Adler pnf in practice download

The approach presented in this richly illustrated guide is based on the concepts set out by Dr. Herman Kabat and taught by Margaret Knott. This edition demonstrates how the principles of the International Classification of Functioning, Disability and Health ICF and aspects of motor learning and motor control are applied in modern PNF evaluation and treatment.

This textbook provides a systematic and easily accessible guide to learning and understanding PNF. Produk Detail: Author : Susan S. This edition demonstrates how the principles of the International Classification of Functioning, Disability and Health ICF and aspects of motor learning and motor control are applied in modern.

The fully revised third edition demonstrates how the principles of the International Classification of Functioning, Disability and Health ICF and aspects of motor learning and motor control from ".

The text provides a useful overview of PNF stretching - safe and easy-to-use method that involves stretching the muscle, contracting it isometrically against resistance, then stretching it again to a new range of motion. Whether you're a fitness professional, therapist, coach, athlete, or student, Facilitated Stretching, Third Edition, will help you assess current muscle function, improve range of motion, increase strength, reduce overuse injuries, and enhance performance. This book is the first to view the effects of development, aging, and practice on the control of human voluntary movement from a contemporary context.

Emphasis is on the links between progress in basic motor control research and applied areas such as motor disorders and motor rehabilitation. Case studies demonstrate the patient examination and treatment process, and show how to achieve consistency in documentation. Review questions are included at the end of each chapter, with answers at the back of the book.

Illustrated step-by-step intervention boxes, tables, and charts highlight important information, and make it easy to find instructions quickly. NEW photographs of interventions and equipment reflect the most current rehabilitation procedures and technology. UPDATED study resources on the Evolve companion website include an intervention collection, study tips, and additional review questions and interactive case studies.

Neurologic Interventions for Physical Therapy, 3rd Editionhelps you develop skills in the treatment interventions needed to improve the function of patients with neurologic deficits. Written by physical therapy experts Suzanne 'Tink' Martin and Mary Kessler, this market-leading text will help you prepare for the neurological portion of the PTA certification exam and begin a successful career in physical therapy practice. Proprioceptive Neuromuscular Facilitation chapter describes how PNF can be used to improve a patient's performance of functional tasks by increasing strength, flexibility, and range of motion - key to the treatment of individuals post stroke.

This is part of a three-volume collection which provides information on innovative development projects in Asia, Latin America and Africa that have actually worked. The 50 cases presented illustrate a wide spectrum of economic and environmental policy and practice. The neuro rehab text that mirrors how you learn and how you practice! Traction is used to: 4 Visual stimuli influence both the head and body 4 Facilitate motion, especially pulling and anti- motion. For example, use traction at the beginning of shoulder flexion The feedback and -forward system can promote a in order to counteract or to facilitate scapula much stronger muscle activity Schmidt and Lee elevation.

For example, when a patient looks at his or her arm or leg while exercising it, a stronger Traction of the affected part is helpful when treating contraction is achieved. Using vision helps the patients with joint pain. Definition Moving the eyes will influence both the head Approximation is the compression of the and body motion. For example, when patients trunk or an extremity.

The head motion in turn will facilitate larger and stronger trunk motion The muscle contractions following the approxima-. Given arm activities against gravity can be combined with gradually and gently, approximation may aid in the approximation instead of traction when this pro- treatment of painful and unstable joints.

Therapeutic Goals Approximation is used to: 2. Giving a stretch to 4 Resist some component of motion. For example, muscles should only be done when the therapist use approximation at the end of shoulder flexion expects to facilitate the dynamic muscle activity. There are three ways to apply the approximation: kStretch Stimulus 4 Quick approximation: the force is applied Therapeutic Goals quickly to elicit a reflex-type response.

The approximation force is always maintained, whether the approximation is done quickly or slow- Stretch stimulus is used during normal activities as ly. The therapist maintains the force and gives resis- a preparatory motion to facilitate the muscle con- tance to the resulting muscular response. An appro- tractions. The stimulus facilitates the elongated priate command should be coordinated with the muscle, synergistic muscles at the same joint, and application of the approximation, for example »hold other associated synergistic muscles Loofbourrow it« or »stand tall.

