In Aduli Neuioielabiliiaiion

Ellam Aiiaii, SPT

}osepl }emeia, SPT
Biyce Siavness, SPT
Angela Coiclado, SPT
Miclael Sieilen, SPT
}ennifei Feiguson, SPT
Learnlng Cb[ecLlves
Ai ile compleiion of ilis pieseniaiion ile siudeni will be
able io:
i. Define piopiiocepiive neuiomusculai faciliiaiion (PNF).
:. Discuss ile iieaimeni plilosoply ilai seives as ile
fiamewoil foi using PNF inieiveniion ieclniques.
. Lisi ile ileoieiical explanaiions foi ile effeciiveness of
PNF ieclniques on incieasing muscle lengil.
. Discuss ile cuiieni use of PNF in aduli
neuioielabiliiaiion.
Learnlng Cb[ecLlves (conL)
. Discuss ile efficacy of PNF as a neuioielabiliiaiion
inieiveniion ieclnique based upon ile mosi cuiieni
liieiaiuie.
. Discuss ile implicaiions of PNF ieseaicl on PT
Piaciice.
lsLory of nl?

Dcvc!opcd by: Di. Heiman Kabai and Maggie Knoii in ile

laie ios and eaily ios as a means of ielabiliiaiion foi
neuiological disoideis sucl as muliiple scleiosis, ceiebial
palsy and poliomyeliiis.
nl ueflnlLlon
O DcIinition: A moioi leaining appioacl used in
neuiomoioi developmeni iiaining io impiove moioi
funciion and faciliiaie maximal musculai coniiaciion.
O SbSt (II): Tle basis of ile PNF plilosoply is ile
idea ilai all luman beings, including ilose wiil
disabiliiies lave uniapped exisiing poieniial."
PNF in piaciice :oo
nl hllosophy
i. Posiiive appioacl: no pain, aclievable iasls, sei up
foi success, diieci and indiieci iieaimeni, siiong
siaii.
:. Higlesi funciional level: funciional appioacl, ICF,
include iieaimeni on body siiuciuie level and aciiviiy
level.
. Mobilize poieniial by iniensive iiaining: aciive
paiiicipaiion, moioi leaining, self iiaining.
PNF in piaciice :oo
hllosophy conL
. Considei ile ioial luman being: wlole peison wiil
lis]lei enviionmenial, peisonal, plysical, and
emoiional faciois.
. Use of moioi coniiol and moioi leaining piinciples:
iepeiiiion in a diffeieni coniexi, iespeci siages of
moioi coniiol, vaiiabiliiy of piaciice.
PNF in piaciice :oo
ow ls nl used Loday?
O PNF iieaimeni las been used io inciease siiengil,
flexibiliiy, cooidinaiion, and funciional mobiliiy.
O Tle main goal of iieaimeni is io faciliiaie ile paiieni
in aclieving a movemeni oi posiuie.
O Siieicles as well as diagonals and ioiaiional exeicise
paiieins aie used io impiove ADLs, funciional
mobiliiy, and ailleiic peifoimance.
PNF in piaciice :oo
nl 1oday conL
Ii is mainly used in Oiilopedic Relab foi
Musculosleleial Injuiies 8 in Neuiological
Relab foi Siiole 8 TBI.
PNF can be used foi any condiiion, lowevei
ile pi. condiiion level may iequiie
modificaiions.
PNF in practice 2007
nl SLreLchlng
O cvvington (Ioo): Developed
concepis of neuiomusculai
faciliiaiion and inlibiiion.
O SbSt: Clinical PNF siieicling
ieclniques.
O ypcs: Coniiaci ielax, lold ielax,
agonisi coniiaci, and lold ielax
wiil agonisi coniiaci.
O voposcd MccSnisms:
auiogenic inlibiiion, iecipiocal
inlibiiion, passive piopeiiies of
ile musculosleleial unii, and
siieicl peicepiion.
nl for SLrengLh
O PNF uiilizes iwo iypes of coniiaciions: Isoionic and
Isomeiiic.
O Uses manual coniacis io pioduce moioi iesponses ilai
influence ile siimulaiion of slin and oilei iecepiois.
O Wlen applying ilese exeicises, ii is impoiiani io apply ile
appiopiiaie iesisiance.
O Tlis iesisiance is meani io faciliiaie ile muscles io
coniiaci, impiove moioi coniiol, and impiove siiengil.
PNF in piaciice :oo
esearch evlews
ulcksLeln eL al (1986)
O Compaied efficacy of aduli siiole ielab ieclniques.
(n = ii)
Conveniional Tieaimeni Exeicises ()
PNF Teclniques ()
Bobail NDT Teclniques ()
Conclusion: "No subsianiial advaniage could be aiiiibuied
io any one of ile iliee ileiapeuiic appioacles."
