Proprioceptive Neuromuscular Facilitation Objectives
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Define PNF.
Describe the three principles of neuromuscular reeducation.
Define facilitation and identify its philosophy of treatment in neuromuscular reeducation.
Describe the PNF principles of overflow, diagonals with rotation, and the developmental sequence.
Describe sensory modalities and their components (if applicable) used in facilitation and select facts
concerning each.
6. Identify the method of employing and the purpose of each of the following techniques and their
components: directed to agonist; reversal of antagonists; and relaxation.
7. Given a list of proponents of facilitation, and a list of characteristics, match the proponents to their
appropriate characteristics.
8. Discuss the stages of motor control.
1.
Define PNF (Proprioceptive Neuromuscular Facilitation).
Proprioceptive: having to do with any of the sensory receptors that provide information concerning
movement and position of the body.
Neuromuscular: pertaining to the nerves and muscles.
Facilitation: to make easy.
Definition: to stimulate a change in neuromuscular response toward normal function
2. Describe the three principles of neuromuscular reeducation.
a. Repeated activation of the nervous pathways from the brain to the muscle results in increased
power, endurance, coordination and ability to repeat the motion with less effort and concentration.
To achieve this two things are used: Maximal resistance and Motion through full available ROM.
b. Muscles are reciprocally innervated. This allows a person to achieve maximum force in a desired
direction since antagonist muscles are relaxing.
c. A maximal muscle contraction depends on the quantity of motor units being excited and the
frequency with which the signal is being sent from the brain to muscle.
3. Define facilitation and identify its philosophy of treatment in neuromuscular reeducation.
Facilitation: to make easy
a. The treatment approach is always positive, reinforcing and using that which the patient can do, on a
physical and psychological level.
b. The treatment is aimed at improving the patient’s performance of functional activities.
4. Describe the PNF principles of overflow, diagonals with rotation, and the developmental sequence.
a. Overflow – This is the principle of the strong helping the weak, the stronger muscles groups within a
pattern and stronger patterns are utilized to increase the response of the weaker muscle groups.
b. Diagonals – They are representative of the mass movement pattern characteristic of the normal
motor activity. Each diagonal contains three components of motion: extension/flexion,
abduction/adduction, and rotation, which is the most important for treatment.
c. Developmental sequence – It is representative of how we all developed from infancy to adulthood.
This means first achieving some movement, then trunk control, then movement of the extremities on a
stable trunk, and lastly skilled activities.
5. Describe sensory modalities and their components (if applicable) used in facilitation and select facts
concerning each.
Proprioceptive input:
a. Quick Stretch – facilitation of muscle contraction, always followed by resistance.
b. Maximal Resistance (appropriate for muscle) – proper use results in irradiation.
•isotonic contraction-greatest resistance which allows full range of motion.
•isometric contraction-greatest resistance without breaking hold.
c. Traction and Approximation-traction stimulates motion (Upper Extremities), approximation stimulates
stabilization in weight bearing positions (Lower Extremities).
Exteroceptive Stimulation:
a. Manual Contact-facilitation and guidance by grip and pressure, gives tactile stimulation. Touch only
surface to be stimulated, avoid circumferential grip, practice lumbrical grip.
b. Temperature Change- cold or hot.
Normal Timing- sequence of muscle contractions resulting in a coordinated movement.
Vestibular Stimulation – slow movement which inhibits tone, or fast which can be considered facilitation.
Verbal Commands – Vocal volume as stimulus to guide motion and facilitate power. Tone of voice
influences quality of response. (Strong=maximal response; soft=relaxation and security for pain patients).
Commands are clear and concise, accompanied by motion.
Visual Cues- Vision facilitates coordination of head and trunk with movement, leads movement, helps
patient in recognizing the direction of movement.
6. Identify the method of employing and the purpose of each of the following techniques and their
components: directed to agonist; reversal of antagonists; and relaxation.
a. Directed to Agonist :
1. Rhythmic Initiation (RI) – begins with passive movement through full range of motion followed by
active-assistive movements, progressing to resisted movements.
2. Repeated Contraction (RC) –repeating the desired pattern to promote the learning process and to
help develop strength and endurance. A quick stretch in the middle of range of motion (or point of
weakness) helps promote this response, followed by resistance.
b. Reversal of Antagonists:
1. Slow Reversal (SR) – an isotonic contraction through the diagonal pattern with a shift in manual
contacts to resist the opposing diagonal pattern. The manual contact shift must be performed
smoothly so that the patient can effectively move from one pattern to another.
2. Rhythmic Stabilization (RS) –gradual isometric contraction of antagonistic and agonistic patterns,
which results in co-contraction of antagonists if the isometric contraction is not broken by the
therapist.
c. Relaxation:
1. Contract-Relax (CR)- an isotonic contraction of the antagonist, allowing rotation against maximal
resistance, but not of the other components, followed by relaxation.
2. Hold-Relax (HR) an isometric contraction is performed of the range of motion-limiting antagonist,
increasing resistance, followed by relaxation and passive movement into new range of motion.
7. Given a list of proponents of facilitation, and a list of characteristics, match the proponents to their
appropriate characteristics.
Other Proponents of Facilitation:
a. NDT (Bobath) – normalizes tone, inhibits synergies, and uses developmental sequence.
b. Movement Therapy (Brunnstrom) – uses synergies for hemiplegia treatment.
c. Sensory Stimulation (Rood) – uses brushing and icing as peripheral stimulation.
d. Compensatory Training –substitution is used to achieve independence.
8. Discuss the stages of motor control.
a. Mobility – discrete movements not well controlled, getting range of motion.
b. Stability – maintain position in a weight bearing, antigravity position.
c. Controlled Mobility – moving while maintain posture.
d. Skill – highly coordinated movement.