli (subliminal) occurring (sum-
mate) to cause excitation.
5 Spatial summation: weak stimuli applied si-
multaneously to different areas of the body
reinforce each other (summate) to cause ex-
citation. Temporal and spatial summation
can combine for greater activity.
5 Irradiation: this is a spreading and increased
strength of a response. It occurs when either
the number of stimuli or the strength of the
stimuli is increased. The response may be ei-
ther excitation or inhibition.
5 Successive induction: an increased excita-
tion of the agonist muscle follows stimu-
lation (contraction) of their antagonists.
Techniques involving reversal of ago-
nists make use of this property (Induc-
tion: stimulation, increased excitability).
5 Reciprocal innervation (reciprocal inhibi-
tion): contraction of muscles is accompa-
nied by simultaneous inhibition of their
antagonists. Reciprocal innervation is a
necessary part of coordinated motion.
Relaxation techniques make use of this
property.
> The nervous system is continuous through-
out its extent – there are no isolated parts
(Sherrington 1947).
References
1.3  Test Your Knowledge: Question
5 The PNF philosophy has an important in-
fluence on your treatment. What are five im-
portant principles of the PNF philosophy?
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 Suppressing Mormonism.

Polygamy, justly denounced as “the true relic of barbarism” while

slavery existed, has ever since the settlement of the Mormons in
Utah, been one of the vexed questions in American politics. Laws
passed for its suppression have proved, thus far, unavailing; troops
could not crush it out, or did not at a time when battles were fought
and won; United States Courts were powerless where juries could not
be found to convict. Latterly a new and promising effort has been
made for its suppression. This was begun in the Senate in the session
of 1882. On the 16th of February a vote was taken by sections on
Senator Edmunds’ bill, which like the law of 1862 is penal in its
provisions, but directly aimed against the crime of polygamy.
President Arthur signed the Edmunds anti-polygamy bill on the
23d of March, 1882.
Delegate Cannon of Utah, was on the floor of the Senate
electioneering against the bill, and he pled with some success, for
several Democratic Senators made speeches against it. The
Republicans were unanimously for the bill, and the Democrats were
not solidly against it, though the general tenor of the debate on this
side was against it.
Senator Vest (Democrat) of Missouri, said that never in the
darkest days of the rule of the Tudors and Stuarts had any measure
been advocated which came so near a bill of attainder as this one. It
was monstrous to contend that the people of the United States were
at the mercy of Congress without any appeal. If this bill passed it
would establish a precedent that would come home to plague us for
all time to come. The pressure against polygamy to-day might exist
to-morrow against any church, institution or class in this broad land,
and when the crested waves of prejudice and passion mounted high
they would be told that the Congress of the United States had
trampled upon the Constitution. In conclusion, he said: “I am
prepared for the abuse and calumny that will follow any man who
dares to criticise any bill against polygamy, and yet, if my official life
had to terminate to-morrow, I would not give my vote for the
unconstitutional principles contained in this bill.” Other speeches
were made by Messrs. Morgan, Brown, Jones, of Florida, Saulsbury,
Call, Pendleton, Sherman, and Lamar, and the debate was closed by
Mr. Edmunds in an eloquent fifteen-minutes’ speech, in which he
carefully reviewed and controverted the objections urged against the
bill of the committee.
He showed great anxiety to have the measure disposed of at once
and met a request from the Democratic side for a postponement till
other features should be embodied in the bills with the remark that
this was the policy that had hitherto proven a hindrance to
legislation on this subject and that he was tired of it. In the bill as
amended the following section provoked more opposition than any
other, although the Senators refrained from making any particular
mention of it: “That if any male person in a Territory or other place
over which the United States have exclusive jurisdiction hereafter
cohabits with more than one woman he shall be deemed guilty of a
misdemeanor, and on conviction thereof he shall be punished by a
fine of not more than $300 or by imprisonment for not more than six
months, or by both said punishments in the discretion of the court.”
The bill passed viva voce vote after a re-arrangement of its sections,
one of the changes being that not more than three of the
commissioners shall be members of the same party. The fact that the
yeas and nays were not called, shows that there is no general desire
on either side to make the bill a partisan measure.
The Edmunds Bill passed the House March 14, 1882, without
material amendment, the Republican majority, refusing to allow the
time asked by the Democrats for discussion. The vote was 193 for to
only 45 against, all of the negative votes being Democratic save one,
that of Jones, Greenbacker from Texas.
The only question was whether the bill, as passed by the Senate,
would accomplish that object, and whether certain provisions of this
bill did not provide a remedy which was worse than the disease.
Many Democrats thought that the precedent of interfering with the
right of suffrage at the polls, when the voter had not been tried and
convicted of any crime, was so dangerous that they could not bring
themselves to vote for the measure. Among these democrats were
Belmont and Hewitt, of New York, and a number of others equally
prominent. But they all professed their readiness to vote for any
measure which would affect the abolition of polygamy without
impairing the fundamental rights of citizens in other parts of the
country.