1rueblood eL al (1989)
O Tesiing efficacy of iesisied pelvic moiions using PNF
foi impioving lemiplegic gaii = : monils s]p siiole.
(n = :o)
Pieiesi: gaii paiameieis assessed
i minuie PNF pelvic paiiein woil
Posiiesi i: gaii assessed immediaiely
Posiiesi :: gaii assessed o minuies laiei
Resulis]Conclusion: o% impioved on gaii vaiiables
(noi clinically sig.) ai fiisi posiiesi. NO subjecis
demonsiiaied caiiyovei o mins afiei iieaimeni!
Jang (1994)
O Tesiing efficacy of iesisied pelvic moiions using PNF
foi impioving lemiplegic gaii. (n = :o)
Gioup i: CVA s]p = . monils
Gioup :: CVA s]p = i. monils
Tieaimeni: o mins, iimes ] weel foi weels
Resulis]Conclusion: Afiei fiisi iieaimeni, Gioup i saw
immediaie impiovemenis in gaii speed and cadence.
Afiei i: sessions, boil gioups lad similai iieaimeni
effecis, iesuliing in incieased gaii speed and cadence.
1rueblood eL al (1989) Jang (1994) boLh used Lhe
same nl Lechnlques for pelvlc moLlon Lo lmprove galL
Jhy Lhe mlxed resulLs?
vucb!ood ct S!. (I)
WSng RY (I)
O Tieaimeni Time: i minuies
O Dosage:
seis of ieps wiil one
minuie iesi inieivals.
O Paiienis weie iieaied and
iesied foi ONE session.
O Tieaimeni Time: o minuies
O Dosage:
io mins iyilmic iniiiaiion,
io mins slow ieveisal,
io mins agonisiic ieveisals.
O Paiienis weie iieaied and
iesied foi TWELVE sessions.
rafL eL al (1992)
O Compaied iieaimenis io impiove funciion of ile aim and
land in clionic lemiplegia. (n = ::)
EMG-iniiiaied E-siim of wiisi exiensois ()
Low iniensiiy E-siim wiil voluniaiy coniiaciion ()
Piopiiocepiive Neuiomusculai Faciliiaiion Exeicises ()
No Tieaimeni ()
Resulis]Conclusion: Fugl-Meyei scoies impioved : % foi
EMG-siim, :% foi B]B, i% foi PNF, and negligible foi no
iieaimeni.
roblems wlLh rafL eL al (1992)
O Small sample size foi eacl gioup.
O Unspecified meilods and dosage.
O EMG-siim gioup lad liglei Fugl-Meyei scoies ai
admission io siudy.
O Many paiienis won'i ioleiaie a max coniiaciion
induced by E-siim.
O In :ooi, ile Heaii and Siiole Foundaiion of Oniaiio
found ilai wlen ile daia was iecalculaied afiei
combining ile PNF gioup wiil ile coniiol gioup, ile
EMG-siim gioup did not lave significanily diffeieni
impiovemenis in Fugl-Meyei scoies!
,anagemenL of Lhe osL SLroke
Arm and and 2001 SlC
recommendaLlons
Oliip:]]piofed.leaiiandsiiole.ca]ClieniImage
s]i]PosiSiioleAimAndHandFinal:oo:%Bi
%D.pdf
lldlrlm SA Lrden Z lllnc , (2007)
O Compaied iieaimenis foi impioving UE musculai
siiengil in paiienis wiil neuiomusculai diseases.
(n = )
PNF Teclniques
Weigli Tiaining
Conclusion: Afiei weels, ioial UE siiengil impioved in
boil gioups wiil no sig. diffeience beiween gioups.
UPPER EXTREMITY FUNCTIONAL LEVEL DID NOT
CHANGE FOR PATIENTS IN EITHER GROUP !!
CLher esearch
O Seveial siudies weie omiiied due io weal evidence:
- pooi ieseaicl designs (lacl of iepioducibiliiy)
- small sample sizes (case iepoiis)
- pooi geneializabiliiy (e.g. lealily, ailleiic subjecis)
-unsubsianiiaied conclusions (lacl of causaliiy)
oncepLual lramework
lor 1 racLlce?
O Naiaiajan ei al. (:oo) suiveyed ioo+ siiole ielab
clinicians wiil i: yis expeiience (SD of .:yis) in
Kansas 8 Missouii.
O :% iepoiied ilai iley believed ilai
ieeducaiing "noimal" movemeni
paiieins AND faciliiaiing adapiaiion
io funciion aie boil impoiiani
iieaimeni aims!
PNF and AdulL
Neurorehabilitation
"Nearly all respondents
that use Brunnstrom/PNF
or Bobath/NDT reported
practicing these
techniques, despite the
lack of evidence to
support the approaches.
