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BASICS OF PROPIOCEPTIVE NEURO MUSCULAR FACILITATION.pptx
1. INTRODUCTION TO PROPRIOCEPTIVE
NEUROMUSCULAR FACILITATION
Definition:
“Methods of promoting or hastening the response of
the neuromuscular mechanism through stimulation
of the proprioceptors”.
Proprioceptive: Having to do with any of the
sensory receptors that give information concerning
movement and position of the body.
Neuromuscular: Involving the nerves and muscles.
Facilitation: Making easier.
IT IS A CONCEPT OF TREATMENT.
2. HERMAN KABAT ► Developed a method of PNF.
SHERRRINGTON ► Provided Neurophysiological
principles.
GELLHORN ► Studied Proprioception and Cortically
induced movement.
GESSEL ► Studied the development of motor
behavior.
MCGRAW ► Studied the development of behavior
and maturation of Neural structures.
HELLEBRANDT ► Studied the combination of
movements
and mass movements
3. FIVE FACTORS TO BE KEPT IN MIND WHILE
EXECUTING PNF THERAPY
PRINCIPLES
PROCEDURES
PATTERNS
POSITIONS
POSTURES
4. BASIC PRINCIPLES
1. All human beings have potentials that are not fully
developed.
2. Motor development takes place in cerviocaudal
sequence or proximodistal direction.
3. Early motor behavior is dominated by reflex activity
whereas mature motor behavior is supported or
reinforced by postural reflex.
4. The growth of motor behavior has cyclic trends as
evidenced by shifts between flexor and extensor
dominance.
5. The goal directed activity is made up of reversing
movements.
5. 6. Normal movement and posture are dependent
upon synergism and a balanced interaction of
antagonist.
7. Developing motor behavior is expressed in an
orderly sequence of total patterns of movements
and posture.
8. Normal development has an orderly sequence but
lacks a step by step quality and generally shows
overlap.
9. Improvement in motor ability depends upon motor
learning.
10. Frequency of stimulation and repetitive activity
are used to promote and retain motor learning as
well as for the development of strength and
endurance.
6. AS PER PHILOSOPHY IS CONCERN, CERTAIN
BASIC PRINCIPLES OF PNF
PNF is an integrated approach: Each treatment is
directed at a total human being, not just at a
specific problem or body segment.
Always focus on mobilizing the patient’s reserves.
Treatment approach should be always positive,
reinforcing the patient can do, on a physical and
psychological level.
The primary goal to help patients to achieve their
highest level of function.
The treatment depends on the activity level as
well as on the participation level (disability).
7.
8. BASIC NEUROPHYSIOLOGIC PRINCIPLES
The work of Sir Charles Sherrington was
important in the development of the procedures
and techniques of PNF.
AFTER DISCHARGE
TEMPORAL SUMMATION
SPATIAL SUMMATION
IRRADIATION
SUCCESSIVE INDUCTION
RECIPROCAL INNERVATION
9. After discharge: The effect of a stimulus
continues after the stimulus stops. If the
strength and duration of the stimulus
increase, the after discharge increases
also. The feeling of increased power that
comes after a maintained static
contraction is a result of after discharge.
Temporal summation: A succession of
weak stimuli (subliminal) occurring within
a certain (short) period of time combine
(summate) to cause excitation.
10. Spatial summation: Weak stimuli applied
simultaneously to different areas of the body
reinforce each other (summate) to cause
excitation. Temporal and spatial summation can
combine for greater activity.
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 either
excitation or inhibition.
11. Successive induction: An increased excitation of
the agonist muscles follows stimulation (contraction)
of their antagonists. Techniques involving reversal of
antagonists make use of this property (Induction:
stimulation, Increased excitability.)
Reciprocal innervations (reciprocal inhibition):
Contraction of muscles is accompanied by
simultaneous inhibition of their antagonists.
Reciprocal innervation is a necessary part of
coordinated motion. Relaxation techniques make use
of this property.
12. THE BASIC PROCEDURES FOR FACILITATION
1. Manual contacts
2. Traction
3. Approximation
4. Stretch
5. Timing for emphasis
6. Maximal Resistance
7. Reinforcement
8. Irradiation and reinforcement
9. Verbal (commands)
10. Vision
11. Timing
12. Body position and mechanics
13. Patterns
13. MANUAL CONTACTS
The therapist’s grip stimulates the
patient’s skin receptors and other
pressure receptors.
The therapist’s hand should be placed to
apply the pressure opposite the direction
of motion.
To stimulate proprioceptors in muscles,
tendons and joints. May be used with or
without resistance.
16. TRACTION AND APPROXIMATION
Traction is elongation of trunk or an
extremity. It is used to facilitate motion and
aid in elongation of muscle when using
stretch reflex.
Approximation is the compression of the
trunk or extremity. It promotes stabilization,
facilitates weight bearing and facilitates
upright reactions.
17.
18. STRETCH
Stretch stimulus: Occurs when the muscle is
elongated. It facilitates muscle contraction and
associated synergistic muscle.
Stretch reflex: Stretch reflex is elicited from the
muscles that are under tension either from
elongation or from contraction.
Reflex has two parts:
1. Short latency spinal reflex: May not be of
functional significance.
2. Longer latency which produces more
powerful contraction.
19. TIMING
Timing is a sequencing of motions.
Normal timing provides continuous
coordinated motion until the task is
accomplished.
Timing for emphasis involves changing
the normal sequencing of motions to
20.
21.
22. MAXIMAL RESISTANCE
The amount of resistance provided during an
activity must be appropriate for the patients
condition and the goal of the activity.
Facilitates muscle contraction.
Increases motor control and learning.
Increases strength.
23. IRRADIATION AND REINFORCEMENT
Irradiation is the Spread of response to
stimulation
Reinforcement is ‘To Strengthen by fresh
addition’
Therapist reinforces weak muscles by the
amount of resistance given to stronger
muscles.
27. BODY POSITION AND MECHANICS
The therapist’s body should be in line with
desired motion or force.
The resistance comes from the therapist’s
body, while the hands and arms stay
comparatively relaxed.
By using body weight, the therapist can give
prolonged resistance without fatigue.
28.
29. The verbal command
tells the patient what
to do and when to do
it. The command is
divided into three
parts .
Preparation
Action
Correction
VERBAL STIMULATION (COMMANDS)
30. VISION
The feedback from the visual sensory system
can promote a more powerful contraction. It
helps the patient to correct position and
motion.
It provides another avenue of communication
and helps to ensure co-operative interaction.
33. The goal of the PNF techniques is to
promote functional movement through
facilitation, inhibition, strengthening, and
relaxation of muscle groups.
The techniques use concentric, eccentric,
and static muscle contractions.
Use a relaxation technique such as Contract-
Relax to increase range of motion.
34. Follow with a facilitatory technique such as
Dynamic Reversals (Slow Reversals) or
Combination of Isotonics to increase the
strength.
The repeated stretch reflex permits muscles
to work longer without fatiguing.
Alternating contractions of the antagonistic
muscles relieves the fatigue.
AFTER DISCHARGE: In PNF, therapists use various techniques (such as stretch, resistance, traction, approximation, and audiovisual commands) to stimulate sensory receptors. By applying the After Discharge Principle, they can enhance muscle function and strength even beyond the immediate stimulation period 1
