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Only done in one direction.
· Can be done in either direction.
· Hand placement doesn’t change (because one direction).
· Hold it there at the end position and then say relax (slowly support back to release i.e. don’t drop the hand ).
· Initiation because new to PNF.
· For hypotonic/weak patient.
· Don’t go all the way but goes half way
· Kari typically start down and goes half way up (because if starting with top gravity will help).
· Uses Isotonic contraction (length of muscle is changed).
· Idea is to tire high tone muscle in the high tone pattern so that OT can guide the extremity in opposite direction (OT artificially creates reciprocal inhibition).
· Used for high tone muscle.
· OT artificially gives resistance so that there is not movement (isometric-no change in length).
· OT holds the arm and ask client to move it so that muscle can be tensed and work hard in isometric contraction.
· Used for high tone:
Eg1. High tone hand-OT does pronation and Supinationà Hands open up
Eg2. High tone elbow: OT does add and abd and elbow opens up.
· OT pick’s a joint, for rhythmic rotation that is adjacent to the joint OT wants to move
· Can be done with head.
· Used for trunk stability.
· OT needs to move slowly so that client can accommodate for resistance to keep their trunk stable.
therapist’s placement of hand on the trunk, pelvis, and shoulders to facilitate movements of these areas of the body. Movements include: upper and
lower trunk flexion, lateral flexion, and lateral rotation, pelvic tilts and rotation, and scapular protraction/retraction, abduction/adduction, rotations and tilts. Hands are placed on the ASIS of the pelvis, lateral aspects of the upper and lower trunk, and scapula/clavicle to facilitate proximal segment movements
achieve the same movements as above for the pelvis, trunk and scapula via therapist’s placement of hands on the upper extremities, including the upper arm,
elbow, forearm, wrist/hand.
Ø Can be used to achieve proximal mobility of the trunk.
Ø OT needs to give patient nudge forward/backward e.g. if on the ball. So that they can adjust in desired posture.
therapist hand contacts placed on the trunk to facilitate separation of the trunk segments in flex, lateral flex, and rotation. Example: hands placed on left upper and right lower trunk to facilitate lateral weight shifting where upper trunk will curve toward one direction and the lower trunk toward the opposite direction.
e.g. ball under abdomen and move forward with hand to separate head, trunk and pelvis. They can do lateral flexion in prone and supine.
used during functional or clinic based activity (functional is preferred). The client’s proximal body segments are relatively stable while the distal segments are allowed to move to engage in an activity. Examples: piano playing, retrieving items from shelves, wiping counters. Physioball can be used for this.
e.g. 1. Child coloring and keeps trunk stable on the ball while coloring.
e.g. 2. Adult in 4-pt having pick up something with hands and putting into bucket while maintaining stability.
used during functional activities and/or clinic based treatment. Use of physioball to achieve good proximal mobility while distal segments are used to keep the body relatively stable. Examples: seated on ball, use feet on floor and hands on table or railing to keep steady, with emphasis on pelvic and trunk movements.
e.g. Bridging exercise- In bed push butt up down, or turn bottom while keeping feet and elbow stable.
e.g. Pt holding onto table while moving pelvis around on the ball while maintaining stability w/hands and feet.
refers to the UE or LE placed in a specific position in order to inhibit an abnormal synergies present. To discourage the typical flexor synergy in the
UE, position client sitting on mat, encourage affected UE to assume extended position with
palm flat on mat next to client. Weight bearing through UE increases this effect. Can also do
this in standing, with UE extended weight bearing on table/counter. For the LE, discourage LE
extensor synergy by encouraging a more flexed position of the hip and knees. Client placed in
an upright seated position achieves this (no rotation of the hips).Can be used for hypertonicity, flexor synergy UE.
E.g. Incisor synergy: Pt sitting on ball with feet on ground (LE) while rolling ball pt weight bear through affected + unaffected feet.
