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PROPRIOCEPTIVE NEUROMUSCULAR PROPRIOCEPTIVE NEUROMUSCULAR FACILITATION (PNF)FACILITATION (PNF)

Harpreet Singh, AIIMSHarpreet Singh, AIIMS

MPT (Neurosciences),MPT (Neurosciences),

Trained-IPNFA, California, USATrained-IPNFA, California, USA

Move

ment

is o

ur

way

to in

tera

ct w

ith

our

envi

ronm

ent

Philosophy…Philosophy…

Life is a series of response to series of Life is a series of response to series of demandsdemands

Efficient mechanism - varietyEfficient mechanism - variety

LimitedLimited

DeficiencyDeficiency unable to respond unable to respond

PNFPNF

Active participation in life develops abilitiesActive participation in life develops abilities Hidden potentials existHidden potentials exist

Repetition is important for learningRepetition is important for learning

Philosophy…Philosophy…

Purposeful movements are directed to a goalPurposeful movements are directed to a goal Tangential activity may be interesting but…Tangential activity may be interesting but…

Effort is directed & channeled – “Goals” Effort is directed & channeled – “Goals” (in treatment, (in treatment, purposeful movements; specific combination of motions)purposeful movements; specific combination of motions)

Hinder optimum functionHinder optimum function

Survival of the fittest OR……………Survival of the fittest OR…………… Strong help the weakStrong help the weak

Main

ideas

Main

ideas

Humans respond in

Humans respond in

accordance with the

accordance with the

demandsdemands Existing

potentials

Existing potentials

may be developed

may be developed

more fullymore fullyMovements must be

Movements must be

specific & directed

specific & directed

towards a goal

towards a goalActivity is necessary

Activity is necessary

for best development

for best development

of strengthof strengthCooperation

Cooperation

S.A.I.D.

PRINCIPLE

Specific adaptations to imposed demands

Body adapts to stress and strain placed on it

Success of the athlete depends on the ability to meet demands

Constructive stress + opportunities for input & integration

Normal Normal vs vs AbnormalAbnormal

Capable of wide range of activitiesCapable of wide range of activities Developmental patterns & learning situationsDevelopmental patterns & learning situations

Endowed with reserves of power (stress Endowed with reserves of power (stress situations)situations)

Development of potentialsDevelopment of potentials Environmental influence & volitionEnvironmental influence & volition

Integrated & efficient without awarenessIntegrated & efficient without awareness

Variations occur but do not prevent FunctionVariations occur but do not prevent Function

Proportional inadequacy – to demands as a Proportional inadequacy – to demands as a result of development; disease; traumaresult of development; disease; trauma

Philosophical principles…Philosophical principles…

Focus on mobilizing the patient’s reserves

An “Integrated” ApproachAn “Integrated” Approach

Approach is always “Positive”Approach is always “Positive”

Helps achieve “highest level” Helps achieve “highest level”

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DefinitionDefinition

A method of placing specific “DEMAND” in A method of placing specific “DEMAND” in order to secure a desired “RESPONSE” order to secure a desired “RESPONSE”

OROR

May be defined as “methods of promoting May be defined as “methods of promoting or hastening the response of the or hastening the response of the neuromuscular mechanism through neuromuscular mechanism through stimulation of the proprioceptors”stimulation of the proprioceptors”

Definition…..Definition…..

Proprioception Receiving stimulus from tissues within bodyReceiving stimulus from tissues within body Information regarding posture & movementInformation regarding posture & movement

NeuromuscularNeuromuscular Motor innervation/muscle strengthMotor innervation/muscle strength

Facilitation Promotion of a natural processPromotion of a natural process In the Nerve TissueIn the Nerve Tissue

Rela

ted a

spect

s of

Rela

ted a

spect

s of

moto

r behavi

or

moto

r behavi

or Development of motor

Development of motor

behavior is expressed as

behavior is expressed as

pattern movement

pattern movementOrdered sequence of motor

Ordered sequence of motor

acts emerges in normal

acts emerges in normal

process of growth

process of growth

Use of Use of developmental developmental

sequencesequence

Fundamental motor activities are interrelated Fundamental motor activities are interrelated and universaland universal

