Advanced Proprioceptive Neuromuscular Facilitation For Neurological Patients Physical Education Essay

Advanced Proprioceptive Neuromuscular Facilitation For Neurological Patients Physical Education EssayProprioceptive Neuromuscular Facilitation (PNF) consists of designs and proficiencys white plague for stimulating the humans proprioceptors to crusade neuromuscular system solvent (1)PNF techniquesPNF techniques, aims, and principleThe first PNF technique is quantify for emphasis, whose aim to strength and remedy courage in weak muscle groups, go down muscle imbalance, and increase ROM. This technique is found on the principle of using hefty component to relieve front on the weaker component normal timing from distal to proximal, but the pattern can be altered by doing what the uncomplaining withdraws. Second PNF technique is hold-relax, aims to achieve relaxation, and increase ROM if pain is present. ground on the principle of moving the joint actively or passively to the limited range, thus provides isometric line contraction to the opposite pattern muscles with max imum subway system. Followed by relaxation and move toward the limited direction actively or passively dep exterminateing on the condition, then repeat it in the new ROM. The thired technique is contract-relax, which targets to increase ROM, and its based on the principle of starting with isotonic contraction of the rotation component, followed by the isometric contraction for weak muscle. Slow reversals is the fourth technique, aims for weaker muscles contraction facilitation, better coordination, and increase endurance. Based on the principle of beginning movement at the well-set component by isotonic contraction with maximal subway immediately followed by isotonic contraction of the weak component with maximal resistance, without any relaxation. The fifth technique is repeated Contractions, its target atomic number 18 increasing ROM, improving strength and endurance in weak muscle group, and correct muscle imbalance. The principle mapd in this technique is reinforcing weak component by repeating maximal isometric contraction of the strong components of the pattern. The last technique is singsong stabilization. The aims of this technique atomic number 18 use when movement at the joint is restricted, to strengthen muscles by co-contraction, improve circulation, improve postural stability in joints, and decrease pain. This technique is based on the principle of beginning with stability at the strong component by isometric contraction with maximum resistance followed by immediate without relaxation isometric contraction of the weak component with maximum resistance, until a co-contraction of the muscles of both component argon build.The aim of using PNF techniques is to compound functional level of movements, by facilitation, inhibition, strengthening, and relaxation of muscles. In PNF concentric, compositors case, and static contractions are utilise alongside with resistance. (2) These techniques are classified felt upch to their functions rever sal antagonist, which is a general class of techniques in which the tolerant of contracts his agonist muscles, then the antagonist, without pause or relaxation. This technique includes dynamic reversals, stabilise reversals, and rhythmic stabilization. an different(prenominal) PNF technique is rhythmic initiation which is a passive rhythmic movement of limb or body through the desired range, and progress into active rhythmic resisted movement. Combination of isotonics, which is another technique in which a combination of concentric, eccentric, and stabilizing contractions are used for specific muscle groups (e.g. agonist) without relaxation, and it starts at the endurings maximum strength or best coordination.Another technique is repeated extend, besides known as repeated contractions its applied in two ways either repeated stretch from the beginning of the range or repeated stretch through the range.Contract-relax and hold-relax, these two techniques either used as direct or indirect treatment. The last PNF technique is replication, which speeds take learning of functional activities. (2)Normal motor activitiesIn normal individuals, the developmental epoch of motor activities are varied, unified , and interrelated. The normal individual learns in his childhood to trudge from supine to prone and vies versa, then sitting,etc. There is a variation of motor activities in the performance and chronological sequence of these activities. The use of developmental sequence of motor activities is wish well when a person lays on a beach and senses danger, and then automatically pedals away into prone then sitting, then scrambles to his feet and runs, these actions serve his need the best, and these reactions are from birth and the people used them according to their needs. (1)PNF principlesThe principles of PNF are reflex action mechanism, restoration of motor abilities, repetition of coordinated movements, and developmental sequence processes. In reflex me chanism, which helps to rise movement and posture by using the coordination of the visual-motor mechanism and the auditory-motor mechanism. While during restoration of motor abilities, PNF patterns and techniques are used to provide suit adapted sensory cues, to enhance motor learning and abilities. Repetition of coordinated movements is used to increase strength and endurance, and adjusts the coordinated movements by the use of graded resistance. The last principle is developmental sequence process, which uses a sequence of training from proximal-to-distal and general-to-specific pattern. In these principles, PNF