This document discusses several sensory motor approaches used in neurophysiotherapy, including Rood's approach, PNF, neurodevelopmental approach, sensory integration, and Brunnstrom's movement therapy. It provides details on the theoretical basis, principles, techniques, and strategies of each approach. Rood's approach focuses on normalizing muscle tone through sensory stimulation to produce purposeful movement. PNF uses techniques like manual contacts, stretch, and traction to stimulate proprioceptors and facilitate desired movement. The neurodevelopmental approach was developed by Bobath and aims to modify abnormal movement patterns.
Brian Mulligan described novel concept of the simultaneous application of therapist applied accessory mobilizations and patient generated active movements
This presentation is detail about Volta therapy which is commonly used in paediatric neurological conditions and also for adults. this presentation explains what are the various techniques, methods of application of Volta therapy, indications, contraindications, etc.
Introduction, principles of sensory re-education hypersensitivity and hyposensitivity, stages of training after nerve repair, uses and benefits, sensory reeducation in stroke - its principle. Actve and passive Sensory reeducation in stroke, orofacial sensory retraining
Neurodynamics, mobilization of nervous system, neural mobilizationSaurab Sharma
This is the presentation which was delivered to third year Bachelor of Physiotherapy students at Kathmandu University School of Medical Sciences (KUSMS), Dhulikhel, Nepal. Different schools of thoughts in manual therapy are the part of curriculum for the undergraduate students at KUSMS.
Brian Mulligan described novel concept of the simultaneous application of therapist applied accessory mobilizations and patient generated active movements
This presentation is detail about Volta therapy which is commonly used in paediatric neurological conditions and also for adults. this presentation explains what are the various techniques, methods of application of Volta therapy, indications, contraindications, etc.
Introduction, principles of sensory re-education hypersensitivity and hyposensitivity, stages of training after nerve repair, uses and benefits, sensory reeducation in stroke - its principle. Actve and passive Sensory reeducation in stroke, orofacial sensory retraining
Neurodynamics, mobilization of nervous system, neural mobilizationSaurab Sharma
This is the presentation which was delivered to third year Bachelor of Physiotherapy students at Kathmandu University School of Medical Sciences (KUSMS), Dhulikhel, Nepal. Different schools of thoughts in manual therapy are the part of curriculum for the undergraduate students at KUSMS.
A type of manual therapy in which the muscle or the joint is altered and placed in a position of comfort for certain duration after which the pain disappears completely or gets reduced. this slide show explains about the principles, mechanism and Phases of PRT
This is the presentation which was delivered to third year Bachelor of Physiotherapy students at Kathmandu University School of Medical Sciences (KUSMS), Dhulikhel, Nepal. Different schools of thoughts in manual therapy are the part of curriculum for the undergraduate students at KUSMS.
This presentation give an upto date insightful information on balance/postural assessment and key domains of Occupational Therapy during assessment of balance using different scales.
Retraining of motor control basing on understanding of normal movement & analysis of motor dysfunction.
Emphasis of MRP is on practice of specific activities, the training of cognitive control over muscles & movt. Components of activities & conscious elimination of unnecessary muscle activity.
In rehabilitation programme involve – real life activities included.
Cyriax, a manual therapy technique, used to treat the soft tissue related pain. invented by James Cyriax who also coined the term "orthopedic medicine". There are various techniques described by Cyriax under the concept which are; infiltration, deep friction massage, manipulation and traction.
Vojta technique is neuromuscular approach deals with all the conditions of CNS and Musculoskeletal system.
Contents :
Introduction
Definition
What is REFLEX LOCOMOTION
Indication
Stimulating Points
Reflex locomotion
Reflex Rolling phase 1
Reflex Rolling phase 2
Reflex creeping
Effects of Vojta technique
A type of manual therapy in which the muscle or the joint is altered and placed in a position of comfort for certain duration after which the pain disappears completely or gets reduced. this slide show explains about the principles, mechanism and Phases of PRT
This is the presentation which was delivered to third year Bachelor of Physiotherapy students at Kathmandu University School of Medical Sciences (KUSMS), Dhulikhel, Nepal. Different schools of thoughts in manual therapy are the part of curriculum for the undergraduate students at KUSMS.
