Neuro #7- Interventions: PNF, NDT, Sensory Stimulation Flashcards
Generally speaking, what is and what is the purpose of PNF, NDT, and Sensory Stimulation?
- Techniques providing exercises/activities designed to reduce specific impairments and improve function of involved body segments
- Overarching goal is to enhance or improve recovery
- There is a developmental focus with emphasis on developmental postures/activities of movement to promote recovery and function.
PNF: what are the basic procedures for facilitation
1- The facilitation of total patterns of movement promoting motor learning in synergistic muscle patterns
2- Utilizes proprioceptive motor elements: stretch resistance, manual contacts, overflow, approximation, traction
3- Utilizes motor learning principles: verbal cues, visual guidance of movement, repetition and practice
List out specific PNF Techniques- new terms (old terms in parenthesis)
1- Rhythmic Initiation
2- Rhythmic Rotation
3- Stabilizing Reversals (Alternating Isometrics)
4- Rhythmic Stabilization
5- Dynamic Reversals (Slow Reversals)
6- Combination of Isotonics ( Agonist Reversals)
7- Replication ( Hold-Relax-Active Motion)
8- Contract-Relaxation Active Contraction (Contract- Relax)
9- Hold-Relax (HR)
10- Repeated Stretch (Repeated Contractions)
Rhytmic Initiation:
Description: (3)
Basis: (3)
Application: (3)
Description:
1- movement is first PASSIVE,
2- then PROGRESS to active ASSISTED,
3- then to ACTIVE motion through increments of range
Basis:
1- slow rhythmical motion acts to inhibit arousal (RAS) and achieve relaxation
2- movement is through the available range, avoiding a protective response from pt
3- movement is slow and maintained, avoiding quick stretches
Application:
1- pts who are unable to initiate movement due to increased tone
2- pts with limited ROM DUE TO INCREASED TONE
3- use to teach an activity
Rhythmic Rotation:
Description: (3)
Basis: (2)
Application: (2)
Description:
1- the pt is relaxed.
2- The PT SLOWLY and PASSIVELY MOVES the part through range
3- while SLOWLY ROTATING and DEROTATING the part on its axis.
Basis:
1- slow and rhythmical motion acts to inhibit (RAS)
2- Rotary movements seem to “unlock” and relax muscles
Application:
1- for pt whose spasticity increases markedly with active movement
2- pts with spasticity and no active movement
Stabilizing Reversals (Alternating Isometrics):
Description: (5)
Application: (2)
Description
1- Intermediate step to Rhythmic Stabilization
2- The pt resists and ISOMETRIC contraction of one pattern
3- Immediately followed with resistance to ISOMETRIC contraction of antagonist pattern
4- Resistance is built up within each shift and over entire sequence
5- (can have a break between, each resistance)
Application
1- use for balancing tone
——when used for this purpose one side of joint is emphasized
2-often used in trunk stabilization
Rhythmic Stabilization:
Description: (4)
Basis: (2)
Application: (2)
Description:
1- SIMULTANEOUS CO-CONTRACTION (ISOMETRIC) of antagonistic patterns
(resist flexion of elbow at wrist at same time resist 2-
extension of shoulder at extensor surface near elbow, then change)
3- by ALTERNATING THE ANTAGONISTIC PATTERNS resisted by each hand.
4- The resistance is gradually built up within each shift and over the entire sequence.
(do not give pt break between each resistance)
Basis:
1-co-contraction effects both sides of the joint
2- Maintained resistance facilitates stabilization
Application:
1-when pt has limited ROM due to splinting or pain
2- Appropriate to develop stability of head, neck and trunk
Dynamic Reversals (Slow Reversals):
Description: (3)
Basis: (2)
Application: (3)
Description:
1- an ISOTONIC contraction of one pattern FOLLOWED by an ISOTONIC contraction of the antagonist pattern.
2- The movements are slow and rhythmical
3- Resistance may be used, but is usually minimal (this is what differentiates from RI)
Basis: (2)
1- the slow rhythmical movements inhibit arousal via RAS
2- resistance stimulates activation
Application: (2)
1- when pt has WEAKNESS limiting ability to initiate movement
2- when increased tone limits initiation of movement or motion through range
to teach an activity
3- This is for a higher functioning pt than rhythmic initiation.