THE TEXT OF THE BILL.

Be it enacted, &c., That section 5,352 of the Revised Statutes of the

United States be, and the same is hereby amended so as to read as
follows, namely:
“Every person who has a husband or wife living who, in a Territory
or other place over which the United States have exclusive
jurisdiction, hereafter marries another, whether married or single,
and any man who hereafter simultaneously, or on the same day,
marries more than one woman; in a Territory or other place over
which the United States has exclusive jurisdiction, is guilty of
polygamy, and shall be punished by a fine of not more than $500
and by imprisonment for a term of not more than five years; but this
section shall not extend to any person by reason of any former
marriage whose husband or wife by such marriage shall have been
absent for five successive years, and is not known to such person to
be living, and is believed by such person to be dead, nor to any
person by reason of any former marriage which shall have been
dissolved by a valid decree of a competent court, nor to any person
by reason of any former marriage which shall have been pronounced
void by a valid decree of a competent court, on the ground of nullity
of the marriage contract.”
Sec. 2. That the foregoing provisions shall not affect the
prosecution or punishment of any offence already committed against
the section amended by the first section of this act.
Sec. 3. That if any male person, in a Territory or other place over
which the United States have exclusive jurisdiction, hereafter
cohabits with more than one woman, he shall be deemed guilty of a
misdemeanor, and on conviction thereof shall be punished by a fine
of not more than $300, or by imprisonment for not more than six
months, or by both said punishments in the discretion of the court.
Sec. 4. That counts for any or all of the offences named in sections
1 and 3 of this act may be joined in the same information or
indictment.
Sec. 5. That in any prosecution for bigamy, polygamy or unlawful
cohabitation under any statute of the United States, it shall be
sufficient cause of challenge to any person drawn or summoned as a
juryman or talesman, first, that he is or has been living in the
practice of bigamy, polygamy, or unlawful cohabitation with more
than one woman, or that he is or has been guilty of an offence
punishable by either of the foregoing sections or by section 5352 of
the Revised Statutes of the United States or the act of July 1, 1862,
entitled “An act to punish and prevent the practice of polygamy in
the Territories of the United States and other places, and
disapproving and annulling certain acts of the Legislative Assembly
of the Territory of Utah;” or, second, that he believes it right for a
man to have more than one living and undivorced wife at the same
time, or to live in the practice of cohabiting with more than one
woman, and any person appearing or offered as a juror or talesman
and challenged on either of the foregoing grounds may be questioned
on his oath as to the existence of any such cause of challenge, and
other evidence may be introduced bearing upon the question raised
by such challenge, and this question shall be tried by the court. But
as to the first ground of challenge before mentioned the person
challenged shall be bound to answer if he shall say upon his oath that
he declines on the ground that his answer may tend to criminate
himself, and if he shall answer to said first ground his answer shall
not be given in evidence in any criminal prosecution against him for
any offense named in sections 1 or 3 of this act, but if he declines to
answer on any ground he shall be rejected as incompetent.
Sec. 6. That the President is hereby authorized to grant amnesty to
such classes of offenders guilty before the passage of this act of
bigamy, polygamy, or unlawful cohabitation before the passage of
this act, on such conditions and under such limitations as he shall
think proper; but no such amnesty shall have effect unless the
conditions thereof shall be complied with.
 Sec. 7. That the issue of bigamous or polygamous marriages
known as Mormon marriages, in cases in which such marriages have
been solemnized according to the ceremonies of the Mormon sect, in
any Territory of the United States, and such issue shall have been
born before the 1st day of January, A. D. 1883, are hereby
legitimated.
Sec. 8. That no polygamist, bigamist, or any person cohabiting
with more than one woman, and no woman cohabiting with any of
the persons described as aforesaid in this section, in any Territory or
other place over which the United States have exclusive jurisdiction,
shall be entitled to vote at any election held in any such Territory or
other place, or be eligible for election or appointment to or be
entitled to hold any office or place of public trust, honor or
emolument in, under, or for such Territory or place, or under the
United States.
Sec. 9. That all the registration and election offices of every
description in the Territory of Utah are hereby declared vacant, and
each and every duty relating to the registration of voters, the conduct
of elections, the receiving or rejection of votes, and the canvassing
and returning of the same, and the issuing of certificates or other
evidence of election in said Territory, shall, until other provision be
made by the Legislative Assembly of said Territory as is hereinafter