This presentation give an upto date insightful information on balance/postural assessment and key domains of Occupational Therapy during assessment of balance using different scales.
Retraining of motor control basing on understanding of normal movement & analysis of motor dysfunction.
Emphasis of MRP is on practice of specific activities, the training of cognitive control over muscles & movt. Components of activities & conscious elimination of unnecessary muscle activity.
In rehabilitation programme involve – real life activities included.
Cyriax, a manual therapy technique, used to treat the soft tissue related pain. invented by James Cyriax who also coined the term "orthopedic medicine". There are various techniques described by Cyriax under the concept which are; infiltration, deep friction massage, manipulation and traction.
Vojta technique is neuromuscular approach deals with all the conditions of CNS and Musculoskeletal system.
Contents :
Introduction
Definition
What is REFLEX LOCOMOTION
Indication
Stimulating Points
Reflex locomotion
Reflex Rolling phase 1
Reflex Rolling phase 2
Reflex creeping
Effects of Vojta technique
Controlled use of sensory stimulus.
Specific Motor response
Normalization of muscle tone
Use of Developmental sequences.
Sensorimotor development = from lower to higher level.
Use of activity to demand a purposeful response.
Practice of sensory motor response is necessary for motor learning.
Principles and application of various Neurological Approaches. Comprises of PNF, ROODS, NDT, BOBATH, SENSORY INTEGRATION, BRUNNSTORM, VOJTA, Motor Re-learning Approach , Neural Tissue Mobilization
;Passive movements are those which are performed by therapist. It is also called Passive Range of motion (PROM). It is divide into Five types .Also passive movements can be done by mechanically.
Joint mobilization refers to a technique of manual therapy by which a therapist applies a brief stretch of 30s or less through traction and gliding along a joint surface.
Mobility and Flexibility of soft tissues (muscles, tendons, fascia, joint capsule, and skins) surrounding the joint along with adequate joint mobility, are necessary for normal ROM.
Mobility: is the ability of segments of the body to move through range of motion for functional activities.
Flexibility: is the ability to move a single joint or series of joints smoothly and easily through an unrestricted, pain –free ROM.
Theoretical framework of infant physiotherapyAnwesh Pradhan
MPT class- Theoretical framework of infant physiotherapy. Require 3 class. Help us to decide the paediatric physiotherapy approach for paediatric patient.
Anatomy of Cranial Nerve for BPT class.
Require 10 classes. Require help of brain specimen during the class. Testing of the nerves can also be taken together.
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
ICH Guidelines for Pharmacovigilance.pdfNEHA GUPTA
The "ICH Guidelines for Pharmacovigilance" PDF provides a comprehensive overview of the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) guidelines related to pharmacovigilance. These guidelines aim to ensure that drugs are safe and effective for patients by monitoring and assessing adverse effects, ensuring proper reporting systems, and improving risk management practices. The document is essential for professionals in the pharmaceutical industry, regulatory authorities, and healthcare providers, offering detailed procedures and standards for pharmacovigilance activities to enhance drug safety and protect public health.
Empowering ACOs: Leveraging Quality Management Tools for MIPS and BeyondHealth Catalyst
Join us as we delve into the crucial realm of quality reporting for MSSP (Medicare Shared Savings Program) Accountable Care Organizations (ACOs).
In this session, we will explore how a robust quality management solution can empower your organization to meet regulatory requirements and improve processes for MIPS reporting and internal quality programs. Learn how our MeasureAble application enables compliance and fosters continuous improvement.
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
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CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
1. Anwesh Pradhan, MPT, PhD Scholar
Associate Professor, Nopany Institute of
Healthcare Studies, Kolkata
Consultant Physiotherapist, Mobility
Physiotherapy & Rehabilitation, Midnapore
Facilitatory and Inhibitory
Techniques
used in Neuro Physiotherapy
2. What are the sensory motor
approaches?
