Proprioceptive Neuromuscular Facilitation

1. Treatment for movement impairment
   1. Due to neurological conditions
   2. Due to injury or surgery

1. Manual Contacts
   1. On the skin overlying target mm groups
      1. Using a lumbrical grip
2. Body Position & Mechanics
   1. Dynamic Clinician Movement
   2. Mirrors Patient Mvmnt
   3. Resistance created through clinician's body weight
3. Stretch
   1. Utilizes the stretch reflex
   2. Quick Stretch

      Annotations:

      • A quick stretch from a lengthened position into a slightly more lengthened position facilitates a muscle and its agonists.
   3. Prolonged Stretch

      Annotations:

      • A prolonged stretch inhibits muscle activity of the stretched muscle and its agonists.
4. Manual Resistance
   1. An internal or external force

      Annotations:

      • Internal resistance is generated by increased tone, tissues stiffness, and length.  External resistance is a function of gravity, or manual or mechanical resistance.
   2. Resistance may facilitate movement

      Annotations:

      • Primarily by decreasing internal resistance through approximation or tactile input.
   3. Resistance may strengthen or train MM
5. Irradiation
   1. Overflow, associated reactions, reinforcement
   2. Response increases as resistance increases
   3. Tends to occur in predictable patterns
6. Joint Facilitation
   1. Traction facilitates mobility

      Annotations:

      • Traction also decreases pain.
   2. Approximation facilitates stability

      Annotations:

      • Through facilitation of proprioceptors and preparation for weight bearing. Weight bearing does not have to happen in only closed chain activities.
7. Timing of Movement
   1. Timing is distal to proximal

      Annotations:

      • But, of course, development occurs in a proximal to distal direction.
   2. Postural control is a precursor
   3. Functional Movement requires strength, range, and sequencing control
8. Patterns of Movement
   1. Diagonal Patterns
   2. Groups of MM work synergistically
   3. Function does not occur in cardinal planes
9. Visual Cues
   1. Facilitate postural alignment & MM contraction
10. Verbal Input
    1. Three phases
       1. Preparatory Phase
       2. Action Phase
       3. Correction Phase

1. BOS
2. COG
3. Number of Weight-Bearing Joints
4. Length of Lever Arm

1. UE D1 Flexion
   1. Crossing a scarf across the shoulder
2. UE D1 Extension
   1. Clicking a seat belt
3. LE D1 Flexion
   1. Crossed soccer kick
4. LE D1 Extension
   1. Supahstah!

1. UE D2 Flexion
   1. Tossing a bouquet
2. UE D2 Extension
   1. Sheathing a sword
3. LE D2 Flexion
   1. Peeing on a hydrant
4. LE D2 Extension
   1. Ballerina

Annotations:

• If the patient's body is facing the 3 o'clock mark

1. 1 o'clock Anterior Elevation
2. 5 o'clock Anterior Depression
3. 7 o'clock Posterior Depression
4. 11 o'clock Posterior Elevation

1. Free Hand = Lead Hand
   1. If the lead hand follows D2 Flexion = Lift
      1. Return is a Reverse Lift
   2. If the lead hand follows D1 Extension = Chop
      1. Return is a Reverse Chop

1. Mobility (Stage I)
   1. Rhythmic Initiation
   2. Rhythmic Rotation
   3. Hold Relax Active Movement
   4. Contract Relax
   5. Hold Relax
2. Stability (Stage II)
   1. Alternating Isometrics
   2. Rhythmic Stabilization
   3. Slow Reversal Hold
3. Controlled Mobility (Stage III)
   1. Agonistic Reversal
   2. Slow Reversal Hold
   3. Slow Reversals
4. Skill (Stage IV)
   1. Agonistic Reversal
   2. Slow Reversal Hold
   3. Slow Reversals