by this section provided, be performed under the existing laws of the
United States and of said Territory by proper persons, who shall be
appointed to execute such offices and perform such duties by a board
of five persons, to be appointed by the President, by and with the
advice and consent of the Senate, and not more than three of whom
shall be members of one political party, and a majority of whom shall
constitute a quorum. The members of said board so appointed by the
President shall each receive a salary at the rate of $3,000 per annum,
and shall continue in office until the Legislative Assembly of said
Territory shall make provision for filling said offices as herein
authorized. The secretary of the Territory shall be the secretary of
said board, and keep a journal of its proceedings, and attest the
action of said board under this section. The canvass and return of all
the votes at elections in said Territory for members of the Legislative
Assembly thereof shall also be returned to said board, which shall
canvass all such returns and issue certificates of election to those
persons who, being eligible for such election, shall appear to have
been lawfully elected, which certificate shall be the only evidence of
the right of such persons to sit in such Assembly: Provided, That said
board of five persons shall not exclude any person otherwise eligible
to vote from the polls on account of any opinion such person may
entertain on the subject of bigamy or polygamy, nor shall they refuse
to count any such vote on account of the opinion of the person
casting it on the subject of bigamy or polygamy; but each house of
such Assembly, after its organization, shall have power to decide
upon the elections and qualifications of its members. And at or after
the first meeting of said Legislative Assembly whose members shall
have been elected and returned according to the provisions of this
act, said Legislative Assembly may make such laws, conformable to
the organic act of said Territory and not inconsistent with other laws
of the United States, as it shall deem proper concerning the filling of
the offices in said Territory declared vacant by this act.
John R. McBride writing in the February number (1882) of The
International Review, gives an interesting and correct view of the
obstacles which the Mormons have erected against the enforcement
of United States laws in the Territory. It requires acquaintance with
these facts to fully comprehend the difficulties in the way of what
seems to most minds a very plain and easy task. Mr. McBride says:
Their first care on arriving in Utah was to erect a “free and
Independent State,” called the “State of Deseret.” It included in its
nominal limits, not only all of Utah as it now is, but one-half of
California, all of Nevada, part of Colorado, and a large portion of four
other Territories now organized. Brigham Young was elected
Governor, and its departments, legislative and judicial, were fully
organized and put into operation. Its legislative acts were styled
“ordinances,” and when Congress, disregarding the State
organization, instituted a Territorial Government for Utah, the
legislative body chosen by the Mormons adopted the ordinances of
the “State of Deseret.” Many of these are yet on the statute book of
Utah. They show conclusively the domination of the ecclesiastical
idea, and how utterly insignificant in comparison was the power of
the civil authority. They incorporated the Mormon Church into a
body politic and corporate, and by the third section of the act gave it
supreme authority over its members in everything temporal and
spiritual, and assigned as a reason for so doing that it was because
the powers confirmed were in “support of morality and virtue, and
were founded on the revelations of the Lord.” Under this power to
make laws and punish and forgive offenses, to hear and determine
between brethren, the civil law was superseded. The decrees of the
courts of this church, certified under seal, have been examined by the
writer, and he found them exercising a jurisdiction without limit
except that of appeal to the President of the church. That the
assassinations of apostates, the massacres of the Morrisites at Morris
Fort and of the Arkansas emigrants at Mountain Meadows, were all
in pursuance of church decrees, more or less formal, no one
acquainted with the system doubts. This act of incorporation was
passed February 8, 1851, and is found in the latest compilation of
Utah statutes. It is proper also to observe that, for many years after
the erection of the Territorial Government by Congress, the “State of
Deseret” organization was maintained by the Mormons, and collision
was only prevented because Brigham was Governor of both, and
found it unnecessary for his purpose to antagonize either. His church
organization made both a shadow, while that was the substance of all
authority. One of the earliest of their legislative acts was to organise a
Surveyor-General’s Department,[41] and title to land was declared to
be in the persons who held a certificate from that office.[42] Having
instituted their own system of government and taken possession of
the land, and assumed to distribute that in a system of their own, the
next step was to vest certain leading men with the control of the
timbers and waters of the country. By a series of acts granting lands,
waters and timber to individuals, the twelve apostles became the
