PROPRIOCEPTIVE NEUROMUSCULAR FACILITATION

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PROPRIOCEPTIVE NEUROMUSCULAR FACILITATION

• Total Rehabilitation Using Your Hands as the
  Primary Tools

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Alpha Motor Neuron
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CONTEXT

• 1946 Dr. Herman Kabat based techniques on
  then-current neurophysiological research
• Margaret Knott and Dorothy Voss

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CONCEPTS

• Maximum Resistance
• Initiate movement in strong portion of ROM
  (overflow)
• Stretch for proprioceptive stimulation
• Combined motions (overflow)
• Alternate agonist/antagonist contractions
• Spiral and diagonal patterns

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PNF

• Proprioceptive and sensory mechanisms
• Feed information to the nervous system
• Facilitate the desired response
• Response contraction for strengthening
• Response relaxation for stretching
• Response improved balance and equilibrium

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Tactile Stimulation
skin



Alpha Motor Neuron
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MANUAL CONTACT

• Stimulate over muscle
• Stimulate on the side of the limb on the
  direction of movement desired
• Prevents confusion
• Lumbrical Grip prevents contact over too many
  surfaces

(04)
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APPROXIMATION

• Compression through a joint
• Stimulate joint receptors
• Facilitate Alpha Motor Neuron
• Purpose Strength and Stability

(11)
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Joint Stimulation
JOINT



Alpha Motor Neuron
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TRACTION

• Joint separation stimulates joint receptors
• Muscle stretch stimulates muscle spindle stretch
  recepetor
• Facilitates Alpha Motor Neuron
• Facilitates Strength and Stability

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QUICK STRETCH

• Stimulates stretch receptors of at the muscle
  spindle
• Facilitates Alpha Motor Neuron
• Facilitates Strength

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Quick Stretch
Muscle Spindle



Alpha Motor Neuron
(06B, 06A)
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TIMING

• Rhythmical reversal of direction
• Distal to proximal coordination

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MAXIMAL RESISTANCE

• By muscle group
• By joint
• By limb

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VISION

• PATIENT LOOKS IN THE DIRECTION YOU WISH THE
  BODY/HEAD TO MOVE
• WATCH THE LIMB TO IMPROVE COORDINATION

Lk Up R
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AGONIST

• Muscle(s) that move the joint in the desired
  direction
• Question What are the agonists to shoulder
  flexion/abduction/external rotation?

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DIAGONAL PATTERNS

• Whole Limb
• Rotational Component
• Diagonal (not pure planar movements)
• Functional

(07)
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UPPER EXTREMITY
F-ABD-ER
F-ADD-ER
E-ABD-IR
E-ADD-IR
(04, 07)
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LOWER EXTREMITY
F-ABD-IR
F-ADD-ER
E-ABD-IR
E-ADD-ER
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RHYTHMIC STABILIZATION

• Isometric hold
• Against manual resistance given in diagonal
  patterns
• Purpose Increase strength and stability around
  a joint
• Can be done with limb fixed (closed chain) or
  limb free (open chain)

(14, 15)
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SLOW REVERSAL

• Isotonic contraction followed immediately by
  isotonic contraction of the antagonistic muscles
• Overflow from strong pattern to weaker pattern
• Purpose Increase strength and facilitate normal
  timing and coordination

(07)
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SLOW REVERSAL-HOLD

• Isometric hold performed in the range of a
  pattern of isotonic diagonal pattern
• Purpose Increase strength in a particularly
  weak or uncoordinated portion of the range.

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HOLD RELAX
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CONTRACT RELAX
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AGONIST CONTRACT
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DEVELOPMENTAL SEQUENCE

• Prone
• Rolling
• Prone on elbows
• Prone push up
• Quadruped
• Crawl
• Kneel
• Half-kneel
• Stand
• Walk

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THERAPEUTIC DEVELOPMENTAL SEQUENCE

• Facilitate normal reflexes and responses
  (pediatrics and neurological impairments)
• Isometric contraction within the stage
• Static
• For stability (FIRST)
• Easiest
• Movement within the stage
• Dynamic
• For strength and coordination (SECOND)
• Hardest

(13-15-12,12B-17)