Accoiding io Naiaiajan ei al. (:oo).
"Cuiieni liieiaiuie does NOT favoi
eiilei Bobail]NDT oi
Biunnsiiom]PNF meilods ovei
oilei iieaimeni opiions
|in siiole ielabiliiaiionj."
O Accoiding io Naiaiajan ei al. (:oo)
$o why are clinicians choosing PNF
for neurorehabilitation treatment?
Though clinicians recognize there is limited evidence, PNF provides:
Time efficient treatment
Treatment of multiple joints/muscles
Movement through functional patterns
$afe motion
mpllcaLlons of nl on 1
racLlce
O Noi enougl evidence io use PNF as sole
iieaimeni in neuioielabiliiaiion paiienis.
O PNF siieicling is suppoiied
by evidence wlen used io
iieai "lealily populaiions."
OTle mosi effeciive PNF ieclnique combines
conceniiic coniiaciion of agonisi, and siaiic
coniiaciion of ile aniagonisi muscle (iaigei muscle)
ORecommendaiions foi Augmenied ROM:
- second coniiaciion lolds (:o% max)
- o-o second ioial duiaiion
- i iepeiiiion (minimum)
- :x]wl
ONoie: Tlese iecommendaiions aie based on
ieseaicl using lealily populaiions.
OSlaiman ei al. (:oo)
PNF $tretching
$hould you Employ PNF?
n reference to your patients impairments and
functional limitations..
1. Does PNF fit in your conceptual framework for
clinical practice?
2. Could PNF address your patient's problems?
3. s PNF considered EBP for your pt. population?**
-Yes to all 3 = Yes to PNF
**PNF use in neurorehab lacks evidence but can be
used in conjunction with other EB interventions!!
eferences
O Adlei, S.S., Becleis, D., 8 Bucl, M. (:oo) PNF in Proctice. An lllustroteJ GuiJe (
rJ
eJ.).
Geimany: Spingei.
O Colby, L.A., Kisnei, C. (:oo) eropeutic Exercise. FounJotions onJ ecniques (
t
eJ.).
Plilidelplia: F.A. Davis Company.
O Diclsiein R, Hocleiman S, Pillai T, 8 Slalam R. Siiole Relabiliiaiion: Tliee Exeicise
Appioacles. Psicol erop. Augusi i, (): i:-i:.
O Kiafi GH, Fiiis SS, 8 Hammond MC. Teclniques io Impiove Funciion of ile Aim and
Hand in Clionic Hemiplegia. Arcives of Psicol MeJicine onJ Reobilitotion.
i:, (): ::o-::.
O Naiaiajan P, Oelscllagei A, Agal A, ei al. Cuiieni clinical piaciices in siiole
ielabiliiaiion: Regional piloi suivey. ournol of Reobilitotion Reseorc c
Development. :oo, ():i-o.
eferences (conL)
O Slaiman M}, Ciesswell AG, 8 Riel S. Piopiiocepiive Neuiomusculai Faciliiaiion
Siieicling: Meclanisms and Clinical Implicaiions. ports MeJicine. :oo,
(ii): :-.
O Tiueblood PR, Wallei }M, Peiiy }, 8 Gionley }K. Pelvic Exeicise and Gaii in
Hemiplegia. Psicol erop. }anuaiy i, (i): i-:.
O Wang RY. Effeci of Piopiiocepiive Neuiomusculai Faciliiaiion on ile Gaii of Paiienis
wiil Hemiplegia of Long and Sloii Duiaiion. Psicol erop. Decembei
i, (i:): iio-iii.
O Yamasliio, K.M. Proprioception Neuromusculor Focilitotion level .
O Yildiiim SA, Eiden Z, 8 Kilinc M. Compaiison of ile Effecis of Piopiiocepiive
Neuiomusculai Faciliiaiion Teclniques and Weigli Tiaining in Paiienis wiil
Neuiomusculai Diseases. |Absiiaci.j Fizoteropi Reobilitoson. Augusi :oo,
i (:): -i.
evlew Learnlng Cb[ecLlves
i. Define piopiiocepiive neuiomusculai faciliiaiion (PNF).
:. Discuss ile iieaimeni plilosoply ilai seives as ile fiamewoil foi
using PNF inieiveniion ieclniques.
. Lisi ile ileoieiical explanaiions foi ile effeciiveness of PNF ieclniques
on incieasing muscle lengil.
. Discuss ile cuiieni use of PNF in aduli neuioielabiliiaiion.
. Discuss ile efficacy of PNF as a neuioielabiliiaiion inieiveniion
ieclnique based upon ile mosi cuiieni liieiaiuie.
. Discuss ile implicaiions of PNF ieseaicl on PT Piaciice.