Rood’s approach
PNF
Neurodevelopmental approach
Sensory integration
Brunnstrom’s movement therapy
3. Theoretical Basis
Reflex and Hierarchical Theory
The basic unit of motor control are reflexes
reflexes => purposeful movement
Damage to the CNS results to re-emergence of the
inability to control the reflexes
Motor control is hierarchically arranged
CNS structures involved with movement can be
grouped into higher, middle and lower levels
Higher centers regulate and control the middle and
lower centers
Damage to the CNS results to disruption of the
normal coordinated function of these levels
4.
5. Manual Facilitatory and Inhibitory
Techniques
Quick stretch
Receptor: muscle spindle endings, detecting length
and
velocity changes.
Stimulus: quick stretch or tapping over muscle belly
or
tendon
Response: activates agonist to contract: reciprocal
innervation effect will inhibit the
antagonist;
activates synergists.
Response is temporary; can add resistance to
6. Prolonged stretch
Receptor: muscle spindle endings and golgi
tendon organ
Stimulus: maintained stretch in a lengthened
range
Response: dampens muscle contraction
Rationale for serial casting and splinting to
increase the effect, activates the antagonist.
7. Resistance
Receptor: muscle spindles
Stimulus: resistance given manually or with
body weight or gravity or mechanical weights
Response: enhances muscle contraction
through recruitment; facilities synergists,
enhances kinesthetic awareness
Resistance needs to be graded dependent on
the patient response and goal; additional
recruitment and overflow may be
counterproductive to movement goal.
8. Approximation
Receptor: joint receptors
Stimulus: Compression of joint surfaces;
manual or mechanical; bouncing; applied in
weight bearing
Response: enhances muscular contraction,
proximal stability and postural extension,
increases kinesthetic awareness and postural
stability.
Effective in combination with rhythmic
stabilization, contraindicated in inflamed
joints.
9. Traction
Receptor: joint receptors.
Stimulus: joint surfaces distracted, usually
manually and at the beginning of movement.
Response: Facilitates muscle activation to
improve mobility and movement initiation.
Useful to activate initial mobility; also used as
part of mobilization.
10. Inhibitory pressure
Receptor: golgi tendon organ, muscle
spindles, tactile receptors.
Stimulus: Firm pressure manually or with body
weight over muscle belly or tendon.
Response: Inhibits muscle activity; damping
effect.
Equipment can be used to achieve effect;
casts and splints, weight bearing activities can
provide inhibitory pressure.
11. Light touch
Receptor: Rapidly adapting tactile receptors,
autonomic nervous system (sympathetic
division).
Stimulus: Brief, light contact to skin.
Response: Increased arousal, withdrawal
response.
Effective in initiating a generalized movement
response, to elicit arousal, contraindicated
with agitated patients or where ANS is
unstable.
12. Maintained touch
Receptor: Slowly adapting tactile receptors,
ANS (parasympathetic division).
Stimulus: Maintained contact or pressure.
Response: Calming effect, desensitizes skin,
provides general inhibition.
Useful for patients with high level of arousal or
hypersensitivity.
13. Manual contacts
Receptor: Tactile receptors, muscle
proprioceptors.
Stimulus: Firm, deep pressure of hands over
body area.
Response: Facilitates contraction of muscle
underneath hands.
Activates muscle response; enhances
sensory and kinesthetic awareness; provides
security and support.
14. Slow stroking
Receptor: Tactile receptors
ANS(parasympathetic division)
Stimulus: Slow, firm stroking with flat hand
over neck or trunk extensors.
Response: Produces calming effect, general
inhibition; induces feeling of security.
Appropriate for overly aroused patients.
15. Neutral warmth
Receptor: Thermo receptors
ANS(parasympathetic division)
Stimulus: Towel or elastic wrap of body or
body parts(warm)
Response: Provides general relaxation and
inhibition; decreased muscle tone; decreased
agitation or pain.
Use for 10-15 mins; avoid overheating;
appropriate for highly agitated patients or
individuals with increased sympathetic
response.