Combination of Isotonics (Agonistic Reversal):
Description: (4)
Basis: (1)
Application: (2)
Description: 1- a rhythmical reversal from shortening to lengthening contractions of a muscle/group. 2- Start out slow. 3- CONCENTRIC TO ISOMETRIC TO 4- ECCENTRIC TO ISOMETRIC contractions
Basis:
1- rhythmical slow movement is used to promote functional stability in a smooth manner
Application:
1- use when weakness prevents the pt from controlling his body through the full range of a lengthening contraction
2- use when spasticity interferes with the pt’s ability to perform lengthening contractions
Replication (Hold Relax Active Movement):
Description: (7)
Basis: (3)
Application: (2)
Description:
1- ISOMETRIC contraction of the agonist (muscle facilitating the desired movement) in shortened range of a pattern against graded resistance.
2- The HOLD is built up
3- The pt is given RELAX command.
4- When PT feels pt relax, the PT quickly moves pt to lengthened range of pattern.
5- Applying a quick stretch,
6- the PT gives appropriate command to have pt
ACTIVELY return to shortened range of the pattern.
7- The PT may assist, track, or resist during active phase.
Basis:
1- the hold in short range increases muscle spindle sensitivity so that during the quick stretch in the lengthened range the muscle spindle discharge is maximized.
2- Commands are given in appropriate manner to facilitate arousal via RAS.
3- Resistance during active phase stimulates isotonics.
Application: (2)
1- pt with weakness and/or
2- unable to initiate movement from lengthened range
Contract- Relax Active Contraction (Contract Relax):
Description: (5)
Basis: (3)
Application: (2)
Description:
1- The technique is done at the point of limitation in range
2- If possible the pt actively moves to that point
3- The PT resists the range limiting pattern (resist the movement that is opposite the desired movement) such that an ISOTONIC contraction for the rotary component and an ISOMETRIC contraction of the other components are acheived.
4- When the pt has moved through the full range of the rotary motion, the command to RELAX is given
5- When relaxation has occurred, the pt moves to new range, or is passively moved by PT
Basis:
1- GTO inhibit range limited pattern
when pt actively moves to range limited pattern end point, the range limiting pattern is reciprocally inhibited.
2- Rotary movements appear to unlock or relax
Application:
1- when motion does not increase pain
2- when involved joint has large rotary component and
Hold Relax:
Description: (7)
Basis: (2)
Application: (2)
Description:
1- This technique is performed at the point of limited range
2- The pt may actively (ore passively) move to the point of limitation.
3- The PT resists ISOMETRIC contraction (for the muscle to be stretched) for the range limiting pattern.
4- The resistance is built up to pt tolerance (maximal) and
5- then maintained (no joint motion is allowed).
6- The command to RELAX is given.
7- When relaxation is felt, the pt is asked to actively move into the desired motion.
Basis:
1- GTO firing will inhibit the range limiting pattern
2- Having pt actively move into desired pattern will result in reciprocal inhibition of the range limiting pattern.
Application:
1- When pt has pain on movement
2- used when involved joint does not have a large rotary component
Repeated Stretch (Repeated Contractions):
Description: (6)
Basis: (1)
Application: (1)
Description:
1- the pt ISOTONICALLY contracts the weak pattern
2- an ISOMETRIC contraction (of the muscle facilitating the desired motion) is asked for at the point the pattern deteriorates
3- The ISOMETRIC contraction is built up
4- a quick stretch is applied to the whole pattern (stretches the muscle facilitating the desired motion) as the pt is asked to move (into the desired position) again.
5- At the end of the range, and ISOMETRIC contraction is performed (like before)
6-The sequence is repeated
Basis:
muscle spindle facilitation and overflow
Application:
use when pt has weakness of whole pattern
(this is like Davies multiple angle isometrics). Pt has weakness for part of range, as opposed to ataxia (where Slow Reversal Hold would be more appropriate)
What PNF technique?
- pt has pain on movement
- invovled joint does not have a large rotary component
Hold Relax
What PNF technique if
- pt is unable to initiate movement due to increased tone
- you want to teach an activity
- pt has limited ROM due to increased tone
Rhythmic Initiation
Different from Slow Reversal because no weakness was listed in reasons!
What PNF technique?
- use when pt has weakness of whole pattern
Repeated Stretch (Repeated Contractions)
What PNF technique?
- want to balance tone by emphasizing one side of joint
- want to stabilize trunk
(pt is low functioning)
Stabilizing Reversals (Alternating Isometrics)
What PNF technique?
- to teach an activity when pt has weakness limiting ability to initiate movement
- when increased tone limits initiation of movement or motion through range
Dynamic Reversal (Slow Reversal)
different from Rhythmic Initiation because weakness is limiting ability to initiate movement
What PNF technique?
- pt with weakness and/or unable to initiate movement from lengthened range
Replication (Hold Relax Active Movement)