practical proprietors of the better and more desirable portions of the
country. By an ordinance dated October 4, 1851, there was granted to
Brigham Young the “sole control of City Creek and Cañon for the
sum of five hundred dollars.” By an ordinance dated January 9, 1850,
the “waters of North Mill Creek and the waters of the Cañon next
north” were granted to Heber C. Kimball. On the same day was
granted to George A. Smith the “sole control of the cañons and
timber of the east side of the ‘West Mountains’.” On the 18th of
January, 1851, the North Cottonwood Cañon was granted exclusively
to Williard Richards. On the 15th of January, 1851, the waters of the
“main channel” of Mill Creek were donated to Brigham Young. On
the 9th of December, 1850, there was granted to Ezra T. Benson the
exclusive control of the waters of Twin Springs and Rock Springs, in
Tooelle Valley; and on the 14th of January, 1851, to the same person
was granted the control of all the cañons of the “West Mountain” and
the timber therein. By the ordinance of September 14, 1850, a
“general conference of the Church of Latter Day Saints” was
authorized to elect thirteen men to become a corporation, to be
called the Emigration Company; and to this company, elected
exclusively by the church, was secured and appropriated the two
islands in Salt Lake known as Antelope and Stansberry Islands, to be
under the exclusive control of President Brigham Young. These
examples are given to show that the right of the United States to the
lands of Utah met no recognition by these people. They appropriated
them, not only in a way to make the people slaves, but indicated their
claim of sovereignty as superior to any. Young, Smith, Benson and
Kimball were apostles. Richards was Brigham Young’s counselor. By
an act of December 28, 1855, there was granted to the “University of
the State of Deseret” a tract of land amounting to about five hundred
acres, inside the city limits of Salt Lake City, without any reservation
to the occupants whatever; and everywhere was the authority of the
United States over the country and its soil and people utterly
ignored.
Not satisfied with making the grants referred to, the Legislative
Assembly entered upon a system of municipal incorporations, by
which the fertile lands of the Territory were withdrawn from the
operation of the preëmptive laws of Congress; and thus while they
occupied these without title, non-Mormons were unable to make
settlement on them, and they were thus engrossed to Mormon use.
From a report made by the Commissioner of the General Land Office
to the United States Senate,[43] it appears that the municipal
corporations covered over 400,000 acres of the public lands, and
over 600 square miles of territory. These lands[44] are not subject to
either the Homestead or Preëmption laws, and thus the non-
Mormon settler was prevented from attempting, except in rare
instances, to secure any lands in Utah. The spirit which prompted
this course is well illustrated by an instance which was the subject of
an investigation in the Land Department, and the proofs are found in
the document just referred to. George Q. Cannon, the late Mormon
delegate in Congress, was called to exercise his duties as an apostle to
the Tooelle “Stake” at the city of Grantville. In a discourse on
Sunday, the 20th day of July, 1875, Mr. Cannon said:[45] “God has
given us (meaning the Mormon people) this land, and, if any
outsider shall come in to take land which we claim, a piece six feet by
two is all they are entitled to, and that will last them to all eternity.”
By measures and threats like these have the Mormons unlawfully
controlled the agricultural lands of the Territory and excluded
therefrom the dissenting settler. The attempt of the United States to
establish a Surveyor-General’s office in Utah in 1855, and to survey
the lands in view of disposing of them according to law, was met by
such opposition that Mr. Burr, the Surveyor-General, was compelled
to fly for life. The monuments of surveys made by his order were
destroyed, and the records were supposed to have met a like fate, but
were afterwards restored by Brigham Young to the Government. The
report of his experience by Mr. Burr was instrumental in causing
troops to be sent in 1857 to assert the authority of the Government.
When this army, consisting of regular troops, was on the way to
Utah, Brigham Young, as Governor, issued a proclamation, dated
September 15, 1857, declaring martial law and ordering the people of
the Territory to hold themselves in readiness to march to repel the
invaders, and on the 29th of September following addressed the
commander of United States forces an order forbidding him to enter
the Territory, and directing him to retire from it by the same route he
had come. Further evidence of the Mormon claim that they were
independent is perhaps unnecessary. The treasonable character of
the local organization is manifest. It is this organization that
controls, not only the people who belong to it, but the 30,000 non-
Mormons who now reside in Utah.
Every member of the territorial Legislature is a Mormon. Every
county officer is a Mormon. Every territorial officer is a Mormon,
except such as are appointive. The schools provided by law and
supported by taxation are Mormon. The teachers are Mormon, and
the sectarian catechism affirming the revelations of Joseph Smith is