16. Slow vestibular stimulation
Receptor: Tonic vestibular receptors
Stimulus: Slow rocking, slow movement on
ball, in hammock, in rocking chair.
Response: Produces calming effect,
decreased arousal, generalized inhibition.
Useful for patients who are defensive to
sensory stimulation, hyperreactive to
stimulation, hypertonic or agitated.
17. Fast vestibular stimulation
Receptor: Semicircular canals
Stimulus: Fast or irregular movement with
acceleration and deceleration component,
such as spinning, use of a scooter board, fast
rolling.
Response: Facilitates general muscle tone
and promotes postural responses to
movement.
Used with patients with hypotonia (CP, Down
syndrome); used to promote sensory
integration.
19. Premise
Motor patterns are developed from fundamental
patterns/ reflexes which are refined and
controlled as an individual mature
Sensory stimulation is applied to muscles and
joints---> normalize tone--> produce desired
movement
Sensorimotor control is developmental
Movement should be purposeful
Repetition of sensorimotor responses is
necessary
20. The Goals
The Goals and basic features of Rood’s theory are:
Normalize muscle tone
Treatment begins at the developmental level of
functioning
Movements is directed toward functional goals
Repetition is necessary for the re-education of
muscular response.
21. Principles of treatment
Tonic neck reflex and labyrinthine reflexes can
assist or retard the effects of sensorimotor
stimulation
Stimulation of specific receptors to produce
response
RULES OF SENSORY INPUT
A fast, brief stimulus produces a large
synchronous movement
A fast, repetitive produces a maintained response
Slow. Rhythmical, repetitive sensory input
deactivates the body
22. Principles of treatment
Muscles have different duties
Heavy work muscles: Stabilizers (Maintenance of
posture)
Light work muscles: Mobilizers (Skilled
movement, repetitive or rhythmical patterns of
distal musculature)
Heavy work muscles should be integrated before
light work muscles
23. Components of Motor Control (Four)
1. Reciprocal inhibition
Innervation, MOBILITY
Phasic or quick type movements
Contraction of agonist while antagonists relaxes
Serves a protective function
2. Cocontraction
Coinnervation, STABILITY
Tonic or static type of movement
Simultaneous contraction of the agonist and
antagonist
Foundation of postural control
24. 3. Heavy work
Mobility superimposed on stability
Proximal muscles contract and move while distal
segments are fixed
4. Skill
Mobility and stability
Proximal segments are stabilized while distal
segments move
27. Techniques and strategies
INHIBITATORY TECHNIQUES
1. Neutral warmth
2. Gentle shaking or rocking
3. Slow rolling
4. Tendinous pressure
5. Light joint compression
6. Maintained stretch
7. Rocking in developmental positions
28. Cutaneous Stimulation by Quick Light
Brushing:
This is used as a preparatory facilitation to
increase excitability of motor neurons which
supply inhibited muscles.
The area to be brushed is specific in terms of the
nerve root supply to skin and muscles.
A soft artist’s or decorator’s brush is used or if
available, an electrically powered brush is used.
For skin supplied by anterior primary rami, the
excitatory effect is local and mainly to superficial
muscles.
For skin supplied by posterior primary rami, the
effects is excitatory to deep back muscles.
29. Brief Application of Cold
Quick wipe with ice ha san excitatory effect which
is immediate and most effective when applied to
skin overlying the extensors of limbs and when
the part is warm.
Brushing or ice application to the palmer surface
of the finger tips alerts mental processes but
should be avoided if spasticity is present.
Ice applied to the lips or tongue facilitates
sucking, swallowing and speech.
30. Slow Stroking
If this is carried out from neck to sacrum over the
centre of the back it will reduce choreo-athetosis or
excessive muscle tone.
It should be applied rhythmically for 3 minutes.
31. Precautions:
USE OF BRUSHING:
1. The area brushed is very specific in terms of
dermatome and myotome.
2. It should be used only for upto 3 seconds in one
place at a time; maximum effect can be delayed
for 20 to 30 minutes where nerve pathways
have not been active through disuse or
inhibition.
