Copyright 2005 Lippincott Williams & Wilkins Proprioceptive Neuromuscular Facilitation National Rehabilitation Center Kim, Seok-Hwan

Copyright 2005 Lippincott Williams & Wilkins

Proprioceptive Neuromuscular Facilitation

National Rehabilitation Center

Kim, Seok-Hwan


Proprioceptive Neuromuscular Facilitation (PNF)

Methods of promoting or hastening the response of the neuromuscular mechanism through

stimulation of the proprioceptor.

Major Goal – Restore or enhance postural responses or normal patterns of motion.


Basic Neurophysiologic Principles of PNFDiagonals of Movement

Innate path in which maximal response of the trunk and extremities can be

facilitated.

Components associated with antagonistic motion:

Flexion versus extension. Abduction versus adduction in extremities and

lateral movement of trunk. Internal vs. external rotation.


Normal coordinated patterns of motion are diagonal in direction with spiral components – Facilitate

strongest output.

Reflects functional relationship of trunk and extremities.

Diagonals may be used to identify:

1. Quality of contractions2. Range of motion3. Functional impairments/limitations


Motor Development

PNF is based on 11 principles drawn from:

Neurophysiology Motor learning Motor behavior


Examination and EvaluationAssessed Areas:

1. Impaired ROM and muscle length

2. Impaired muscle power

3. Impaired muscle endurance

4. Impaired balance

5. Impaired posture

6. Impaired motor control

7. Pain


Factors Included During the Evaluation

Patient’s short-term and long-term goals.

Patient’s receptive potential for language, vision, and manual contacts to promote cuing.

Patient’s strengths.

Patient’s weaknesses.


Treatment Implementation

Treatment interventions may include:

1. Modification of environment

2. Education and compensation for the impairment

3. Treatment directed at changing the patient’s neuromuscular capabilities


Patterns of Facilitation

Manually resistive exercises that create the diagonals of movement by coupling pairs of antagonistic patterns, providing a path for reversing motions, and using the agonist–

antagonist relationship of the nervous system as techniques are applied.


Procedures

1. Body positioning and mechanics2. Manual contacts3. Manual and maximal resistance4. Irradiation5. Verbal and visual cuing6. Traction and approximation7. Stretch8. Timing


Body Positioning and Mechanics

Be positioned in the diagonal plane or treatment plane whenever possible.

Shoulders and hips face toward direction of movement.

Forearms in this plane is important.



Manual Contacts

Use contacts overlying agonist muscle group to strengthen contractions and/or direction of movement.

Use lumbrical grip to provide contact.Contact the target group (direct effect)

or synergist or antagonist (indirect).


Manual and Maximal Resistance

Resistance to motion enhances muscle activation.

Direction, quality, and quantity of resistance are adjusted according to treatment goals.

Resistance should be no greater than the resistance that allows full ROM.


Irradiation (Overflow)

Spread of energy from agonist to complimentary agonists and antagonists within a pattern.

Irradiation is stimulated through clinician’s use of resistance.

Weaker muscle groups benefit while working in synergy with more normal partners.


Verbal Cuing

Should be clear and concise.Begin by detailing a particular

patient response.Change to more simple cues for

subsequent repetitions.Alter tone according to goal (e.g.,

soft voice for inhibition)


Approximation and Traction

Stimulates receptors to facilitate co-contraction and stability around the joint.

Employed through the use of weight-bearing developmental postures.

Traction is commonly used with pulling movements to inhibit compression.


Stretch

Often performed at the starting position of a pattern or movement.

Result – Reflex activation.Resistance through entire range provides

continued stretch through tension.Stretch can be repeated at start of range

or superimposed during a pattern.


Techniques of Facilitation

1. Rhythmic initiation

2. Repeated contractions

3. Reversals of antagonists

4. Dynamic reversals of antagonists

5. Stabilizing reversals

6. Rhythmic stabilization

7. Hold and relax

8. Contract and relax

9. Combination of isotonics (dynamics)


Uses of Rhythmic Initiation

Initiate movement.Define the direction or pattern of

movement.Set the appropriate rate of movement.Improve coordination and sense of

motion.Promote general relaxation.


Uses of Repeated Contractions

Help to initiate movement.Strengthen agonist movement

pattern from lengthened range.Strengthen agonist movement

pattern within available ROM.Redirect motion within pattern or

task.


Use of Reversals of Antagonists

To facilitate agonist.

Improve balance between agonist and antagonist.


Use of Dynamic Reversals of Antagonists

Increase active ROM.Improve strength in the available

ROM.Improve balance and coordination

of antagonist.Improve endurance of antagonistic

patterns.


Use of Stabilizing Reversals

Improve balance and stability.Improve strength.Integrate a new posture or ROM into function.


Use of Rhythmic Stabilization

Improve strength of antagonists.Improve balance of antagonists.Improve stability.Increase active and passive ROM

following technique.Decrease pain.


Use of Hold and Relax

Improve PROM.Provide relaxation.Reduce pain.


Use of Contract and Relax

Improve passive ROM.

Provide relaxation.


Use of Combination of Isotonics

Increase strength of agonist.

Increase active ROM.

Teach functional control.


SummaryPNF is a manual therapy approach that applies

postures, movement patterns, contacts, cues, and goals. All = Maximally facilitating.

Treatment is based on improving function, and using functions that are possible to reach those are attainable goals.

PNF lends itself to use as an adjunct to other treatment approaches.

Documents

Copyright 2005 Lippincott Williams & Wilkins Proprioceptive Neuromuscular Facilitation National Rehabilitation Center Kim, Seok-Hwan