Proprioceptive: refers to stimuli aroused in an organism through the movement of its tissues
Neuromuscular: pertaining to nerves and muscles
Facilitation: hastening of any natural process
Movement occurs in spiral-diagonal patterns; natural patterns of movement would stimulate the NS more normally than would therapy isolating individual muscles; methods of promoting and hastening the response of the neuromuscular mechanism through stimulation of the proprioceptor; methods used to place specific demands on specific muscles in order to elicit a desired reaction
energy is channeled from stronger to weaker muscle groups or patterns
Successive induction: an increased response of the agonist results after contraction of its antagonist
facilitation of the agonist results in simultaneous inhibition of the antagonist
Based on mass movement patterns that are spiral and diagonal in nature, which resembles movement seen in everyday functional activities
facilitation techniques are superimposed on normal movement patterns and postures through the therapist’s manual contact, verbal commands and visual cues
Manual Contacts-Tactile System
-Developmentally the tactile system matures before the auditory and visual system; the tactile system is also more efficient, using both temporal and spatial discrimination, the other systems only use one
-Contact over a muscle group facilitates that muscle group to contact, guide, and reinforce the response
-Observing how therapist hand placement changes as the movement pattern changes affects success
-Best point of manual contact varies slightly with people
-It is important for the client to feel the movement patterns
-Direction, quality, and quantity of resistance is adjusted to prompt a smooth and coordinated response, whether for stability or mobility
-When applying resistance, consider the tx goal:
Endurance, quality of movement, presence of spasticity
-Cues should be clear, concise, and appropriate to the patient’s needs and comprehension
-Use quiet voice for relaxation, reassurance (high tone)
-Use loud voice for greater recruitment of muscle fibers or greater ROM (low tone)
-Timing is critical for appropriate response
-Cues should be short-avoid wordiness
Pull up and across
Push down and out
-Cue client to watch UE as it moves through pattern
-Visual stimuli assist in initiation and coordination of movement
-Visual input should be monitored to ensure that the client is tracking in the direction of the movement
-Positioning of the therapist in relation to the client is important, as it influences how the client will move (client needs to each forward with the LUE, position yourself on the left side)
causes muscle contraction; may be repeated throughout the pattern; does not work on completely flaccid muscle
(shoulder extension-abduction-IR): scapula depression; adduction, and rotation; shoulder extension, abduction, and IR; elbow in flexion or extension; forearm pronation; wrist extension to the ulnar side; finger extension and abduction; and thumb in palmar abduction
The total approach to NDT provides continuous application of NDT principles to all pt interactions and care
Room arrangement-hemiplegic side of pt should face the door, so client is forced to turn head to see who is entering/leaving room
Approach-all people must approach pt from the hemiplegic side to encourage eye contact and awareness of the affected side; if pt has trouble turning head toward affected side, use physical cues to turn head
Naming-during bathing tasks and other self-care axs, enourage client to name various body parts to increase awareness of affected side
Encouraging independence-pt should be involved in self-cares from the very beginning; guide affected extremities through movement, allow client to feel UE/LE move through the task
Bed positioning-proper positioning normalizes tone, weight bearing increases awareness of hemiplegic side, and decreases fear of shifting weight through affected side
Supine bed positioning-flaccid arm should be positioned in bed to maintain muscle length; elbow extension; shoulder girdle abduction; external rotation
NDT evaluation – how to assess posture, symmetry, weight bearing.
Formal assessment looks at:
-Observation of-posture, shortening, elongation, midline shift, weight bearing, and head position
What attempts are made at movement and mobility/stability?
-Tone feel-posture/tone of head, neck, trunk, limb (placing high and low)
What is symmetry and muscle balance of these?
-Postural reflex mechanism/equilibrium reactions of trunk-check postural control (pelvic movement-tilts, lateral shifts, separating trunk from pelvis), weight bearing abilities, righting reactions, protective responses; check movement over BOS
Inhibition-decreasing abnormally high tone
Facilitation-increasing abnormally low tone
Trunk separation-dissociation of the upper and lower trunk through rotation
Key points of control-points of contact or hand placement that the therapist uses to effectively regulate tone
Proximal points of control are the shoulder, trunk, and pelvis
Distal points of control are the extremities
Bed positioning via NDT strategy.
Flaccid arm should be positioned in bed to maintain muscle length
Shoulder girdle abduction
Scapular retraction=anterior pelvic tilt, trunk extension
Scapular protraction=posterior pelvic tilt, trunk flexion
Shoulder external rotation=anterior pelvic tilt, trunk extension
Shoulder internal rotation=posterior pelvic tilt, trunk flexion
Forearm supination=anterior pelvic tilt, trunk extension
Forearm pronation=posterior pelvic tilt, trunk flexion
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