PNF Mat work Principles used as used in functional clinical ...

PNF Mat work Principles used as used in functional clinical ...

PNF MAT USED IN FUNCTIONAL REHABILITATION ..... FILLING IN THE BLANKS Robyn Smith Department of Physiotherapy UFS 2011 PRINCIPLES OF MAT WORK: Synonymous with term functional strengthening Key PNF principles are still to be applied namely stretch, resistance and the use of diagonals PNF special techniques may also be used to address specific aims e.g. Strengthening, endurance etc. During PNF mat work the patient is involved in functional activities or positions

Mat work activities incorporate both the elements of mobility & stability PRINCIPLES OF MAT WORK: Normal developmental sequencing forms the basis for PNF mat work activities certain components are required for certain levels of motor tasks e.g. In supine, sitting, standing. A functional task needs to be broken down into components which can be practiced and strengthened before entire activity can be done Proximal control and stability before distal mobility Central control involves the spine/trunk (including the cervical thoracic and lumbar spine), the shoulder girdle and the pelvis Functional goals and the patients functional level will determine your choice of activities

WHERE DO I START? Where does one start? Subjective interview with patient regarding his functional abilities & difficulties Objective examination of how patient does functional activity Where do I start with therapy? Identify functional problems and underlying causes and components that are problematic Set a functional goal for patient/therapy sessions start in a position initially that patient can get into independently or with help Work for stability and balance in position (rhythmical stabilization NB here)

Work then for functional motion into and out of the position into another TAKE PATIENTS CURRENT STRENGTH INTO ACCOUNT Make use of your grading of muscle strength to decide on the techniques one could potentially use to address the muscles weakness Grade 3-5 Grade 02 Tapping ice brushing Strengthening weights

/theraband Facilitation Suspension & reeducation board Functional strengthening TAKE PATIENTS CURRENT STRENGTH INTO ACCOUNT PNF can be used across the strength spectrum through making use of special techniques and addressing the specific requirements patient and any precautionary measures Grade 0-2 Grade 3-5

Rhythmic initiation & stabilization Dynamic reversal endurance Active patterns in diagonals Repeated stretch strengthening Combination isotones eccentric control WHAT ARE FUNCTIONAL POSITIONS AND HOW DO I DECIDE WHICH ARE APPROPRIATE?

Use of functional activities are often age dependant e.g. C=child crawling and using prone are appropriate but often with an 80 year old they do not make use of these positions in ADL. Positions used for PNF therapy may therefore include : Supine Side lying Sideling or reverse on elbows Crook lying Puppy Four-point kneeling Kneeling or high kneeling

Sitting on mat or high sitting on chair Standing WHAT ARE FUNCTIONAL TASKS THEN ? Rolling over in bed to reach for a glass on bedside table Being able to sit up over side of bed Being able to move forward to point chair and stand up Being able to stand up and sit out in chair Being able to walk from bed to a chair in the room Being able to do pressure relief Being able to climb a stair Being able to walk safely and independent with crutches COMPONENTS ANALYSIS AND IDENTIFICATION OF

SUITABLE PNF PATTERNS AND SPECIAL TECHNIQUES Standing up from chair requires: Adequate UL strength to push up on chair (mm. Latissimus- extension adduction ER using chairs armrests ) Sufficient trunk strength, anterior weight transfer and balance in sitting (chop/lifting in sitting position) Being able to bum shuffle forward to point chair (anterior pelvis elevation resistance can be given pelvis/shoulder) Weight transfer and initiate standing walking stance(rhythmic initiation, anterior depression shoulder or anterior elevation pelvis) Sit down slowly (combination isotones eccentric control) Standing (rhythmic stabilization) balance and stability in

standing REFERENCES Smith, R. 2011. PNF dictate, learning material UFS. (unpublished) Old PNF notes (UFS) Adler, S.S, Beckers, B. & beck, M. 1993. PNF in Practice. An illustrated guide pp169-231

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