PROPRIOCEPTIVE NEUROMUSCULAR FACILITATION (PNF) Mazyad Alotaibi

Proprioceptive neuromuscular facilitation (PNF) is an approach to therapeutic exercise that combines functional based diagonal patterns of movement with techniques of neuromuscular facilitation to evoke motor responses and improve neuromuscular control and function

Definition of Terms Proprioceptive: the sensory receptors that give information concerning movement and position of the body Neuromuscular: involving the nerves and muscles Facilitation: making easier

PNF Include Stimulation for proprioceptive and sensory mechanisms Feed information to the nervous system Facilitate the desired response through: Muscle contraction for strengthening Muscle relaxation for stretching Improved balance and equilibrium

BASIC PROCEDURES Resistance Irradiation and reinforcement Manual contact Body positioning and body mechanics Verbal commands Visual cues Traction and approximation Stretch Timing Patterns

RESISTANCE The amount of resistance provided during an activity must be correct for the patient’s condition and the goal of the activity. This is called optimal resistance. Resistance is used in the treatment to: Facilitate the ability of the muscle to contract Increase motor control Help the patient gain an awareness of motion and its direction Increase strength

IRRADIATION & REINFORCEMENT Irradiation : the spread of response to stimulation Reinforcement : means “to strengthen, make stronger”

IRRADIATION & REINFORCEMENT Increasing the amount of resistance will increase the amount and extent of the muscular response. Examples: Resist muscle activity of the sound limb to produce contraction of the muscles in the immobilized contralateral limb. Resist supination of the forearm to facilitate contraction of the external rotators of that shoulder

MANUAL CONTACT This refers to how and where the therapist’s hands are placed on the patient. Effects: Stimulates the muscle’s extroceptores Stimulates the synergistic muscle to reinforce the movement

BODY POSTION & BODY MECHANICS The therapist body should be in line of motion Shoulder and pelvis face the direction of motion. Therapist stands in walk standing position. The resistance comes from the therapist’s body weight, while the hands and arms stay comparatively relaxed.

VERBAL STIMULATION (COMMANDS) Tells the patient what to do and when to do Instructions need to be clear and concise without the use of unnecessary words. May be combined with passive movement to teach the patient the desired motion The timing of the command is very important The volume with which the command is given affects the strength of resulting muscle contraction. Louder command when strong muscle contraction is required. Softer and calmer tone when the goal is relaxation and relief of pain.

VISUAL CUES The feedback from visual sensory system can promote a more powerful muscle contraction Helps the patient to control and correct his position and motion Moving the eyes will influence both the head and body motion Eye contact between patient and therapist provides a mode of communication

TRACTION & APPROXIMATION The therapeutic effects of traction and approximation is due to stimulation of joint receptors. Traction is applied when the movement is occurring against the gravity Approximation is applied when the movement occurs in the direction of gravitational pull

APPROXIMATION Compression through a joint stimulate joint receptors Facilitate stability The approximation is always maintained, whether done quickly or slowly When the therapist feels that the active muscle contraction decreases the approximation is repeated and resistance is given

STRETCH The stretch stimulus occurs when the muscle is elongated The lengthened position of the muscle is the starting position of each pattern and the stretch is maintained throughout the movement. All the components of a pattern must be stretched simultaneously Stretching will Stimulate the activity of muscle spindle

TIMINGS Timing is the sequencing of motions Normal timing of most coordinated and efficient motions is from distal to proximal

PATTERNS Each pattern has three dimension : - Flexion or extension - Abduction or adduction - Rotation Movement occurs in a straight line, in diagonal direction with a rotatory component Patterns are named according to the direction of movement and therefore finishing, not the starting position. In completing the pattern the muscle contracts through full range from its lengthened to its shortened position

UPPER EXTREMITY F-ABD-ER F-ADD-ER E-ABD-IR E-ADD-IR

Diagonal One Diagonal Two F-ADD-ER E-ABD-IR E-ADD-IR F-ABD-ER Diagonal One Diagonal Two

F-ADD-ER E-ABD-IR

F-ABD-ER E-ADD-IR

LOWER EXTREMITY F-ABD-IR F-ADD-ER E-ABD-IR E-ADD-ER

F-ABD-IR F-ADD-ER

F-ABD-IR F-ADD-ER

Bilateral Asymmetrical Bilateral Asymmetrical ‘Chopping’ ‘Lifting’

Bilateral symmetrical patterns