Proprioceptive Neuromuscular Facilitation

Tina Recalde, DPT, MS, ATC, CSCS


Primary Goal

Promote functional movement through use of facilitation, inhibition, strengthening, and relaxation of muscle groups

Used to make functional motion easier through use of proprioceptive signals to nerves and muscles

Tina Recalde, DPT, MS, ATC, CSCS



Developed at Kabat-Kaiser Institute
– – –

1946-1951 Based on neurophysiology and motor development Emphasis placed on application of maximal resistance throughout ROM Used many combinations of motions
 

Primitive patterns Postural and righting reflexes
Tina Recalde, DPT, MS, ATC, CSCS 2012

DPT. ATC. MS. CSCS 2012  Motion performed – –  Stretch applied to groups of muscles – .Components  Positioning of a part was valuable – Created stronger contraction in desired muscle groups First in strongest part of range Progressing toward weaker parts of range Usually synergists for greater proprioceptive stimulation Tina Recalde.

DPT. CSCS 2012 . MS.Components Continued   Process of overflow (reinforcement) – Used throughout in combination of motions Used to increase ROM and improve endurance Repeated contractions – Tina Recalde. ATC.

ATC. resulted in increased response of the agonist  rhythmic stabilization Applying same procedure of alternating resistance to isotonic contractions of antagonist and agonist also had a facilitating effect  slow reversal Tina Recalde. CSCS 2012 . DPT. MS.Sherrington’s Law of Successive Induction    1949 Having pt isometrically contract agonist. then antagonist.

MS.Combinations of Motions    1951 Combinations which permitted maximum elongation of related muscle groups so that stretch reflex could be elicited throughout a “pattern” were most effective Patterns were spiral and diagonal in character with similarity to normal. functional patterns of motion Tina Recalde. DPT. ATC. CSCS 2012 .

Definitions  Proprioceptive – Receiving stimulation within the tissues of the body Pertaining to nerves and muscles  Neuromuscular – Tina Recalde. MS. DPT. ATC. CSCS 2012 .

Proprioceptors    Corpuscles of Ruffini Muscle Spindles Golgi Tendon Organs (GTOs) Tina Recalde. MS. CSCS 2012 . DPT. ATC.

CSCS 2012 . ATC.Corpuscles of Ruffini   Located within skin. MS. DPT. and joint capsules Respond to distension Tina Recalde. ligaments.

ATC. DPT.Muscle Spindles   Located in skeletal muscle Respond to changes in length – – Excitatory synapses with motorneurons of stretched muscle Inhibitory synapses with motorneurons of antagonist muscles Tina Recalde. MS. CSCS 2012 .

MS. DPT. CSCS 2012 . ATC.Golgi Tendon Organs   Located in muscles and tendons Protect against harmful levels of tension development Tina Recalde.

Definitions  Facilitation – – – Promotion or hastening of any natural process Effect produced in nerve tissue by passage of an impulse Resistance of nerve is diminished so that a 2nd application of stimulus evokes reaction more easily Tina Recalde. CSCS 2012 . DPT. ATC. MS.

CSCS 2012 .Definitions  PNF – – Methods of promoting or hastening normal responses of neuromuscular mechanism through stimulation of proprioceptors placing specific demands in order to secure a desired response Tina Recalde. ATC. MS. DPT.

MS. and kinesiology Tina Recalde. ATC. DPT. anatomy.Principles  Knowledge of normal neuromuscular mechanisms – Motor development. CSCS 2012 . neurophysiology.

Normal Neuromuscular Mechanism  Capable of a wide range of motor activities within limits of: – – – Anatomical structure Developmental level Inherent and previously learned neuromuscular responses  Integrated and efficient without awareness of individual muscle action. CSCS 2012 . reflex activity. DPT. ATC. and a multitude of other neurophysiological reactions Tina Recalde. MS.

MS. ATC. CSCS 2012 . trauma.Deficient Neuromuscular Mechanism    Inadequate to meet demands of life in proportion to degree of deficiency Response may be limited as a result of faulty development. or disease of nervous or musculoskeletal systems Specific demands placed by PT/PTA have a facilitating effect upon pt’s neuromuscular mechanism to reverse pt’s limitations Tina Recalde. DPT.

CSCS 2012 . ATC. MS.PNF Objectives      Increase ability to move or remain stable Guide movement through use of proper grips and appropriate resistance Achieve coordinated movement through use of timing Increase stamina Avoid fatigue Tina Recalde. DPT.

ATC.Limitation  Avoid causing or increasing pain Tina Recalde. DPT. CSCS 2012 . MS.

CSCS 2012 . DPT.Basic Procedures        Patterns Resistance Irradiation and reinforcement Manual contact Traction and approximation Stretch Timing Tina Recalde. ATC. MS.

ATC. DPT. MS.Patterns of Facilitation  Mass movement patterns – Brain knows nothing of individual muscle action but knows only movement   Combining specific components of motion that allow consistent activation Spiral and diagonal in character in keeping with spiral and rotary characteristics of skeletal system Tina Recalde. CSCS 2012 .