patterns and techniques are precisely applied to developmental activities by using techniques based on isotonic contractions for improving movement and isometric contractions for improving stability. (1)Developmental sequenceIn the developmental sequence the physical healer uses the forrad motion of primitive movements and postures for to a greater extent advanced move ments and postures. The healer also uses progression from general-to-specific pattern, specific movement to change placements and postures, eye-head coordination to enhance movements. In addition, this developmental sequence provides total pattern of movements, which includes head, have it away, re primary(prenominal)s, and four extremities, in various relations like ipsi askant, bi asquint symmetrical, bilateral pass asymmetrical, and reciprocal, in which certain segments move while others adjust to the movement. And this sequence promote the forbearings ability to contract muscle isotonically during movements and isometrically during balance activities, and also enhance the transition from isometric to isotonic contraction. From this we find that PNF restore motor function in a person with a disability, by using variety of principles, patterns, and techniques used in level activities to enhance movement, self-care, and independence. (1)Body of knowledgeMat activitiesMat acti vities involves all principles of PNF, these activities include both stability and movement, which could be single or have complex movements. To vary the effect of reflexes or gravity on the body, mat activities done in various positions which are chosen by the physical healer to control abnormal movements. Its better to begin with strong and pain free movements, because it focuses on irradiation from strong parts of movements to facilitate achieving the desired movements. (2) to a fault the use of prejudice movements involve greater number of muscle groups or movements (1). Any chosen mat application is broken down into parts. In such treatment, the progression is by using weight bearing activities involving more extremities. (2)Activities practiced on the mat teach the patient mobility which is moving in the position, stability which is illustrationing balance in the position, skill which combines mobility with stability or in transition. And the condition of the patient det ermines whether to start with any of these. (2) Basic procedures used in these activities to promote patients working capacity with marginal fatigue are approximation to enhance stabilization and balance, traction and stretch to increase patients ability movements, grips and proper body position in which the physical therapist guides patients movement, resistance to enhance and reinforce movements, and it includes graded resistance which strengthen the weaker movements, and resisting strong movement for irradiation to the weaker movements. Another basic procedures are timing for emphasis which use strong movements to exercise the weaker ones, and patterns to enhance functional activities performance. (2) All of the previous techniques, patterns, and basic procedures are used in mat activities, as follow for stability, stabilizing reversals and rhythmic stabilization are used. While for mobility, combination of isotonics, rhythmic initiation, dynamic reversals, and repeated stretch are used. And for Skill, a combination of moving and stabilizing techniques are used.(2) The advantages of mat activities are safe for people who fear to fall, performing activities without limitations, well-distributed balance, and postural reactions and reflexes are induced more effectively. (1)The activitiesMat characteristicsThe characteristics that should be in a mat used for activities are firm, smooth, comfortable, protect patient from abrasions and stress, large enough to accommodate both the therapist and the patient, and the size is 6 feet for adult, and 4 feet for child(1) rosterThe first mat activity practiced with a neurological patient is turn, which is divided into two parts the first part is turn to mid-position, which is a concentric action of flexor chain, and the other part is from mid-position to the end and it is an eccentric action of the extensor chain. For facilitating throw awaying, the therapist can use different combination of scapula, coxa, uterine c ervix, or extremities pattern.Figure XX trilled facilitation by Head rolling facilitation by ScapulaFirst facilitating rolling by scapula, if the therapist resists prior pattern of scapula, this forget facilitate previous rolling, while resisting female genitals pattern of scapula, facilitate backward rolling.The patient can also facilitates rolling by moving his head in the same direction of rolling. The given commands for rolling with scapular anterior depression eg. For left pull your shoulder toward your opposite(right) hip, lift your head, pull your left leg down and across, pull your foot up and across, then roll. While commands given for rolling backward with piece of tail elevationpush back.In order to start, the therapist should stretches the scapula in the elongated range, and continue this diagonal movement until dead body muscles stretch. After that, the therapist applies resistance to initial scapular contraction until the contraction of trunk muscles is felt, t hen allows it to move. Locking scapula at the end of the range by applying more resistance with either approximation or traction. Types of scapular patterns in rolling are Anterior elevation, in which the patient rolls forward with trunk mention and rotation, and it facilitated by have it away extension and rotation in the rolling direction. Posterior elevation, in which the patient rolls backward withFigure XXX Rolling facilitation by Scapulatrunk extension, and facilitated by neck extension in the rolling direction. Posterior depression, the patient perform a backward roll, with trunk extension, lateral flexion, and rotation, and facilitated by neck lateral flexion and full rotation in the rolling direction. And anterior depression, in which the patient rolls forward with trunk flexion, and facilitated by neck flexion in the rolling direction.