Greater facilitation comes from properly aligned and in a weight-bearing position lengthening all the synergistic muscles of a limb or before the approximation is given.

For example, elongation of the anterior When the therapist feels that the active muscle tibial muscle facilitates that muscle and also facili- contraction decreases, the approximation is repeat- tates the hip flexor—adductor—external rotator mus- ed and resistance is given.

If all the muscles of the hip and ankle are stabilizing activity, the therapist should lengthened simultaneously, the excitability in those use the one which is most effective. It is limb muscles increases further and spreads to the also possible to use a maintained approxi- synergistic trunk flexor muscles.

For example, using PNF activities in an upright kStretch Reflex position and combining them with approximation Therapeutic Goals together with concentric and eccentric muscle How, why, and when to use the stretch reflex is activity may be the most effective treatment.

Using described in 7 Chap. Functional movement 2 from contraction. However, first proximal stabil- ity must be present before the distal movement can The reflex has two parts. The first is a short latency begin. The second part, called Definition the functional stretch response, has a longer latency In adults, normal timing of most coordinated but produces a more powerful and functional con- and efficient motions is from distal to proximal.

To be effective as a treatment, the muscular contraction following the stretch must be resisted. The evolution of control and coordination during The strength of the muscular contraction pro- development proceeds from cranial to caudal and duced by the stretch is affected by the intent of the from proximal to distal Jacobs In infancy subject, and therefore, by prior instruction.

Mon- the arm determines where the hand goes, but after keys show changes in their motor cortex and strong- the grasp matures the hand directs the course of er responses when they are instructed to resist the the arm movements Halvorson The small stretch.

The same increase in response has been motions that adults use to maintain standing shown to happen in humans when they are told to balance proceed from distal foot to proximal hip resist a muscle stretch Hammond ; Evarts and and trunk Nashner To restore normal Tannji ; Chan Points to Remember Normally the timing of an activity is from distal to proximal.

Moving an extremity presupposes In patients with increased tonus such as some- that the central part of the body is stabilized. Mov- one with spinal spasticity, a reflex is easily pro- ing the leg forward in gait requires that the trunk voked and can be used to initiate a movement.

Central stability is needed to move an ticity, by eliciting movement in the direction extremity. However, studies showed that timing can opposite of the spastic pattern. Definition 2. This alteration of Definition timing stimulates the proprioceptive reflexes in the Timing is the sequencing of motions. The best results come when the strong muscles score at least »good« in strength Manual Muscle Test grade 4; Partridge The strong motions of the hip and knee are blocked and the dorsiflexion—eversion of the ankle exercised using repeated stretch reflex.

The stronger shoulder motions are blocked while exer- cising radial extension of the wrist There are two ways the therapist can alter the knee joint. Meanwhile, for stimulating the compo- normal timing for therapeutic purposes. This re- sistance to the static contraction locks in that The patterns of facilitation may be considered one segment, so resisting the contraction is called of the basic procedures of PNF.

For greater clarity, »locking it in«. Example Timing for emphasis for the dorsiflexion—supination— 2. Muscle strengthening. Irradiation and reinforcement Irradiation The spread of the response of Facilitates muscle contractions including the effect on the nerve impulses of a given contralateral side. Reinforcement Increase stimulation by addi- tion of new stimulus. Manual contact receptors and other pressure When used on the trunk, promotes trunk stability.

Provides confidence and security. Promotes tactile-kinesthetic perception. Body position Therapist: Position in direction Enables patient to work in an economical and goal-oriented and of movement.

Verbal Tells the patient what to do Guides the start of movement. Affects the strength of the muscle contractions or of relaxation. Promotes attentiveness of the patient. Helps the patient learn a functional activity. Visual The patient follows and con- Stimulates muscle activity in terms of coordination, strength, stimulation trols his movements by hav- and stability.

Informs therapist on appropriateness of the applied stimulus; whether it was too intensive or caused pain. Informs therapist about the pain intensity and compatibility of the applied stimuli. Provides an avenue of communication and helps achieve a cooperative interaction. Traction and approximation Traction An extension of the trunk or Facilitates motion, especially pulling and antigravity motions.

