Proprioceptive Neuromuscular Facilitation/ Kabat & Knott Approach
PNF Basic Procedures
Patterns of Movement: normal activity occurs in synergistic and functional movement patterns
- UE Diagonal 1
- UE Diagonal 2
- LE Diagonal 1
- LE Diagonal 2
- Trunk patterns include chop and lift patterns, bilateral lower extremity (LE) patterns, scapula and pelvis pat- terns, and head/neck patterns.
Timing: normal timing ensures smooth, coordinated movement; distalà proximal movements
Timing for Emphasis: Max resistance is used to facilitate a strong contraction & to allow overflow to occur from strong to weak components within a synergistic pattern
Resistance: facilitates muscle contractions and motor control
- Tracking or Light Resistanceà facilitates weak muscles and is usually applied with light stretch
- Maximal Resistanceà generates max effort and is adjusted to ensure smooth, coordinated movement
- Facilitates weak muscles to contract; enhances kinesthetic awareness of motion; increases strength; increase motor control and motor learning
Overflow or Irradiation: the spread of muscle response from stronger muscles to weaker muscles in a synergistic movement pattern; max resistance is the primary mechanism for overflow or irradiation
Manual Contacts: grips are used to provide pressure to tactile and pressure receptors; pressure is applied opposite of the desired direction of motion
Positioning: muscles at optimal range of function allow for optimal muscle responses (length-tension relationship); muscle tension is the greatest at the mid-range of movement
Therapist Position and Body Mechanics: therapists should be positioned in line with the desired motion for optimal direction of resistance
Verbal Commands: preparatory (used to ready & instruct the patient), action (to guide the patient while in motion), corrective (used to provide feedback for modifications of movement)
- Directions should be clear/ concise, strong commands should be used when max movement is the goal, and a soft action voice should be used when relaxation is the goal
Vision: used to guide the patient’s movement, enhance muscle contraction and patterns of movement
Stretch: end range stretch facilitates muscle contraction; repeated stretch can be used to reinforce a contraction in weaker muscles
Approximation (compressing joint surfaces): use to facilitate extensor/ stabilizing muscle contraction and stability; applied during upright, weightbearning positions and in PNF extensor patterns
Traction: used to facilitate muscle contraction and motion, especially in flexion/ pulling patterns; gentle distraction is used to reduce joint pain
PNF Techniques
- Reversal of Antagonists: techniques that promote agonist contractions followed by antagonist muscle contractions
- Repeated Contractions: isometric contractions from a lengthened range; enhanced by resistance; induced by quick stretches
- Combination of Isotonics: resisted concentric movementsà agonist movementsà stabilizing contraction THEN eccentric movements à lengthening contractions, moving slowly back to the start position with no relaxation between contractions
- Rhythmic Initiation: voluntary relaxation followed by passive movements progressing to AAROM then active resistive movements then active movements
- Contract-Relax: Strong, small range isotonic contraction of the restricting muscles (antagonists) with emphasis on the rotators is followed by an isometric hold.
- Hold-Relax: Strong isometric contraction of the restricting muscles (antagonists) is resisted, followed by voluntary relaxation, and passive movement into the newly gained range of the agonist pattern.
- Replication: holding a shortened range/ end position of a movement
- Resisted Progression: Manually applied stretch, approximation, and tracking resistance used to facilitate pelvic motion and locomotion; resistance is light in order to not disrupt momentum, coordination, and velocity.
Rhythmic Rotation: Relaxation is achieved with slow, repeated rotation of a limb at a point where limitation is noticed. As muscles relax the limb is slowly and gently moved into the range.
Resources for full article “A Detailed Outline of Neurorehabilitation Technique for Post-Stroke Symptoms”:
Corbett, A. (2012). Stroke. Brain Foundation: Headache Australia. Retrieved on December 9, 2012 from http://brainfoundation.org.au/a-z-of-disorders/107-stroke#effectsofstroke
Cuccurullo S, editor. Physical Medicine and Rehabilitation Board Review. New York: Demos Medical Publishing; 2004. Stroke Rehabilitation. Available from: http://www.ncbi.nlm.nih.gov/books/NBK27209/
Dickstein, R., Hocherman, S., & Shaham, R. (1986). Stroke Rehabilitation: Three Exercise Therapy Approaches. Physical Therapy Journal, 66 (8).
Ernst, E. (1990). A review of stroke rehabilitation and physiotherapy. Stoke. Retrieved on December 10, 2012 from http://stroke.ahajournals.org/content/21/7/1081
IPNFA. (2012). What is IPNFA? Proprioceptive Neuromuscular Facilitation from facilitation to participation. Retrieved on November 25, 2012 from http://www.ipnfa.org/index.php?id=115
Kollen, B., Lennon, S., Lyons, B., Wheatley-Smith, L., Scheper, M., Buurke, J., Halfens, J., Geurts, A., & Kwakkel, G. (2009). Stroke Rehabilitation What is the Evidence? American Heart Association Journals. Retrieved on November 25, 2012 from http://stroke.ahajournals.org/content/40/4/e89
Mayo Clinic Staff. (2012). Stroke. Diseases and Conditions. Retrieved on November 25, 2012 from http://www.mayoclinic.com/health/stroke/DS00150
O’Sullivan, S. & Schmitz, T. (2007). Strategies to Improve Motor Function. Physical Rehabilitation 5th ed. Retrieved on November 25, 2012 from http://www.google.com/url?url=http://docs.thinkfree.com/tools/download.php%3Fmode%3Ddown%26dsn%3D861433&rct=j&sa=U&ei=1JLGUOuvBNTOqQHI9oGwDg&ved=0CBUQFjAA&sig2=4094qnrZ_b4KrzUbJGHsIw&q=physical+rehabilitation+5th+ed+osullivan+and+shmitz+Strategies+to+Improve+Motor+Function+chapter+13&usg=AFQjCNGi1S0r5Dc1uP6pMAu7uWtmIaAWxA