(2)Rolling facilitation by PelvisSecond, Pelvic facilitation in rolling, the resistance applied to anterior pattern of pelvis facilitate f orward rolling, while resistance to undersurface pattern of pelvis facilitate backward rolling. The patient can flex the neck to facilitate forward roll, and extend the neck for backward roll. Commands for the patient when rolling forward with anterior elevation pull your pelvis up and roll forward, while when rolling backward roll with posterior depression sit down into my top and roll back.The therapist places the pelvis in the elongated range and continue this diagonal movement until trunk muscles stretch. therapist resists initial pelvic contraction until he/she feels contraction of the desired trunk muscles, then allows it to move. In order to lock the pelvis at the end of the range, the therapist essential apply more resistance with either approximation or traction. Types of pelvic patterns used in rolling are Anterior elevation, in which the patient rolls forward with trunk flexion, flexes the neck for facilitation. Posterior elevation, in which backward rolling is perform ed with trunk lateral shortening, and facilitated by ipsilateral neck rotation. Posterior depression, in which the patient rolls backward with trunk extension, and extends the neck for facilitation. And anterior depression, in which the patient rolls forward with trunk extension and rotation, the facilitation in this pattern is neck extension and rotation in the rolling direction.(2)Rolling facilitation by scapula and pelvic patterns combinationCombining scapular and pelvic patterns can facilitate rolling, by performing pelvic anterior elevation and scapular anterior depression for forward rolling, while performing pelvic posterior depression and scapular posterior elevation backward roll .(2)Figure XXX Rolling facilitation by pelvisRolling facilitation by upper extremitiesIn upper extremities facilitation in rolling, trunk muscles should be strengthen in order to facilitate, by corporate trust strong section muscles with scapular patterns. Adduction patterns used to facilitate for ward rolling, while abduction patterns used to facilitate backward rolling. Also, head movements with the arm used for facilitation. Irradiation into trunk muscles, by resisting strong muscles of elbow. In order to facilitate upper extremities, the distal grip of the therapist is placed on patients hand or distal forearm to control the whole extremity. However, the therapist proximal grip is on or near patients scapula, which is more effective for guidance and resistance of the patients head movements. send on rolling commands with extension-adduction patternsqueeze my hand and pull your arm down to your opposite hip, lift your head, then roll. For backward roll with flexion-abduction patternwrist back, lift your arm up follow your hand with your eyes, then roll back.Figure XXX Rolling facilitation by pelvisTo start rolling, the therapist needs to stretch the arm and scapular muscles of the patient, and puts the arm in the elongated range and then tract. Sustaining this diagonal m ovement and traction, until synergistic trunk muscles stretch and maintain initial arm movements, until the therapist feels contraction of the trunk muscles, then allows it to move. Locking of upper extremities can be at any strong point in ROM. To lock the arm at end of the range, is by applying approximation with resistance to rotation.Types of rolling using one arm are Forward roll with trunk-extension, lateral flexion and rotation, facilitated by neck extension and rotation in rolling direction, and the patterns used are flexion-adduction-external rotation and ulnar thrust pattern. Backward roll with trunk-extension, lateral flexion and rotation, which is facilitated by neck lateral flexion and full rotation in the rolling direction, and the patterns used are extension-abduction-internal rotation and ulnar withdrawal pattern. Forward roll with trunk-flexion, facilitated by neck flexion in the rolling direction, and the patterns used are extension-adduction-internal rotation and radial thrust pattern. And backward roll with trunk-extension, facilitated by neck extension in the rolling direction, and the patterns used are flexion-abduction.