Helps prepare for stretch reflex and stretch stimulus. Provides relief of joint pain. Approximation Compression of the trunk or Promotes stabilization. Facilitates weight-bearing and the contraction of antigravity muscle. Facilitate upright reactions. Used to resist some component of motion. Stretch stimulus Occurs when a muscle is Facilitates muscle contractions. Timing Sequencing of motions. Normal timing Normal timing provides con- Improves coordination of normal movement.

Timing for Changing the normal Redirects energy from the stronger to the weaker muscles. PNF patterns Synergistic combinations of Facilitates and increases muscular response. Exp Brain Res 55—68 Dietz V, Noth J Pre-innervation and stretch responses of triceps brachii in man falling with and without visual control.

Phys Ther 54 10 : — muscle training in man. Arch Phys Med Rehab — Hoessly M Use of eccentric contractions of muscle to Hellebrandt FA, Houtz SJ Mechanisms of muscle train- increase range of movement in the upper neuron syn- ing in man: experimental demonstration of the overload drome.

Spektrum Akademischer Verlag, investigation. Robert Wartenburg lecture. Neurology Brooks VB The neural basis of motor control. Physiother Can- quisition. TINS 3: — an anthology. Rosenbaum DA Human motor control. Brain Res — behaviour: the motor action controversy. Elsevier, Am- Fischer E Factors affecting motor learning. Phys Ther 12 : — prove chronic motor deficit after stroke.

Springer, Gellhorn E Proprioception and the motor cortex. Louis neuromotor processes. Foundations for physical therapy in Exercise. Human Kinetics Champaign rehabilitation. Genet cular facilitation: patterns and techniques, 3rd ed. Harper Psychol Monogr — Merriam- Phys Med 46 1 : 41—51 Webster, Springfield Hammond PH The influences of prior instruction to the subject on an apparently involuntary neuromuscular response. Phys Ther Rev 40 2 : 98— Reprinted in: Jacobs MJ Development of nor- mal motor behavior.

Be- wegung lehren und lernen, 5. In: Ingle DJ et al. A Be- havioral Emphasis. Human Kinetics Sherrington C The integrative action of the nervous system, 2nd ed. Mosby, St. We use both reversal techniques to A PNF technique is a sequenced method of facilita- increase strength and range of motion. The goal of the PNF techniques is to promote 3 functional movement through facilitation, inhibi- The techniques described are: tion, strengthening, and relaxation of muscle 4 Rhythmic Initiation groups.

The techniques use concentric, eccentric, 4 Combination of Isotonics G. Johnson and and static muscle contractions. These muscle con- V. Saliba, unpublished handout also tractions with properly graded resistance and called Reversal of Agonists; Sullivan et al. Use a relaxation technique — Stabilizing Reversal such as Contract—Relax to increase range of — Rhythmic Stabilization motion.

Follow with a facilitatory technique 4 Repeated Stretch Repeated Contraction such as Dynamic Reversals Slow Reversals or — Repeated Stretch from beginning of Combination of Isotonics to increase the range strength and control in the newly gained range — Repeated Stretch through range of motion.

After using a strengthening 4 Replication technique such as Repeated Stretch repeated stretch reflex , go immediately into Dynamic Reversals Slow Reversals to relieve fatigue in In presenting each technique we give a short charac- the exercised muscles.

The repeated stretch terization, the goals, uses, and any contraindications. Alternating contractions of the an- examples, and ways in which they may be modified. Knott and Voss , both names are given. For example, Reversal of Antagonists is a gen- jGoals eral class of techniques in which the patient first 4 Aid in initiation of motion contracts the agonistic muscles then contracts their 4 Improve coordination and sense of motion antagonists without pause or relaxation. Within that class, Dynamic Reversal of Antagonist is an isotonic 1 G.

Saliba were the first to use the terms technique where the patient first moves in one di- »stabilizing reversal of antagonists«, »dynamic reversal of rection and then in the opposite without stopping.

In this tech- of Physical Art The intended goal of the movement can be conveyed to the patient via verbal, visu- 3. Vicky Saliba. The return jCharacterization motion is done by the therapist. Combined concentric, eccentric, and stabilizing 4 The therapist resists the active movement, contractions of one group of muscles agonists maintaining the rhythm with the verbal com- without relaxation.

