Proprioceptive Neuromuscular

7/30/2019 Proprioceptive Neuromuscular

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MUHAMMED KOCABIYIK

PHYSICAL MEDICINE & REHABILITATIONIV. CLASS V. GROUP



The method:Patient contract isometrically resulted in increased

response of the agonist, this was named rhythmic stabilization . Following using this stabilization, it wasfound slow reversal technique , alternate resistance toisotonic contractions of antagonist and agonist also hada facilitating effect.

Definitions of PNF:Proprioceptive , means receiving stimulation within thetissues of the body.Neuromuscular , means pertaining to the nerves and

muscles.

Facilitation , means the effect produced in nerve tissue bythe passage of an impulse.Therefore, PNF can be defined as, methods of promoting

or hastening the response of the neuromuscularmechanism through stimulation of the proprioceptors.



To perform PNF exercises, it is important toremember the following

Principles :

Patient must be taught the pattern.Have the patient watch the moving limb movedpassively.The patient must give proper verbal command.

Manual contact with appropriate pressure is veryimportant.• Contraction of the muscle group is facilitated by hand

placement.•

Apply maximal resistance throughout ROM.• Resistance will change.• Rotation of movement will change throughout ROM.• Distal movement should occur first .



Plan of volume:1. Patterns of motion2. Various techniques used to promote the desired

response

3. Application of the method for improvement ofvital and related functions.4. Suggestions for evaluation of the patient

performance and for planning treatment

program.



The upper extremity has two diagonals:1. Flexion–abduction –external rotation

and extension–adduction

–internalrotation

2. Flexion–adduction –external rotationand extension –abduction –internalrotation



Shoulder FlexionExternal RotationAdduction

Forearm SupinationWrist Radial DeviationFingers Flexion



Shoulder ExtensionInternal Rotation

Abduction

Forearm Pronation

Wrist Ulnar Deviation

Fingers Extension



Shoulder FlexionExternal RotationAbduction

Forearm SupinationWrist Radial DeviationFingers Extension



Shoulder ExtensionInternal Rotation

Adduction

Forearm Pronation

Wrist Ulnar Deviation

Fingers Flexion



Types of exercises used for upper extremityproprioceptive training:

1. Balance training. One major category of proprioceptiveexercise is balance training. These exercises help totrain the proprioceptive system in a mostly staticactivity. Activities or exercises in weight bearingusing unstable supporting surface, profitter, swissball, balance board are example of balance training inthe upper extremity.

2. Kinetic chain exercises . Open-chain manual resistanceexercises with rhythmic stabilization are alsoconsidered proprioceptively enriched. In either case,resistance can be modified, depending on pain, as thepatient progresses



Quadruped stabilization on a balanceFour closed-chain exercises have been described to

stimulate co-activation in the shoulder: pushups,horizontal abduction on a slide board, and tracingcircular motions on a slide board with the dominantand non-dominant arms. These exercisesaccommodate for the individual's tolerance to jointloads by progressing from a quadruped to a push-upposition.

Wall push-ups are also useful and can beproprioceptively enhanced by having a physicaltherapist or resistance band provide resistance tothe patient's back.



3. Sport-specific maneuvers. Rehabilitation isincomplete until maneuvers specific to the sportand the athlete's position in the sport can beperformed maximally and without pain or loss offunction.Starting sport-specific maneuvers withweighted resistance (eg, swinging a weightedtennis racket or baseball bat), Functional

positions, such as overhead throwing, should beincorporated and are more sport-specific.



4. PNF (Proprioceptive neuromuscularfacilitation): These techniques may be defined asmethods of promoting or hastening the responseof the neuromuscular mechanism throughstimulation of the proprioceptors. Emphasis isplaced on the application of maximal resistancethrough out the range of motion, using manycombinations of motions in a pattern format.Motion is first performed in the strongest partof the range, with progression toward theweaker parts of the range of motion. Thepatterns used are spiral and diagonal incharacter and closely resemble the movements

used in sports and in occupational activities.



5. Plyometrics. It is a quick powerful movementinvolving pre-stretching of a muscle, followed by ashortening cycle. The stretch shortening cycleoccurs when elastic loading, through a quickeccentric muscular contraction, is followed by aburst of concentric muscular contraction.

6. Ballistic stretching uses the momentum of amoving body or a limb in an attempt to force itbeyond its normal range of motion. This isstretching, or "warming up", by bouncing into (orout of) a stretched position, using the stretchedmuscles as a spring which pulls you out of the

stretched position.

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Proprioceptive Neuromuscular