T&p Exam Ii

Front 1

PNF has 6 objectives:

Back 1

to increase strength
to increase flexibility
to increase ROM (applied passively, assisted, actively, or with resistance)
to increase coordination
to increase balance
to decrease pain
*used in therapeutic exercise

Front 2

GOALS:

Back 2

restore of enhance the postural response and or normal pattern of motion in a functional manner
direct - focusing on target muscle
indirect - more related to the synergists or antagonist muscle group

Front 3

PNF is based on 3 principles:

Back 3

- successive induction - contraction of one muscle followed by its antagonist. e.g. contract stronger extensors to warm up before using weaker flexor group.
- reciprocal inhibition - contraction of one muscle while its antagonist is relaxed, allowing a joint to move. e.g. actively contract biceps to inhibit triceps.
- process of irradiation - is when maximal contraction of a muscle recruits the help of additional muscles. e.g. for a stroke pt return happens proximal to distal, so facilitate movement at shoulder to get some overflow into the hand.

Front 4

Basic Levels of Progression:

Back 4

1. Mobility – in a gravity-reduced position we learn the movements
2. Stability – learn how to statically hold a position against gravity
3. Controlled mobility – hold a position and moving against gravity
4. Skill – refined movement

Front 5

Agonists & Antagonists

Back 5

Agonists - directions that is being performed by that muscle
Antagonists - direction that is being performed in relation to the opposing muscle

Front 6

Main Components of PNF:

Back 6

- flexion or extension
- toward or away midline
- rotation
*based on 3 dimensions - not cardinal planes

Front 7

PNF Diagonal 1 - Upper Extremity (D1)

Back 7

D1 Flexion - flexion/adduction/external rotation with wrist & finger flexion/RD (start in extension position)
D1 Extension - extension/abduction/internal rotation with wrist & finger extension/UD (start in flexion position)

Front 8

PNF Diagonal 2 - Upper Extremity (D2)

Back 8

D2 Flexion - flexion/abduction/external rotation with wrist & finger extension/RD (start in extension position)
D2 Extension - extension/adduction/internal rotation with wrist & finger flexion/UD (start in flexion position)

Front 9

D1 Analogy
D2 Analogy

Back 9

D1 F - reaching across to grab seatbelt
D 1 E - pushing something down & away from you
D2 F - “Y” of YMCA song
D2 E - buckling seatbelt when riding shotgun

Front 10

Line of Movement

Back 10

rotation is the initiating movement, then the other 2 components are initiated.

Front 11

Isotonic/Isometric/Eccentric Defintions

Back 11

Isotonic - tension remains unchanged and muscle length changes
Isometric - muscle length remains unchanged
Eccentric - muscle length elongates

Front 12

Stretch

Back 12

stimulus - muscle responds with greater contraction force when put in a stretched position due to increased surface area
response - quick stretch elicits a response when placed beyond point of tension

Front 13

Manual Resistance

Back 13

should demand sufficient resistance
allow full ROM to be completed
shouldn’t break patients movement
shouldn’t elicit Valsalva Maneuver

Front 14

Joint Facilitation

Back 14

traction - separating the joints (promotes mobility)
approximation - applying a weight bearing force on joints via compression (promotes stability)

Front 15

Agonist Contraction

Back 15

HR or CR done, then pt moves limb into new range actively. Called HR-AC or CR-AC.

Front 16

Rhythmic Initiation

Back 16

sequence passive - active-assisted - active - resisted (make sure they are doing correct movements hands off. Used for patients having difficulty initiating movement (e.g. Parkinson’s patients). Allows the patient to understand the proper movement that is expected of them.

Front 17

Hold-Relax

Back 17

directed towards “tight” antagonist, isometric. (E.g. pt holds antagonist isometric, then PT passively moves pt further in range). “hold, hold, push into me”

Front 18

Contract-Relax

Back 18

directed towards “tight” antagonist, isotonic. (E.g. pt performs isotonic contraction of antagonist against resistance from the PT, then PT passively moves them further into the range). “push, push, push”

Front 19

Testing Stability

Back 19

- Alternating Isometrics (AI) – PT gives resistance alternating F/E, add/abd, ER/IR to get pt to do isometrics of m across the jt
- Rhythmic Stabilization (RS) – next step after AI, promotes co-contraction of m around a jt. PT provides stimulus similar to AI but less predictable. pt has to be ready for anything.

Front 20

Testing Strength

Back 20

- Repeated Contractions (RC) if want to work on shoulder flexion, start in D2E, pt actively brings it into D2F (can be against resistance), relaxes, passively brought back down to D2E by PT, repeat. (apply resistance in one direction repeatedly)
- Agonist Reversal (AR) – aka slow reversal (SR), start c antagonist pattern first, then perform agonist pattern. Successive induction concept. (e.g. resist F, then resist E. Start c antagonist first to warm up the agonist/apply resistance in both directions)