For treatment, start where mands. Good, 4 Functional training in eccentric control of now let me move you back down and then up movement again. Now relax and let me bring you for- desired direction ward. Let me bring you forward. Now push up range of motion straight again. Example jModification Trunk extension in a sitting position. Normally we start with contraction of the stronger 3. First the proximal grip changes to the distal hand, then the distal hand moves to the proximal grip.

This can be 4 When you are ready for the patient to move in done before and after reversing direction. Reversing lower extremity motion from flexion into 5 For example, doing a dynamic reversal only extension with stabilization after the reversal.

Points to Remember 4 Only use an initial stretch reflex. Do not re-stretch when changing the direction because the antagonist muscles are not yet under tension.

When using extremity pattern, make sure to first initiate the opposite direction distally. The com-. Approximation or traction jModifications should be used to increase stability.

Example Trunk stability. Stay still. Now start matching me in the back. The patient 4 The technique should begin with the stronger maintains the position of the part without try- group of muscles for facilitation of the weaker ing to move. Neither the move farther into the restricted range. When the 4 To gain relaxation without pain the technique patient once again fully responds, the therapist may be done with muscles distant from the painful area.

In the third edition , 4 Resist alternate trunk flexion and extension until Voss et al. Change Hand grip: May grip on both sides and change direction from one part of the body to another part is allowed of resistance slowly Muscle activity: From agonist to antagonist to agonist to Muscle activity: Agonistic and antagonistic activity antagonist together possible co-contraction Patient needs one direction; to control both directions Patient is still able to control both directions together is too difficult.

For example, the therapist may prevent any hip motion from occurring while kContraindications resisting the ankle dorsiflexion and eversion 4 Joint instability through its range.

Pay particular attention to the Repeated Contractions rotation. Drawing by Eisermann jGoals 4 Next give a preparatory command to coordi- 4 Increase active range of motion nate the stretch reflex with a new and increased 4 Increase strength effort by the patient.

You can »Foot up, pull your leg up and out. The patient must maintain the contraction or muscles as »agonists. Resisted isotonic contraction of the restricting 4 Repeat the stretch reflex if you feel the patient muscles antagonists followed by relaxation and start to move in the wrong direction. A rule of thumb is three to jGoal four re-stretches during one pattern. Now, pull it up harder. Active motion or motion against a while re-stretching and resisting the weaker little resistance is preferred for the positive in- muscles timing for emphasis.

The authors feel that the con- sion with the hip motion stabilized. Points to Remember 4 After sufficient time, the therapist tells the patient to relax. Ac- 4 A rule of thumb is three to four re-stretch- tive motion is preferred and may be resisted. Keep turning your hand down. The authors feel that use the agonist. Ac- 3. The mo- tion may be resisted if that does not cause pain. Resisted isometric contraction of the antagonistic muscles shortened muscles followed by relaxation For decreasing pain:.

If For increasing range of motion that still causes pain, resist the synergistic muscles 4 The therapist or patient moves the joint or of the opposite pattern instead. Active motion is jIndication preferred. The therapist may resist if that does 4 When the contraction of the restricted muscles not cause pain.

Direct better than indirect Direct or indirect Command: Strong, »push« »pull« Command: Soft, slow, »stay or hold here« Fast relaxation, not limited by pain Relax: slower and PT matches with own relaxation Move actively into the new ROM Move actively into the new pain-free range of motion. PT can assist into the new range if painful Strengthen the new range Strengthen new range if pain is acceptable jDescription 4 Both you and the patient breathe to improve 4 The patient is in a position of comfort.

Match my resistance. Build 4 Resist the synergists of the shortened or the resistance up slowly and keep it at a pain-free painful muscle.

Blue: passive or assistive movement by the therapist in the opposite direction. Red: active return by the patient in the direction of the end range of the functional act.

Drawing by Ben Eisermann 3. Teaching the patient the outcome of 4 At the end the patient should perform the ac- a movement or activity is important for functional tivity or motion alone, without facilitation or work for example, sports and self-care activities manual contact by the therapist. Points to Remember jGoals 4 Exercise or teach functional activities 4 Teach the patient the end position outcome 4 Use all the Basic Procedures for facilitation of the movement. Their Goals jDescription Suggestions for PNF techniques that can be used to 4 Place the patient in the target position or in achieve a particular goal are outlined below.