32. Precautions:
3. Do not use mechanical tools with revolutions of
360 or higher to operate a brush as this can
completely inhibit nerve pathways.
4. In case of flaccidity, brushing may cause a
seizure; should this occur slow rhythmical
stroking should be used over the posterior rami
dermatomes for 3 minutes.
5. Brushing the skin of the ear and the outer thirds
of forehead should be avoided as it has central
inhibiting effect.
33. Precautions:
WHILE USING ICE:
1. Ice used behind the ear can lead to a sudden
lowering of the blood pressure.
2. Ice applied to special receptors areas in the
sole of the feet or the palm of the hand should
be avided in young children as it is potentially
nocioceptive.
3. Ice applied over the skin supplied by the
posterior primary rami may set up a chain of
effects on viscera over which one has on
control.
4. Ice used on left shoulder may be dangerous if
there is known cardiac disease.
35. Proprioceptive neuromuscular facilitation
(PNF) is a rehabilitation technique that was
initiated over 50 years ago. It is used to
stimulate the neuromuscular system in an
effort to excite proprioceptors (sensory organs
in muscles, tendons, bones, and joints) in
order to produce a desired movement.
by Ph.D Mark Damian Rossi, P.T.,
C.S.C.S.
36. Knott and Voss defined facilitation as “the
promotion of any natural process; specifically,
the effect produced in nerve tissue by the
passage of an impulse”.
The term proprioceptive means sensory
stimulation that is received from the receptors
within the body’s own muscles, tendons and
joints.
37. Neuromuscular means this technique applies
to the nerves and the muscles.
Therefore PNF is defined as an approach that
includes methods of promoting or hastening
the response of the neuromuscular
mechanism through stimulation of the
proprioceptors.
38. Stimulation techniques used during
PNF
Manual contacts
Application: Pressure is given to the skin over
muscle being facilitated.
Presumed benefit: Manually contacting the
patient utilizes sensory cues to direct the
patient’s attention to the desired movement.
Pressure activates mechanoreceptors.
39. Vision
Application: Patient is asked to watch the
movement and to participate in giving the
movement direction.
Presumed benefit: Visually directed
movement is used as reinforcement and to
offer extrinsic feedback to the patient as he or
she learns the movement.
40. Verbal commands
Application: Tone of voice and specific
commands are used selectively to prepare the
patient for movement, direct the movement
and motivate the patient.
Presumed benefit: voice is used to affect the
quality of the patient’s response. Tone and
timing of commands are used as teaching
aids.
41. Stretch
Application: Quick stretch is given to the
muscle being facilitated. Stretch can be
applied at the beginning of the motion or
intermittently throughout the range of motion
to activate or reinforce muscle activation/
contraction.
Presumed benefit: Quick stretch activates the
muscle spindles and excites the agonist
muscle through activation of the
monosynaptic reflex arc.
42. Traction
Application: Separation of the joint surfaces to
activate joint receptors.
Presumed benefit: Traction stimulus activates
proprioceptive joint receptors, theorized to
promote movement.
43. Approximation
Application: Compression of joint surfaces
together, usually done with body part in a
weight bearing position.
Presumed benefit: approximation is used to
activate proprioceptive joint receptors to
promote muscular co-contraction, joint
stability and weight bearing.
44. Timing
Application: Timing is selectively used by the
therapist to either facilitate motor learning as the
patient recognizes the familiarity of a frequently
used movement pattern(normal timing) or to
emphasize a specific portion of the movement
pattern (timing for emphasis)
Presumed benefit: The movement patterns used
in PNF are based on typically occurring patterns
of normal movement, used in work and sports.
Timing is an important component of learning a
movement pattern.
45. Rhythmic stabilization
Application: Rhythmic, alternating isometric
contractions of agonist and antagonist without
intermittent relaxation; resistance is carefully
graded to achieve co-contraction.
Presumed benefit: Used to promote weight
bearing and holding and improve postural
stability, strength and proximal control.
47. Brunnstrom is credited with two main
contributions: a description of the stereotypical
synergy patterns and the recovery stages of
patients seen following a cerebrovascular
accidents.