regularly taught therein. The municipal corporations are under the
control of Mormons. In the hands of this bigoted class all the
material interests of the Territory are left, subject only to such checks
as a Federal Governor and a Federal judiciary can impose. From
beyond the sea they import some thousands of ignorant converts
annually, and, while the non-Mormons are increasing, they are
overwhelmed by the muddy tide of fanaticism shipped in upon them.
The suffrage has been bestowed upon all classes by a statute so
general that the ballot-box is filled with a mass of votes which repels
the free citizen from the exercise of that right. If a Gentile is chosen
to the Legislature (two or three such instances have occurred), he is
not admitted to the seat, although the act of Congress (June 23,
1874) requires the Territory to pay all the expenses of the
enforcement of the laws of the Territory, and of the care of persons
convicted of offenses against the laws of the Territory. Provision is
made for jurors’ fees in criminal cases only, and none is made for the
care of criminals.[46] While Congress pays the legislative expenses,
amounting to $20,000 per session, the Legislature defiantly refuses
to comply with the laws which its members are sworn to support.
And the same body, though failing to protect the marriage bond by
any law whatever requiring any solemnities for entering it, provided
a divorce act which practically allowed marriages to be annulled at
will.[47] Neither seduction, adultery nor incest find penalty or
recognition in its legal code. The purity of home is destroyed by the
beastly practice of plural marriage, and the brows of innocent
children are branded with the stain of bastardy to gratify the lust
which cares naught for its victims. Twenty-eight of the thirty-six
members of the present Legislature of Utah are reported as having
from two to seven wives each. While the Government of the United
States is paying these men their mileage and per diem as law-makers
in Utah, those guilty of the same offense outside of Utah are leading
the lives of felons in convict cells. For eight years a Mormon delegate
has sat in the capitol at Washington having four living wives in his
harem in Utah, and at the same time, under the shadow of that
capitol, lingers in a felon’s prison a man who had been guilty of
marrying a woman while another wife was still living.
For thirty years have the Mormons been trusted to correct these
evils and put themselves in harmony with the balance of civilized
mankind. This they have refused to do. Planting themselves in the
heart of the continent, they have persistently defied the laws of the
land, the laws of modern society, and the teachings of a common
humanity. They degrade woman to the office of a breeding animal,
and, after depriving her of all property rights in her husband’s estate,
[48]
all control of her children,[49] they, with ostentation, bestow upon
her the ballot in a way that makes it a nullity if contested, and
compels her to use it to perpetuate her own degradation if she avails
herself of it.
No power has been given to the Mormon Hierarchy that has not
been abused. The right of representation in the legislative councils
has been violated in the apportionment of members so as to
disfranchise the non-Mormon class.[50] The system of revenue and
taxation was for twenty-five years a system of confiscation and
extortion.[51] The courts were so organized and controlled that they
were but the organs of the church oppressions and ministers of its
vengeance.[52] The legal profession was abolished by a statute that
prohibited a lawyer from recovering on any contract for service, and
allowed every person to appear as an attorney in any court.[53] The
attorney was compelled to present “all the facts in the case,” whether
for or against his client, and a refusal to disclose the confidential
communications of the latter subjected the attorney to fine and
imprisonment.[54] No law book except the statutes of Utah and of the
United States, “when applicable,” was permitted to be read in any
court by an attorney, and the citation of a decision of the Supreme
Court of the United States, or even a quotation from the Bible, in the
trial of any cause, subjected a lawyer to fine and imprisonment.[55]
The practitioners of medicine were equally assailed by legislation.
The use of the most important remedies known to modern medical
science, including all anæsthetics, was prohibited except under
conditions which made their use impossible, “and if death followed”
the administration of these remedies, the person administering them
was declared guilty of manslaughter or murder.[56] The Legislative
Assembly is but an organized conspiracy against the national law,
and an obstacle in the way of the advancement of its own people. For
sixteen years it refused to lay its enactments before Congress, and
they were only obtained by a joint resolution demanding them. Once
in armed rebellion against the authority of the nation, the Mormons
have always secretly struggled for, as they have openly prophesied,
its entire overthrow. Standing thus in the pathway of the material
growth and development of the Territory, a disgrace to the balance of
the country, with no redeeming virtue to plead for further
indulgence, this travesty of a local government demands radical and
speedy reform.
 The South American Question.