Points to Remember 4 The patient holds that position while the thera- pist resists all the components. Use all the basic 1. Change rate of motion — Hold—Relax — Rhythmic Initiation Increase strength — Combination of Isotonics — Dynamic Reversals 3. Increase stability patients on the participation level?

Louis, San Fransisco — Rhythmic Stabilization Markos PD Ipsilateral and contralateral effects of pro- prioceptive neuromuscular facilitation techniques on — Repeated Stretch from beginning of hip motion and electro-myographic activity. Increase endurance ing voluntary contraction. Increase range of motion ent fibers, central pathways, discharge characteristics.

Manual Ther 2 : — stretching and improvement of hamstring flexibility. Res Quart Exercise Sports 1 : 47—51 posterior thigh muscles.

J Sport Rehab 9 : — Sarburg PR, Schrader JW Proprioceptive neuromuscu- Chalmers G Re-examination of the possible role of lar facilitation techniques in sports medicine: a reassess- Golgi tendon organ and muscle spindle reflexes in pro- ment. J Sports Med Phys prevention. J Strength Conditioning intensity in contract—relax proprioceptive neuromuscu- Res 3 : — lar facilitation stretching.

Br J Sports Med. J Strength Conditioning Res 3 : — Kabat H Studies on neuromuscular dysfunction, XII: Rhythmic stabilization; a new and more effective tech- nique for treatment of paralysis through a cerebellar mechanism. Buck 4. Our treatment person. Test for causal impairment and deficits 7 Sect. On the Re-test for causal impairment and activity basis of this evaluation, we set general and specific limitation 7 Sect. The therapist designs a treatment plan that illustrates how the goals will be achieved and this is then shared with the patient.

Continuous assessment 4. We will use this knowl- such as organs, limbs, and their components. The therapist asks for the personal goals of the patient. These measure- 5 Able to move and stabilize ments should be done quickly and should be as sim- 5 Motion is controlled and coordinated ple as possible and reproducible.

Examples for measurements on the structural position level: — Dynamic: loss of the ability to move or 5 Muscle strength test control motion 5 Tests for joint mobility 5 Specific deficits the reasons for the functio- 5 Ashworth scale muscle tone nal losses 5 Two-point discrimination sensitivity — Pain b.

This is not dogmatic. They can be the limitations of the activity: which impair- changed or complemented. As the skills of the ments can be responsible for these limitations? The therapist should be ty and for each treatment session. General goals and one specific treatment goal for 4 What are the treatment goals of the patient? Static dysfunction: A patient who has difficulty maintaining standing balance after suffering a head injury. Begin treatment in a requirements of the patient and the defined treat- more stable and less threatening position.

PNF uses muscle contractions to affect 2. Dynamic dysfunction due to pain: A patient the body. Modalities such as heat and one mile 1. The therapist combines and modifies the proce- 3. Dynamic dysfunction due to the loss of ability dures and the techniques to suit the needs of each to move: A patient who has had a stroke with patient.

Treatment should be intensive, mobilizing resultant hemiplegia. Begin treatment with weight shifting in a stable position. For example: Specific: the goal is specific for each individual.

Decrease pain Measurable: the goal is measurable, for example, 2. Increase range of motion distance of walking. Increase strength, coordination, and control of Acceptable: the therapist and the patient agree motion on the goal. Develop a proper balance between motion and Realistic: the goal is attainable by the patient stability with his specific problem. Increase endurance Time: the goal should be met within a reason- able amount of time. The results achieved after each The therapist designs a treatment to meet the pa- treatment are documented.

Factors to be considered include: and results of the treatment are clear. This form of 1. Direct or indirect treatment assessment requires objective testing. These tests 2. Appropriate activities should be done on all levels: body function and 5 Movement or stability body structure, activity and participation. The best position for the patient. Techniques and procedures 5. Patterns and combinations of patterns Example 6.

Functional and goal oriented tasks. While the patient stands on the involved leg, the therapist gives approximation through the pelvis to The treatment of the therapist should always be: facilitate weight-bearing. Goal oriented: all the activities are focused on the treatment goal. Definition Process oriented: all aspect of the treatment In indirect treatment, the chosen facilitation is should be related to and influence each other. The indirect way of treatment uses with a specific treatment goal in mind and if neces- the principle of synergistic muscles.