(2)Rolling facilitation by U.L bilateral combinationBilateral combination used in upper extremities rolling facilitation are Forward roll with trunk flexion, which is Chopping and Reverse of Chopping. And backward roll with trunk extension, which is Lifting. (2)Figure XXXX Rolling facilitation by U.L bilateral combinationRolling facilitation by lower extremitiesIn the facilitation of lower extremities in rolling, combining strong leg muscles with pelvic patterns are used for facilitation and strengthen trunk muscles. Flexion patterns of lower limbs facilitate forward rolling and extension patterns facilitate backward rolling. Irradiation into trunk muscles by resisting strong muscles of the knee. Head moves in flexion to facilitate forward roll and in extension for backward roll. Physical therapist distal grip is placed on the patients foot to control the whole extremity. It will be more effective activity, if the knee movements are resisted. And the proximal grip of the therapist is on patients thigh or pelvis, in flexion-abduction the proximal hand on contralateral iliac crest to facilitate trunk flexion. Commands given for forward roll with flexion-abduction patternfoot up, pull your leg up and out, then roll away. And for backward roll with extension-adduction patternpush your foot down, kick your leg back, then roll back toward me.Figure XXXX Rolling facilitation by U.L bilateral combinationStarting position for this rolling is to stretch the leg and lower trunk muscles, and putting the leg in the elongated range of pattern and apply traction. And this movement is maintained until the therapist feels contraction of trunk muscles, then allows it to move. The locking can be at any strong point in ROM.Types of rolling with one leg are Flexion-adduction, for rolling forward with trunk flexion. Exten sion-abduction, for rolling back with trunk extension and elongation. Flexion-abduction, for rolling forward with trunk lateral flexion, flexion ,and rotation. And extension-adduction, for rolling back with trunk extension, elongation, and rotation.(2)Rolling facilitation by L.L bilateral combinationBilateral combination of lower extremities for facilitating rolling are Lower extremity flexion, by rolling forward with trunk flexion. And lower extremity extension, by rolling back with trunk extension. (2)Rolling facilitation by neckThe last pattern for facilitating rolling is neck patterns. These patterns are used to facilitate rolling when patient has no pain free motion or no strong movement in scapula or arm. The main force in neck flexion is traction, while in neck extension we apply gentle compression. In rolling, neck flexion is used to facilitate rolling forward from supine to side-laying, and neck extension is used to facilitate rolling back from side-laying to supine. (2)Pro ne-on-elbowsAfter achieving rolling, the next mat activity is prone-on-elbows exercise. There are three methods that enable the patient to assume this position, are side-laying, rolling from supine-to-prone, and prone position. If any of the previous methods are against gravity, the therapist resists concentric contraction. And if it is gravity assisted, the therapist resists eccentric contraction.Figure XXXX Prone-on-elbowsIn order for the patient to achieve this position, the therapist should apply stabilization with approximation for scapula, and resistance in diagonal and rotatory direction is necessary. The patient must avoid trunk sag. The therapist should keep the patients head, neck, and trunk aligned, and apply gentle resistance on the head for stabilization along with rhythmic stabilization. And if the patient jargoon do isometric contraction, the therapist can use stabilizing reversal. When the patient is able to maintain this position, the therapist can work on improvin g head, neck, and shoulder, neck resisted motions which is effective, resisted arm motions to strengthen the weight-bearing arm, upper trunk rotation, and weight shimmy. (2)Side-sittingThe paitent then progresses from prone-on-elbow position into side-sitting. This position involves weight-bearing on arm, leg, and trunk of one side, while the other arm is free to function, then the patient should learn mobility like scooting. Four methods to assume this position, which are side-laying, prone-on-elbows, sitting, and four-footed. The physical therapist in this position, can work on activities of balance, like upper extremity weight-bearing exercises , and scapular and pelvic reciprocal motions, in which the movements of this combination promotes trunk mobility, and stabilizing contraction of this combination promotes trunk stability. Activities of mobility in this position are scooting, moving to sitting, to prone on elbows, and to quadruped position. (2) four-footedThe other mat ac tivity that follows side-sitting is quadruped. In this position the patient will be able to exercise trunk, hips, knees, and shoulder, using isotonics and dynamic reversals. Also the patient will be able to move from one place to another. The physical therapist makes sure that the patient has strong scapular muscles to support the weight of upper trunk. Patient with spinal pain or has stabilization problems, can practice activities in this position, but the therapist must be assertive of absence of pain in knee joint. The patient can assume this position by two methods, are prone-on-elbows, and side-sitting. In quadruped position, the therapist can works on activities of balance, by using stabilizing reversal and rhythmic stabilization techniques, for balance and stabilization of the trunk and extremity joints. Also the therapist can work on rocking forward and backward, by using combination of resistance, isotonics, and dynamic reversals. Crawling can be practiced in this position, by applying resistance on scapula, pelvis, neck, arms, and legs movements, in order to enhance patients skill. (2)Figure XXX Facilitation to QuadrupedKneelingIn this position the patient will be able to exercise trunk, hips, and knees, while arms are free and used for support, able to move from one place to another, and moves from kneeling to standing. For patients who have knee pain and cant assume this position, they can work in kneeling down. Kneeling will help to promote the strength, coordination, and ROM of hips and knees, by exercise moving between kneeling and side-sitting, and by combining isotonics contractions for concentric and eccentric muscles. To assume