If it was not shrewdly surmised before it is now known that had

President Garfield lived he intended to make his administration
brilliant at home and abroad—a view confirmed by the policy
conceived by Secretary Blaine and sanctioned, it must be presumed,
by President Garfield. This policy looked to closer commercial and
political relations with all of the Republics on this Hemisphere, as
developed in the following quotations from a correspondence, the
publication of which lacks completeness because of delays in
transmitting all of it to Congress.
Ex-Secretary Blaine on the 3d of January sent the following letter
to President Arthur:
“The suggestion of a congress of all the American nations to assemble in the city
of Washington for the purpose of agreeing on such a basis of arbitration for
international troubles as would remove all possibility of war in the Western
hemisphere was warmly approved by your predecessor. The assassination of July 2
prevented his issuing the invitations to the American States. After your accession
to the Presidency I acquainted you with the project and submitted to you a draft
for such an invitation. You received the suggestion with the most appreciative
consideration, and after carefully examining the form of the invitation directed
that it be sent. It was accordingly dispatched in November to the independent
governments of America North and South, including all, from the Empire of Brazil
to the smallest republic. In a communication addressed by the present Secretary of
State on January 9, to Mr. Trescot and recently sent to the Senate I was greatly
surprised to find a proposition looking to the annulment of these invitations, and I
was still more surprised when I read the reasons assigned. If I correctly apprehend
the meaning of his words it is that we might offend some European powers if we
should hold in the United States a congress of the “selected nationalities” of
America.
“This is certainly a new position for the United States to assume, and one which I
earnestly beg you will not permit this government to occupy. The European powers
assemble in congress whenever an object seems to them of sufficient importance to
justify it. I have never heard of their consulting the government of the United
States in regard to the propriety of their so assembling, nor have I ever known of
their inviting an American representative to be present. Nor would there, in my
judgment, be any good reason for their so doing. Two Presidents of the United
States in the year 1881 adjudged it to be expedient that the American powers
should meet in congress for the sole purpose of agreeing upon some basis for
arbitration of differences that may arise between them and for the prevention, as
far as possible, of war in the future. If that movement is now to be arrested for fear
that it may give offense in Europe, the voluntary humiliation of this government
could not be more complete, unless we should press the European governments for
the privilege of holding the congress. I cannot conceive how the United States
could be placed in a less enviable position than would be secured by sending in
November a cordial invitation to all the American governments to meet in
Washington for the sole purpose of concerting measures of peace and in January
recalling the invitation for fear that it might create “jealousy and ill will” on the
part of monarchical governments in Europe. It would be difficult to devise a more
effective mode for making enemies of the American Government and it would
certainly not add to our prestige in the European world. Nor can I see, Mr.
President, how European governments should feel “jealousy and ill will” towards
the United States because of an effort on our own part to assure lasting peace
between the nations of America, unless, indeed, it be to the interest of European
power that American nations should at intervals fall into war and bring reproach
on republican government. But from that very circumstance I see an additional
and powerful motive for the American Governments to be at peace among
themselves.
“The United States is indeed at peace with all the world, as Mr. Frelinghuysen
well says, but there are and have been serious troubles between other American
nations. Peru, Chili and Bolivia have been for more than two years engaged in a
desperate conflict. It was the fortunate intervention of the United States last spring
that averted war between Chili and the Argentine Republic. Guatemala is at this
moment asking the United States to interpose its good offices with Mexico to keep
off war. These important facts were all communicated in your late message to
Congress. It is the existence or the menace of these wars that influenced President
Garfield, and as I supposed influenced yourself, to desire a friendly conference of
all the nations of America to devise methods of permanent peace and consequent
prosperity for all. Shall the United States now turn back, hold aloof and refuse to
exert its great moral power for the advantage of its weaker neighbors?
If you have not formally and finally recalled the invitations to the Peace
Congress, Mr. President, I beg you to consider well the effect of so doing. The
invitation was not mine. It was yours. I performed only the part of the Secretary—
to advise and to draft. You spoke in the name of the United States to each of the
independent nations of America. To revoke that invitation for any cause would be
embarrassing; to revoke it for the avowed fear of “jealousy and ill will” on the part
of European powers would appeal as little to American pride as to American
hospitality. Those you have invited may decline, and having now cause to doubt
their welcome will, perhaps, do so. This would break up the congress, but it would
not touch our dignity.
 “Beyond the philanthropic and Christian ends to be obtained by an American
conference devoted to peace and good will among men, we might well hope for
material advantages, as the result of a better understanding and closer friendship
with the nation of America. At present the condition of trade between the United
States and its American neighbors is unsatisfactory to us, and even deplorable.
According to the official statistics of our own Treasury Department, the balance
against us in that trade last year was $120,000,000—a sum greater than the yearly
product of all the gold and silver mines in the United States. This vast balance was
paid by us in foreign exchange, and a very large proportion of it went to England,
where shipments of cotton, provisions and breadstuffs supplied the money. If
anything should change or check the balance in our favor in European trade our
commercial exchanges with Spanish America would drain us of our reserve of gold
at a rate exceeding $100,000,000 per annum, and would probably precipitate a
suspension of specie payment in this country. Such a result at home might be
worse than a little jealousy and ill-will abroad. I do not say, Mr. President, that the
holding of a peace congress will necessarily change the currents of trade, but it will
bring us into kindly relations with all the American nations; it will promote the
reign of peace and law and order; it will increase production and consumption and
will stimulate the demand for articles which American manufacturers can furnish
with profit. It will at all events be a friendly and auspicious beginning in the
direction of American influence and American trade in a large field which we have
hitherto greatly neglected and which has been practically monopolized by our
commercial rivals in Europe.
As Mr. Frelinghuysen’s dispatch, foreshadowing the abandonment of the peace
congress, has been made public, I deem it a matter of propriety and justice to give
this letter to the press.

Jas. G. Blaine.

The above well presents the Blaine view of the proposition to have
a Congress of the Republics of America at Washington, and under
the patronage of this government, with a view to settle all difficulties
by arbitration, to promote trade, and it is presumed to form alliances
ready to suit a new and advanced application of the Monroe doctrine.
The following is the letter proposing a conference of North and
South American Republics sent to the U. S. Ministers in Central and
South America:
Sir: The attitude of the United States with respect to the question of general
peace on the American Continent is well known through its persistent efforts for
years past to avert the evils of warfare, or, these efforts failing, to bring positive
conflicts to an end through pacific counsels or the advocacy of impartial
arbitration. This attitude has been consistently maintained, and always with such
fairness as to leave no room for imputing to our Government any motive except the
humane and disinterested one of saving the kindred States of the American
Continent from the burdens of war. The position of the United States, as the
leading power of the new world, might well give to its Government a claim to
authoritative utterance for the purpose of quieting discord among its neighbors,
with all of whom the most friendly relations exist. Nevertheless the good offices of
this Government are not, and have not at any time, been tendered with a show of
dictation or compulsion, but only as exhibiting the solicitous good will of a
common friend.