Hellebrandt et al. Other experiments have described electromyo- The authors distinguish between direct and indirect graphic EMG activity in the agonistic and antago- treatment. The decision of the therapist to use the nistic muscles of the contralateral upper or lower direct or the indirect method depends mostly on the extremity during resisted isotonic and isometric specific problems of the patient.

The trunk musculature can also be exercised jDirect Treatment indirectly. For example, the abdominal muscles con- tract synergistically when a person raises his arm. Definition This activity occurs in normal subjects and in pa- In direct treatment, the therapist treats the af- tients suffering from central nervous system fected body part or area that is involved.

For disorders as well Angel and Eppler An example, the muscles near the joint or within a increased passive range of motion can be gained in- certain problematic part of the movement.

To give the patient maximum benefit from in- Direct treatment may involve: direct treatment the therapist resists strong move- 1. Use of treatment techniques on the affected ments or patterns.

Maximum strengthening occurs limb, muscle, or motion. When pain is a presenting Indirect treatment can also be applied when symptom, treatment focuses on pain-free areas the treatment goals are for strengthening.

The of the body. Using carefully guided and controlled maximal strength can be reached when the the- irradiation the therapist can treat the affected limb rapist combines patterns that are weak with pat- or joint without risk of increasing the pain or injury. The patient is able to do more Indirect treatment may involve: in the treatment and can reach the highest possible 4 Use of the techniques on an unaffected or less effects sooner when the stronger patterns are re- affected part of the body.

The therapist directs sisted. By assessing the results after each treatment, the therapist can Example determine the effectiveness of both the treatment To gain range in shoulder flexion, abduction, and activity and treatment session and can then modify external rotation.

Changing the treatment procedures or the 4 After resisting the contraction, the therapist and techniques the patient relax. Increasing or decreasing facilitation by chang- 4 This use of Hold—Relax will produce a contraction ing the use of: and relaxation of the ipsilateral pectoralis major 5 Reflexes muscle.

The treated arm need not be moved but 5 Manual contact may remain in a position of comfort. Increasing or decreasing the resistance given body. Working with the patient in positions of func- tion Example 5.

Progressing to more complex activities To improve lower extremity weight-bearing. These tests will be evaluated and compared. A further advantage of the indirect treatment is that it gives the patient the opportunity to be treated 4. If the pain is initially in the foreground, then the treatment is The following examples of procedures, techniques, generally performed in a pain-free area. Pain b. Techniques a.

Combinations — Isometric muscle contraction — Contract—Relax followed by Combination — Bilateral work of Isotonics in the new range — Traction — Contract—Relax followed by Slow Rever- — Position for comfort sals, beginning with motion into the new b. Combinations 4. Coordination and control — Hold—Relax followed by Combination of a. Procedures Isotonics — Patterns of facilitation — Rhythmic Stabilization followed by Slow — Manual contact grip Reversal Dynamic Reversals moving — Vision first toward the painful range — Proper verbal cues, decreased cueing as 2.

Decreased strength and active range patient progresses of motion — Decreasing facilitation as the patient a. Procedures progresses — Appropriate resistance b. Techniques — Replication — Repeated Stretch from beginning of range c. Facilitation from stronger antagonists nists 2.

Prevention and relief of fatigue — Combination of Isotonics combined c. Stability and balance range Repeated Contractions of the a. Procedures weak pattern — Approximation — Rhythmic Stabilization at a strong point — Vision in the range of motion followed by Re- — Manual contact grip peated Contractions of the weak pattern — Appropriate verbal commands 3. Decreased passive range of motion b. Endurance letic performance. Varying the activity or exercise be- myotonic dystrophy.

Med Sci Sports Exerc patient to work longer and harder. Attention to — breathing while exercising as well as specific breath- Partridge MJ Repetitive resistance exercise: a method ing exercises work to increase endurance.

Phys Ther — a. Procedure Pink M Contralateral effects of upper extremity pro- prioceptive neuromuscular facilitation patterns. Phys — Stretch reflex Ther — b. Technique Richardson C, Toppenberg R, Jull G An initial evalua- — Reversal of antagonists tion of eight abdominal exercises for their ability to pro- — Repeated Stretch and Repeated Contrac- vide stabilization for the lumbar spine.

