Proprioceptive neuromuscular facilitation
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editors-In-Chief: Abhishek Singh, B.P.T [2]
Overview
Proprioceptive neuromuscular facilitation is a motor learning approach used in neuro-motor development training to improve motor function and facilitate maximal muscular contraction.
Historical perspective
According to Kabat (1951) "The basis of the PNF philosophy is the idea that all human beings, including those with disabilities have untapped existing potential.
PNF BASIC PROCEDURES FOR FACILITATION
Patterns Of Motion
Normal Motor activity occurs in synergistic & functional patterns of movement. PNF technique are "spiral & diagonal" in character and combine motion in all 3 planes i.e. flexion/extension, abduction/adduction and rotation.
Extremities patterns are named according to the movement occurring at the proximal joint or by diagonal(antagonist patterns are make up the diagonal).
UPPER EXTREMITIES
- D1 Flexion- Flexion,Adduction,External Rotation.
- D1 Extension-Extension,Abduction,Internal rotation.(Antagonist pattern of D1 flexion).
- D2 Flexion- Flexion, Abduction, External Rotation.
- D2 Extension- Extension,Adduction,Internal Rotation.(Antagonist pattern of D2 flexion).
LOWER EXTREMITIES
(D1 Flexion of Lower Extremities is similar to Upper Extremities pattern).
- D1 Flexion- Flexion,Adduction,External Rotation.
- D1 Extension- Extension,Abduction,Internal Rotation.(Antagonist pattern of D1 flexion).
- D2 Flexion- Flexion, Abduction,Internal Rotation.
- D2 Extension- Extension,Adduction,External Rotation.(Antagonist pattern of D2 flexion).
HOW TO PERFORM UPPER EXTREMITIES PNF PATTERN
D1 Flexion
- Starting Position
- Patient Position- Extension/abduction/internal or medial rotation of the shoulder with pronation of the forearm,extension with ulnar deviation of the wrist,extension of the fingers,extension and abduction of the thumb.The therapist ensure that patient near to the side of plinth to enable the arm to be taken to extension. The patient's arm should be abducted around 20°-30° from the side of the body.Care must be taken that patient's finger are in fully extension before the movement begins.
- Therapist Stance- Therapist stands at patient's upper arm level in Lunge position facing towards the patient's feet & with his weight on her front right foot & parallel with proposed line of movement.During the arm's movement of patient,therapist transfers his weight from the front foot to the back foot rotating so that he can watch the movement throughout the movement pattern.
- Grip- Therapist grasp the patient's right palm approaching from palm approaching from radial side. He uses the lumbrical grip ensuring that extensor surface of patient's hand does not touch.Fingers of right hand placed on flexor aspect of patient's wrist approaching from ulnar side.
- Commands- Therapist prepares patient for the movement by saying 'now' & then follows this with command like"grip my hand, pull up and across the face.
- Movements- Flexion of fingers, particularly the little & ring fingers,adduction & flexion of thumb, flexion of wrist towards the radial side with supination of the forearm,flexion,adduction & lateral rotation of the shoulder joint,while scapular joint is in rotation,elevation & protraction.Movement is initiated by rotary component.Movement then occurs at distal joints followed in succession by more proximal joints until whole extremities is moving.
Flexion/Adduction/External or Lateral Rotation with Elbow Flexion
Starting Position-
- Patient Position- As for D1 flexion.
- Therapist Position- Stance & grip as for D1 flexion.The therapist may move his right hand nearer to the patient's elbow.
- Movement- As in the D1 flexion with addition of elbow flexion.This is the eating pattern.
Flexion/Adduction/External or Lateral Rotation with Elbow Extension
Starting Position
- Patient Position- Same as D1 flexion with addition of elbow flexion.
- Therapist Position- Stance & grip similar to D1 flexion.
- Movement- Similar to D1 flexion with addition of elbow extension.Similar to the fundamental component of upper cut in boxing.
D1 EXTENSION
Extension/Abduction/Internal/Medial Rotation
Starting Position
- Patient Position- Flexion/Adduction/External or Lateral Rotation,forearm supinated,flexion and radial deviation of wrist,fingers flexed,flexion & adduction of thumb.
- Therapist Position- In Lunge position facing head of the patient at patient's upper arm level. Therapist weight is on front left foot & parallel with the line of movement.During movement therapist weight is transfers from front foot to the back foot,rotating so that watch patient's movement.
- Grip- Right hand & lumbrical grip of therapist grasps dorsum of patient's right hand ensuring stretch is obtained,main emphasis is on exteroceptors on ulnar side of patient's hand with pressure from therapist fingers.After movement has started fingers of therapist's left hand are placed on extensor surface of patient's wrist.
- Commands- 'Now'-'push'.
- Movement-
- Fingers-Extension(particularly ring & little)
- Thumb- Extension & abduction
- Wrist- Extension & ulnar deviation
- Forearm- Pronation
- Shoulder/Gleno-Humeral Joint- Extension,abduction & internal rotation
- Scapula- Rotation,depression & adduction.
Extension/Abduction/Internal/Medial Rotation with Elbow Flexion
Starting Position
- Patient Position- Same as D1 extension.
- Therapist Position- Position & grip of right hand as for D1 extension,but left hand fingers are placed at elbow approaching from ulnar side for free elbow flexion movement.
- Movement - Same as D1 extension with addition of elbow flexion.
Extension/Abduction/Internal/Medial Rotation with Elbow Extension
Starting Position
- Patient Position- Same as D1 extension with addition of elbow flexion.
- Therapist Position- Position & grip same as D1 extension.
- Movement- Same as D1 extension along with elbow extension.Movement similar in eating when hand is returning from mouth.
References
1-Physical Rehabilitation: Susan B O'Sullivan & Thomas J Schmitz (Fifth Edition)
2-Proprioceptive Neuromuscular Facilitation Patterns: P J Waddington