THE CENTRAL AND SOUTH AMERICAN STATES.

For some years past a growing disposition has been manifested by certain States
of Central and South America to refer disputes affecting grave questions of
international relationship and boundaries to arbitration rather than to the sword.
It has been on several occasions a source of profound satisfaction to the
Government of the United States to see that this country is in a large measure
looked to by all the American powers as their friend and mediator. The just and
impartial counsel of the President in such cases, has never been withheld, and his
efforts have been rewarded by the prevention of sanguinary strife or angry
contentions between peoples whom we regard as brethren. The existence of this
growing tendency convinces the President that the time is ripe for a proposal that
shall enlist the good will and active co-operation of all the States of the Western
Hemisphere both North and South, in the interest of humanity and for the
common weal of nations.
He conceives that none of the Governments of America can be less alive than our
own to the dangers and horrors of a state of war, and especially of war between
kinsmen. He is sure that none of the chiefs of Government on the Continent can be
less sensitive than he is to the sacred duty of making every endeavor to do away
with the chances of fratricidal strife, and he looks with hopeful confidence to such
active assistance from them as will serve to show the broadness of our common
humanity, the strength of the ties which bind us all together as a great and
harmonious system of American Commonwealths.

A GENERAL CONGRESS PROPOSED.

Impressed by these views, the President extends to all the independent countries
of North and South America an earnest invitation to participate in a general
Congress, to be held in the city of Washington, on the 22d of November, 1882, for
the purpose of considering and discussing the methods of preventing war between
the nations of America. He desires that the attention of the Congress shall be
strictly confined to this one great object; and its sole aim shall be to seek a way of
permanently averting the horrors of a cruel and bloody contest between countries
oftenest of one blood and speech, or the even worse calamity of internal
commotion and civil strife; that it shall regard the burdensome and far-reaching
consequences of such a struggle, the legacies of exhausted finances, of oppressive
debt, of onerous taxation, of ruined cities, of paralyzed industries, of devastated
fields, of ruthless conscriptions, of the slaughter of men, of the grief of the widow
and orphan, of embittered resentments that long survive those who provoked them
and heavily afflict the innocent generations that come after.

THE MISSION OF THE CONGRESS.

The President is especially desirous to have it understood that in putting forth

this invitation the United States does not assume the position of counseling or
attempting, through the voice of the Congress, to counsel any determinate solution
of existing questions which may now divide any of the countries. Such questions
cannot properly come before the Congress. Its mission is higher. It is to provide for
the interests of all in the future, not to settle the individual differences of the
present. For this reason especially the President has indicated a day for the
assembling of the Congress so far in the future as to leave good ground for the hope
that by the time named the present situation on the South Pacific coast will be
happily terminated, and that those engaged in the contest may take peaceable part
in the discussion and solution of the general question affecting in an equal degree
the well-being of all.
It seems also desirable to disclaim in advance any purpose on the part of the
United States to prejudge the issues to be presented to the Congress. It is far from
the intent of this Government to appear before the Congress as in any sense the
protector of its neighbors or the predestined and necessary arbitrator of their
disputes. The United States will enter into the deliberations of the Congress on the
same footing as other powers represented, and with the loyal determination to
approach any proposed solution, not merely in its own interest, or with a view to
asserting its own power, but as a single member among many co-ordinate and co-
equal States. So far as the influence of this Government may be potential, it will be
exerted in the direction of conciliating whatever conflicting interests of blood, or
government, or historical tradition that may necessarily come together in response
to a call embracing such vast and diverse elements.

INSTRUCTIONS TO THE MINISTERS.

You will present these views to the Minister of Foreign Affairs of Costa Rica,
enlarging, if need be, in such terms as will readily occur to you upon the great
mission which it is within the power of the proposed Congress to accomplish in the
interest of humanity, and the firm purpose of the United States of America to
maintain a position of the most absolute and impartial friendship toward all. You
will, therefore, in the name of the President of the United States, tender to his
Excellency, the President of ——, a formal invitation to send two commissioners to
the Congress, provided with such powers and instructions on behalf of their
Government as will enable them to consider the questions brought before that
body within the limit of submission contemplated by this invitation.
The United States, as well as the other powers, will in like manner be
represented by two commissioners, so that equality and impartiality will be amply
secured in the proceedings of the Congress.
In delivering this invitation through the Minister of Foreign Affairs, you will
read this despatch to him and leave with him a copy, intimating that an answer is
desired by this Government as promptly as the just consideration of so important a
proposition will permit.
I am, sir, your obedient servant,

James G. Blaine.
 Minister Logan’s Reply.