Aust Physiother tions —11 kHemiplegia 4. Neurol Rep 7 1 :3—4 On which three levels should the therapist car- Harro CC Implications of motor unit characteristics to ry out, plan, evaluate, and adapt his treatment speed of movement in hemiplegia.

J Neurol hip replacement. Which tests and re-tests are Neurosurg Psychiatry — possible for this patient on the three ICF levels? Phys Ther — lateral effects of unimanual training.

J Appl Physiol — py Association monograph. Proceedings of the II Step conference. Foun- the influence of pacing. Arch to muscle training in man. Pain, manage- mental hypothesis. Phys Ther 68 2 — ment and control in physiotherapy. Arch Neurol prioceptive neuromuscular facilitation techniques on — hip motion and electromyographic activity. Phys control. Ann Neurol — for rehabilitation outcomes research.

Clin Orthop — Potney et al. Phys Ther — Prentice WE Jr An electromyographic analysis of the effectiveness of heat or cold and stretching for inducing relaxation in injured muscle. The sagittal plane: flexion and extension 2. The coronal or frontal plane: abduction and Normal functional motion is composed of mass adduction of limbs or lateral flexion of the movement patterns of the limbs and the synergistic spine trunk muscles Kabat The motor 3.

The transverse plane: rotation cortex generates and organizes these movement patterns, and the individual cannot voluntarily leave We thus have motion that is »spiral and diagonal« a muscle out of the movement pattern to which it Knott and Voss Stretch and resistance rein- belongs. This does not mean that we cannot con- force the effectiveness of the patterns, as shown by tract muscles individually, but our discrete motions an increased activity in the muscles.

The increased 5 spring from the mass patterns Beevor ; Kabat muscular activity spreads both distally and pro- These synergistic muscle combinations ximally within a pattern and from one pattern to form the PNF patterns of facilitation. Treatment uses irradiation from those synergistic combina- tions of muscles patterns to strengthen the desired 5. Some people believe that you must know and use When we exercise in the patterns against resis- the PNF patterns to work within the concept of PNF.

The rotational component and the appropriate procedures. The patterns, while of the pattern is the key to effective resistance.

Cor- not essential, are, however, valuable tools to have. Too much resistance to rotation will pre- patterns allows problems to be treated indirectly. Two antagonistic pat- planes: terns make up a diagonal. For example, an upper. The proximal and distal joints of the limb are linked in the pattern. The middle joint is free to flex, extend or maintain its position. For example, finger flexion, radial flexion of the wrist, and forearm supination are integral parts of the pattern of shoulder flexion— adduction—external rotation.

The elbow, however, may flex, extend, or remain in one position. The trunk and limbs work together to form complete synergies. For example, the pattern of shoulder flexion—adduction—external rotation with anterior elevation of the scapula combines with trunk extension and rotation to the opposite side to complete a total motion.

If you know the synergistic muscle combinations, you can work out the pat- terns. If you know the pattern, you will know the. When an extremity is in its from Klein-Vogelbach fully lengthened position the synergistic trunk muscles are also under tension. The therapist should feel tension in both the limb and trunk muscles.

The groove of the pattern is that line drawn by 5 The trunk did not rotate or roll. For the head and neck, the groove is drawn by a plane through the nose, chin, The normal timing of an extremity pattern is: and crown of the head.

The groove for the upper 4 The distal part hand and wrist or foot and an- trunk is drawn by the tip of the shoulder and for the kle moves through its full range first and lower trunk by the hip bone. Because the trunk and holds its position.

Pictures of the complete patterns with 4 Rotation is an integral part of the motion and the therapist in the proper position come in the fol- is resisted from the beginning to the end of the lowing chapters. To move concentrically through the entire range We can vary the pattern in several ways: of a pattern: 4 By changing the activity of the middle joint in 4 The limb is positioned in the »lengthened the extremity pattern for function range.

The 5 There is no pain, and no joint stress. The next 5 The trunk does not rotate or roll. In this combination, the hamstring adduction.

Next time, the same 5 Symmetrical reciprocal: the limbs move in pattern is used with the knee staying straight.