this position, is by three methods, are side-sitting, kneeling-down, quadruped position. Activities that can be practiced in this position are balance activities such as, scapula and head motions resistance, using stability reversals and rhythmic stabilization techniques to promote trunk strengthen and stability. Othe r balance activities are resistance to pelvic motion, pelvis and scapula motions, trunk and head motion, and resisting arm movement when sitting of the heels. Another activity, which can be practiced in this position is move on the knees forward, backward, and sideways. (2)Half-KneelingThis mat activity is where the patient can go to standing position. There are two methods to assume this position kneeling and standing. The physical therapist can work on activities of balance, such as strengthening trunk and lower extremity muscles, by using stabilizing and moving techniques. Activities of weight shifting over back leg with trunk elongation, this activity challenge patients balance, coordination, ROM, and strength. Activities of shifting weight to front leg, which increase DF ROM. And standing up as the last activity. (2)Sit-to-standIn order for the patient to stand up from a chair, he or she should moves forward in the chair, stand up, get his or her balance in standing. The patie nt should be able to rise from sitting on surfaces of different heights.Sit-to-stand is divided into two parts. The first part which involves flexion of head, neck, and trunk, pelvic anterior tilt, and knee extension with forward movement over the base of support. The second part of this activity is backward movement toward a vertical position characterized by extension of head, neck, and trunk, posterior pelvic tilt, and the knees go into extension and backward movement as the trunk comes over the base of support. Commands given for a patient standing up from the cornerstone pull yourself forward, and push with your right foot. Now push with both feet, lift your head to the left, stand up. Hold, now pull your left foot forward and whole tone on it.In this activity the therapist holds the patients iliac crests in order to increase the patients ability in standing up. Then the therapist rocks the pelvis by rhythmic initiation and stretches it into posterior tilt, and resists or ass ists as it moves into anterior tilt. Rhythmic initiation is used enable the patient to place his or her hands on bars or chairs arm, and stabilizing contractions and combination of isotonics are used to enable the patient to assist with their arms. When the patient is moving toward standing, the therapist should assist his or her pelvis by guiding it through anterior tilt. Resistance is applied to the movement that the patient is capable of doing it without help. In the time the patient stands with upright posture, the therapist moves the pelvic into the appropriate degree of posterior tilt. For promoting weight bearing, approximation is done through the pelvic. (2 1)2.2.9 StandingThis position is considered to be the first stage in walking and a form of functional activity. In standing the therapist should stand in a diagonal plane in front of the leg that initially will receive the patients weight. Commands given in this activityHold, dont permit me pull your head forward, dont let me push your hip back. Hold, dont let me turn you to the other side. Hold dont let me pull you forward.Accepting the patients body weight on his or her lower limb, is fulfilled by combining approximation through the pelvis on the strong side with stabilizing resistance at the pelvis. For the weaker side, the therapist uses the same techniques in addition to blocking the knee. Then the therapist stabilizes lower trunk and legs by combining approximation and stabilizing reversals at the pelvis. The same techniques directed at the shoulders used to stabilize upper and lower trunk. When using combination of isotonics with small motions or stabilizing reversals, it will resist balance in all directions, and itll work on stabilizing the head, shoulders, pelvis, and their combinations. . (21)ConclusionIn conclusion, deficient neuromuscular mechanism leads to limited response due to faulty development, trauma, or disease of the nervous or musculoskeletal systems. As we know, PNF is rela ted to normal response of the neuromuscular mechanism, which enables it to widen the range of motor activities within the limitations of anatomical structure, developmental level, and inherent and previously learned neuromuscular response. By using various combinations, patterns, and techniques of PNF, the patient will be able to detect and restore his or her previous functional level.Refrences1. Voss, Dorothy E., Ionta, Marjorie K., Myers, Beverly J. (1968). Proprioceptive neuromuscular facilitation patterns and techniques. Philadelphia Harper and Row.2. Adler, Susan S., Beckers, Dominiek, Buck, Math. (2003). PNF in Practice an illustrated guide. Germany Springer.Content PageContent pageIntroduction 2Background about PNF 2PNF techniques 2Normal motor activities 4PNF principles 4Developmental sequence 5Body of knowledge 6Mat activities 6The activities 7Mat characteristics 7Rolling 7Rolling facilitation by Scapula 9Rolling facilitation by Pelvis 11Rolling facilitation by scapula and pelvic patterns combination 11Rolling facilitation by upper extremities 12Rolling facilitation by U.L bilateral combination 15Rolling facilitation by lower extremities 16Rolling facilitation by L.L bilateral combination 17Rolling facilitation by neck 17Prone-on-elbows 18Side-sitting 19Quadruped 20Kneeling 21Half-Kneeling 23Sit-to-stand24Standing25Conclusion26