Every human being has experienced and learnt Every human being has experienced and learnt behavior in same waybehavior in same way

Primitive to mature but retain aspectsPrimitive to mature but retain aspects

The ingredients of normal movements provides The ingredients of normal movements provides a basis for development/ restoration of motor a basis for development/ restoration of motor functionfunction

Function & development

Function is a spectrum of ADLs

Different for different tasks, people

Fundamental elements observed during developmental progression Foundation of function

Foundation of basic motor control

Sequence gives insight into original acquisition of skill

Deve

lopm

enta

l

Deve

lopm

enta

l Ski

lls:

Ski

lls:

Sta

ges

Of

Moto

r

Sta

ges

Of

Moto

r C

ontr

ol

Contr

ol

Mobility Mobility Initial mobility

Initial mobility Stability (static postural control)

Stability (static postural control)

Tonic holding

Tonic holding Co-contraction

Co-contractionControlled mobility (dynamic

Controlled mobility (dynamic

postural control)

postural control) Static- dynamic control

Static- dynamic control

Skill Skill

Prin

ciple

s of

Prin

ciple

s of

deve

lopm

enta

l act

ivit

ies

deve

lopm

enta

l act

ivit

ies

Useful for patients of all

Useful for patients of all

agesages Activates postural

&

Activates postural

&

righting reflexes

righting reflexes Appropriate “sensory cues”

Appropriate “sensory cues”

Repetition & resistance

Repetition & resistance

Use of developmental rules

Use of developmental rules

Component patterns of total

Component patterns of total

patterns are converted into

patterns are converted into

spiral & diagonal patterns

spiral & diagonal patterns

of facilitation for selectivity

of facilitation for selectivity

Recapitulate developmental

Recapitulate developmental

sequence – one activity

sequence – one activity

foundation for

next

foundation for

next

advancedadvanced Primitive before complex -

Primitive before complex -

abilityability

Basic ConceptsBasic ConceptsAspects of motor behaviorAspects of motor behavior

Total to individuatedTotal to individuated

Proximal distal to distal proximalProximal distal to distal proximal

Reflexive to deliberateReflexive to deliberate

Motile to stableMotile to stable

Overlapping to integrativeOverlapping to integrative

Gross to selectiveGross to selective

Incoordinate to coordinateIncoordinate to coordinate

Timed & sequential action of musclesTimed & sequential action of muscles

Movements occur in diagonal patternsMovements occur in diagonal patterns with with rotational components, not in single planerotational components, not in single plane Resemble ADL’s and sport specific activitiesResemble ADL’s and sport specific activities

Neuro

phys

iolo

gy

Neuro

phys

iolo

gy

…… AfterdischargeAfterdischarge

Temporal Temporal summationsummation

Spatial Spatial summationsummation

IrradiationIrradiation

Successive inductionSuccessive induction

Reciprocal innervationReciprocal innervation

NEU

RO

MU

SCU

LAR S

YSTE

M

Coordinated muscular activity Dynamic joint stability

Postural control

Optimal movement patterns

Sensory system

CNS & PNS

Sk. Muscle

Injury – vicious circle

Ove

rflow

O

verfl

ow

Spread of facilitation

Spread of facilitation Synergists to prime

Synergists to prime movermoverAlso termed

Also termed associated associated movementsmovementsAssociated reactions –

Associated reactions –

abnormal inhibitory

abnormal inhibitory controlcontrol

Sum

mary

Sum

mary

1)Positive Approach

1)Positive Approach2) Everyone has the

2) Everyone has the

potentialpotential3) PNF is an integrated

3) PNF is an integrated

approach aimed at

approach aimed at

physical, intellectual and

physical, intellectual and

emotionalemotional4) Objectives functional

4) Objectives functional

PNF uses the most

PNF uses the most powerful parts of the body

powerful parts of the body

to facilitate and

to facilitate and strengthen the most

strengthen the most

vulnerable.vulnerable.5) Facilitating the

5) Facilitating the maximum response of the

maximum response of the

patientpatient6) Repeat6) Repeat7) Activity continues

7) Activity continues

8) Optimize a function

8) Optimize a function