The following is an abstract of the reply of Minister Logan to the

above.
“From a full review of the situation, as heretofore detailed to you, I
am not clear as to being able to obtain the genuine co-operation of all
the States of Central America in the proposed congress.—Each, I
have no doubt, will ultimately agree to send the specified number of
commissioners and assume, outwardly, an appearance of sincere co-
operation, but, as you will perceive from your knowledge of the
posture of affairs, all hope of effecting a union of these States except
upon a basis the leaders will never permit—that of a free choice of
the whole people—will be at an end. The obligation to keep the peace,
imposed by the congress, will bind the United States as well as all
others, and thus prevent any efforts to bring about the desired union
other than those based upon a simple tender of good offices—this
means until the years shall bring about a radical change—must be as
inefficient in the future as in the past. The situation, as it appears to
me, is a difficult one. As a means of restraining the aggressive
tendency of Mexico in the direction of Central America, the congress
would be attended by the happiest results, should a full agreement be
reached. But as the Central American States are now in a chaotic
condition, politically considered, with their future status wholly
undefined, and as a final settlement can only be reached, as it now
appears, through the operation of military forces, the hope of a
Federal union in Central America would be crushed, at least in the
immediate present. Wiser heads than my own may devise a method
to harmonize these difficulties when the congress is actually in
session, but it must be constantly remembered that so far as the
Central American commissioners are concerned they will represent
the interests and positive mandates of their respective government
chiefs in the strictest and most absolute sense. While all will
probably send commissioners, through motives of expediency, they
may possibly be instructed to secretly defeat the ends of the
convention. I make these suggestions that you may have the whole
field under view.
“I may mention in this connection that I have received information
that up to the tenth of the present month only two members of the
proposed convention at Panama had arrived and that it was
considered as having failed.”
Contemporaneous with these movements or suggestions was
another on the part of Mr. Blaine to secure from England a
modification or abrogation of the Clayton-Bulwer treaty, with the
object of giving to the United States, rather to the Republics of North
and South America, full supervision of the Isthmus and Panama
Canal when constructed. This branch of the correspondence was sent
to the Senate on the 17th of February. Lord Granville, in his despatch
of January 7th to Minister West in reference to the Clayton-Bulwer
Treaty controversy, denies any analogy between the cases of the
Panama and Suez Canals. He cordially concurs in Mr. Blaine’s
statement in regard to the unexampled development of the Pacific
Coast, but denies that it was unexpected.
He says the declaration of President Monroe anterior to the treaty
show that he and his Cabinet had a clear prevision of the great future
of that region. The development of the interests of the British
possessions also continued, though possibly less rapidly. The
Government are of the opinion that the canal, as a water way
between the two great oceans and Europe and Eastern Asia, is a work
which concerns not only the American Continent, but the whole
civilized world. With all deference to the considerations which
prompted Mr. Blaine he cannot believe that his proposals will be
even beneficial in themselves. He can conceive a no more melancholy
spectacle than competition between nations in the construction of
fortifications to command the canal. He cannot believe that any
South American States would like to admit a foreign power to erect
fortifications on its territory, when the claim to do so is accompanied
by the declaration that the canal is to be regarded as a part of the
American coast line. It is difficult to believe, he says, that the
territory between it and the United States could retain its present
independence. Lord Granville believes that an invitation to all the
maritime states to participate in an agreement based on the
stipulations of the Convention of 1850, would make the Convention
adequate for the purposes for which it was designed. Her Majesty’s
Government would gladly see the United States take the initiative
towards such a convention, and will be prepared to endorse and
support such action in any way, provided it does not conflict with the
Clayton-Bulwer treaty.
Lord Granville, in a subsequent despatch, draws attention to the
fact that Mr. Blaine, in using the argument that the treaty has been a
source of continual difficulties, omits to state that the questions in
dispute which related to points occupied by the British in Central
America were removed in 1860 by the voluntary action of Great
Britain in certain treaties concluded with Honduras and Nicaragua,
the settlement being recognized as perfectly satisfactory by President
Buchanan. Lord Granville says, further, that during this controversy
America disclaimed any desire to have the exclusive control of the
canal.
The Earl contends that in cases where the details of an
international agreement have given rise to difficulties and
discussions to such an extent as to cause the contracting parties at
one time to contemplate its abrogation or modification as one of
several possible alternatives, and where it has yet been found
preferable to arrive at a solution as to those details rather than to
sacrifice the general bases of the engagement, it must surely be
allowed that such a fact, far from being an argument against that
engagement, is an argument distinctly in its favor. It is equally plain
that either of the contracting parties which had abandoned its own
contention for the purpose of preserving the agreement in its entirety
would have reason to complain if the differences which had been
settled by its concessions were afterwards urged as a reason for
essentially modifying those other provisions which it had made this
sacrifice to maintain. In order to strengthen these arguments, the
Earl reviews the correspondence, quotes the historical points made
by Mr. Blaine and in many instances introduces additional data as
contradicting the inferences drawn by Mr. Blaine and supporting his
own position.
The point on which Mr. Blaine laid particular stress in his
despatch to Earl Granville, is the objection made by the government
of the United States to any concerted action of the European powers