It highlights the importance of the current
emphasis on working towards the goal of
voluntary control and functional limitations
experienced by patients as they work towards
recovery.
48. A basic concept of Brunnstrom’s approach is
that of synergies or motor patterns which are
patterned, recognizable flexion, or extension
movements of the entire limb, evoked by
attempts to move or by sensory stimulation,
characteristically seen during the period of
recovery following a neurological incident
such as CVA.
Repeated use of the synergy which makes
isolated motor control more difficult, is viewed
as inappropriate and undesirable.
49. Practical training activities to stimulate out of
synergy isolated movements are encouraged.
Concepts of motor learning such as positive
reinforcement and repetition are
stressed(Sawner & La Vigne,1992; Smith &
Sharpe,1994).
The stages of recovery are used as an overall
framework from which to view the patient’s
progression towards recovery of voluntary
motor control(Martin & Kessler,2000).
51. Originally, NDT concentrated on the effects of the
disturbed postural control mechanism on
movement.
Its basic concept is that motor function can be
improved by modifying abnormal movement
patterns, and movement is a changeable,
dynamic phenomenon that can be affected by
external sensory inputs. (Bobath and Bobath,
1984; Valvano & Long, 1991)
52. NDT Techniques
Handling
Clinical use: Hands are used to support and
assist movement (active and passive) from
one position to another; active assisted
movement is always encouraged.
Application: Use of hands; light touch,
intermittent touch or firm manual contact to
guide and assist with movement.
53. Positioning
Clinical use: Used to provide alignment,
comfort, support, prevent deformity and
provide readiness to support or enhance
independent movement.
Application: Positioning for support is used to
provide stability and alignment and prevent
deformity.
Positioning is also used to promote optimal
independent function or position from which
movement can most likely occur.
54. Use of adaptive equipment
Clinical use: Used to provide postural support,
prevent deformity, promote alignment,
enhance function and offer mobility, a
common adjunct to intervention for children
with neurological impairment.
Application: Equipment can be used
dynamically to assist in movement control.
55. Key points of control
Clinical use: Parts of the body are chosen as
optimal from which to guide the person’s
movement.
Application: Proximal key points of control
include trunk, shoulders and pelvis; distal
points are hands and feet.
56. Facilitating transitional movement
Clinical use: Facilitates key movement
components during active transitional
movement.
Application: Provides facilitation of antigravity
control, weight bearing, weight shifting,
responses to movement such as automatic
postural responses, rotation and dissociation.
57. Use of sensory input
Clinical use: Voluntary movement control is
facilitated through use of proprioceptive
inputs, exteroceptive inputs, visual, vestibular
and verbal inputs.
Application: proprioceptive inputs include
weight bearing, approximation, stretching and
traction or tapping.
Exteroceptive inputs include manual guidance
and therapeutic use of hands.
58. Motor learning strategies
Clinical use: Active movement is encouraged
through practice, repetition, feedback and use
of functional activities.
Application: Use of variable practice and
problem solving in natural environment
promotes motor learning.
60. It is based on three main assumptions:
1. Individuals receive information from their
bodies and the environment, process and
interpret the information within their CNS
and use the information in a functional
manner.
2. Individuals with sensory processing will
demonstrate problems in planning and
execution of adaptive responses.
61. 3. Individuals who receive stimulation within a
meaningful context will have the opportunity
to integrate the sensory information,
demonstrating more efficient motor skills and
adaptive behaviors (Long and Toscano,
2002).
Sensory integration is a theoretical
intervention frame of reference that is built
around the relationship between the brain and
behavior.
62. Sensory stimulation activities emphasizing the
tactile, proprioceptive, and vestibular systems
are selected to engage the individual in the
meaningful, self directed context.(Ayres,1973;
Bundy et al.,2002)
Intervention activities are often directed at
promoting antigravity flexion or extension,
increasing proprioception and a sense of
gravitational security, promoting equilibrium
responses and balance, and enhancing
tolerance of and integration of vestibular
stimulation.