DPT. MS.Straight Motion Pattern of Facilitation Flexion Flexion Flexion Pivot of Action Pivot of Action Extension Extension Extension Tina Recalde. CSCS 2012 . ATC.

Major Parts of Body      Head and neck Upper trunk Lower trunk UE LE Tina Recalde. DPT. MS. ATC. CSCS 2012 .

MS. DPT.Diagonals   2 diagonals of motion for each major part of body Each diagonal has: – – 2 patterns  Antagonistic to each other Major component of flexion or extension  Major component combined with 2 other components – Motion toward or away from midline – Rotation Tina Recalde. ATC. CSCS 2012 .

Diagonals Flexion Flexion Pivot of Action Extension Extension Tina Recalde. MS. DPT. CSCS 2012 . ATC.

ATC. MS. DPT. CSCS 2012 .LE PNF Patterns D2 Hip flxn Hip abdn Hip IR Ankle DF Foot eversion Toe extn D1 Hip flxn Hip addn Hip ER Ankle DF Foot inversion Toe extn Hip extn Hip abdn Hip IR Ankle PF Foot eversion Toe flxn Hip extn Hip addn Hip ER Ankle PF Foot inversion Toe flxn Tina Recalde.

ATC. DPT. MS. CSCS 2012 Shoulder extn Shoulder addn Shoulder IR Scapular depression and abdn Forearm pronation Ulnar wrist flexion Finger flxn .UE PNF Patterns D2 Shoulder flxn Shoulder abdn Shoulder ER Scap elevation & addn Forearm supination Radial wrist extn Finger extn D1 Shoulder flxn Shoulder addn Shoulder ER Scapular elevation & abdn Forearm supination Radial wrist flxn Finger flxn Shoulder extn Shoulder abdn Shoulder IR Scapular depression & addn Forearm pronation Ulnar wrist extn Finger extn Tina Recalde.

Naming of Patterns  Each pattern is named either: 1. ATC. For position of the proximal jt. Tina Recalde. at the end of the pattern OR For the motions being performed at the proximal jt. MS. DPT. 2. CSCS 2012 .

MS. ATC.Naming of Diagonals   D1 or D2 Or for the 2 patterns that comprise the diagonal (ex: flex/abd/ER – ext/add/IR Tina Recalde. DPT. CSCS 2012 .

DPT. CSCS 2012 . ATC. coordinated mvmt to occur Tina Recalde.Resistance  Used to: – – – – Facilitate ability of muscles to contract Increase motor control Help pt gain awareness of motion Increase strength   Amount should be appropriate for injury or goal of activity Should allow smooth. MS.

MS. CSCS 2012 . ATC.Irradiation and Reinforcement    Occurs with appropriately applied resistance Facilitation spreads both distally and proximally Used to increase response to stimulation Tina Recalde. DPT.

CSCS 2012 . ATC. DPT. MS.Manual Contact      Use of PT/PTA’s hands with varying grip and pressure to guide mvmt and increase strength Stimulates mechanoreceptors in skin Allows pt to adjust motion based upon grip and pressure applied Should relay info about proper and expected direction of mvmt Applied in opposite direction of desired motion Tina Recalde.

MS. ATC. DPT.Traction     Stimulates sensory receptors within joints Elongation of trunk or extremities and acts as a stimulus by elongating muscles Used to facilitate pulling and antigravity motions Applied gradually and maintained throught motion Tina Recalde. CSCS 2012 .

MS. facilitate wtbearing. and correct antigravity muscles Tina Recalde. CSCS 2012 .Approximation     Stimulates sensory receptors within joints Compression of trunk or extremities Facilitates contraction of muscles to correct applied pressure Used to promote stabilization. DPT. ATC.

DPT.Stretch Reflex   Elongation of muscles Used to facilitate contraction and decrease muscle fatigue Tina Recalde. CSCS 2012 . ATC. MS.

coordinated movements to occur Normal timing for most coordinated activities begins distally and moves proximally – – – Distal portion moves through full ROM first and holds position Other components move together and complete their motion Rotation is the only motion resisted throughout entire pattern Tina Recalde. DPT.Timing   Sequence of motions that is required to allow smooth. ATC. CSCS 2012 . MS.

Previte. J. (1990). Tina Recalde. & Buck. M.. E. I. (1993). Proprioceptive Neuromuscular Facilitation Patterns and Techniques. D. F. New York: McGrawHill. & Voss. M. DPT. ATC. Proprioceptive facilitation of muscle tension during unilateral and bilateral knee extension. V. International Journal of Sports Medicine.References     Adler. Roy. Beckers. Knott. Human physiology. 11(4). (1968). Katch... New York: Harper & Row. S. L. P. 289-292. P. CSCS 2012 . & Lagasse. Sylvestre.. (1983). D. A. M. MS. New York: Springer-Verlag. J. S.. PNF in practice: An illustrated guide.. Katch. M.

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