Flexion Abduction External Rotation o

Muscles principal components (Kendall and McCreary 1993) Trapezius, levator scapulae, serratus anterior Flexion, abduction, external rotation Deltoid (anterior), biceps (long head), coracobrachialis, supraspinatus, infraspinatus, teres minor Extensor carpi radialis (longus and brevis) Extensor digitorum longus, interossei Extensor pollicis (longus and brevis), abductor pollicis longus Fig. 7.2. Flexion-abduction-external rotation. a Starting position b mid-position c end position d emphasizing...

Introduction and Basic Procedures

Lower extremity patterns are used to treat dysfunctions in the pelvis and leg caused by muscular weakness, incoordination, and joint restrictions. We can use these leg patterns for treatment of functional problems in walking and climbing up and down stairs, with activities such as rolling, and moving in bed. Your imagination can supply other examples. The leg patterns are also used to exercise the trunk. Resistance to strong leg muscles produces irradiation into weaker muscles elsewhere in the...

Changing the Patients Position

There are many advantages to exercising the patient's arms in a variety of positions. These include letting the patient see the arm, adding or eliminating the effect of gravity from a motion, and working with functional motions in functional positions. There are also disadvantages for each position. Choose the positions that give the desired benefits with the fewest drawbacks. 7.8.1 Arm Patterns in a Side Lying Position In this position the patient is free to move and stabilize the scapula...

Info

The patient's left arm is in flexion-adduction-external rotation. The right hand grips the left wrist with the right arm in modified flexion-abduction-external rotation. The patient looks at the left hand, putting the neck in modified extension to the right (O Fig. 10.1 a). Traction the left arm and scapula until you feel the trunk muscles elongate. Continue the traction to give stretch to the arms and the trunk. Push your arms down to me and lift your head. Now keep your arms down here and...

Introduction Why Do Mat Activities

The mat program involves the patient in activities incorporating both movement and stability. They range from single movements, such as unilateral scapula motions, to complex combinations requiring both stabilization and motion, such as crawling or knee walking. The activities are done in different positions, for function and to vary the effects of reflexes or gravity. The therapist also chooses positions that can help control abnormal or undesired movements. Mat treatment unites all the parts...

To Maggie Knott teacher and friend

Devoted to her patients, dedicated to her students, a pioneer in profession Proprioceptive neuromuscular facilitation (PNF) is a philosophy and a concept of treatment. The PNF philosophy is timeless, and the concept is a continuous process of growth. This third edition of our book, with a complete review, better user-friendly layout and integration of the latest developments, aims to support this growth. PNF has been one of the most recognized treatment concepts in physical therapy since the...

Flexion Abduction Internal Rotation o

Muscles principal components (Kendall and McCreary 1993) Flexion, abduction, internal rotation Tensor fascia lata, rectus femoris, gluteus medius (anterior), gluteus minimus Extensor hallucis, extensor digitorum Fig. 8.2a,b. Flexion-abduction-internal rotation Fig. 8.2a,b. Flexion-abduction-internal rotation The toes extend as the foot and ankle move into dorsiflexion and eversion. The eversion promotes the hip internal rotation, and these motions occur almost simultaneously. The fifth...

Extension Adduction Internal Rotation o

Adduction Internal Rotation Shoulder

Muscles principal components (Kendall and McCreary 1993) Serratus anterior (lower), pectoralis minor, rhomboids Extension, adduction, internal rotation Pectoralis major, teres major, subscapularis Brachioradialis, pronator (teres and quadratus) Flexor digitorum (superficialis and profundus), lum-bricales, interossei Flexor pollicis (longus and brevis), adductor pollicis, opponens pollicis Your left hand contacts the palmar surface of the patient's hand. Your fingers are on the radial side (2nd...

Flexion to the Left extension to the Right o

Side Lying Hip Flexion Extension

9.3.1 Flexion Left Lateral Flexion Left Rotation (o Fig. 9.1 c, d) The patient is sitting. You are standing behind the patient to the right of center. Put the finger tips of your right hand under the patient's chin. Hold the top of the patient's head with your left hand, just left of center. Your left hand and fingers point in the line of the diagonal. Give the resistance with the fingers and palm of that hand. To apply traction with your proximal hand, hook the carpal ridge of your left hand...

Extension Abduction Internal Rotation o Fig 811

Hip Abduction And Internal Rotation

Muscles principal components (Kendall and McCreary 1993) Extension, abduction, internal rotation Gluteus medius, gluteus maximus (upper), hamstrings Gastrocnemius, solcus, peroneus longus and brevis Hold the foot with the palm of your left hand along the plantar surface. Your thumb is at the base of the toes to facilitate toe flexion. Your fingers hold the medial border of the foot while the heel of your hand gives counter pressure along the lateral border. Your right hand holds the posterior...

Extension Abduction Internal Rotation o Fig 711

Resisted Shoulder Abduction Table

Muscles principal components (Kendall and McCreary 1993) Extension, Abduction, Internal Rotation Latissimus dorsi, deltoid (middle, posterior), triceps, teres major, subscapularis Brachioradialis, pronator (teres and quadratus) Extensor digitorum longus, lumbricales, interossei Abductor pollicis (brevis), Extensor pollicis Your left hand grips the dorsal surface of the patient's hand. Your fingers are on the ulnar side (5th metacarpal), your thumb gives counter-pressure on the radial side (2nd...

Mat Activities

Amputee Bed Based Exercises

In mat treatments, we can have prone, supine and more upright activities, but there is much duplication of positions and activities. When necessary teach the patient to stabilize in each new position. The following examples of mat activities and exercises are not an allinclusive list but are samples only. As you work with your patients you will find many other positions and actions to help them achieve their functional goals. Short-sitting (legs over edge of mats) Certain functional activities...

Flexion Adduction External Rotation o

Resisted Shoulder Abduction Table

Muscles principal components (Kendall and McCreary 1993) Serratus anterior (upper), trapezius Flexion, adduction, external rotation Pectoralis major (upper) deltoid (anterior), biceps, cora-cobrachialis Flexor digitorum (superficialis and profundus), lumbri-cales, interossei Flexor pollicis (longus and brevis), adductor pollicis, op-ponens pollicis Your right hand contacts the palmar surface of the patient's hand. Your fingers are on the ulnar side (5th metacarpal), your thumb gives counter...

Spiral And Diagonal

Synergistic Muscle Patterns

Baker RJ, Bell GW (1991) The effect of therapeutic modalities on blood flow in the human calf. J Orthop Sports Phys Ther 13 23-27 Miglietta O (1964) Electromyographic characteristics of clonus and influence of cold. Arch Phys Med Rehabil 45 508-512 Miglietta O (1962) Evaluation of cold in spasticity. Am J Phys Med Rehabil 41 148-151 Olson JE, Stravino VD (1972) A review of cryotherapy. Phys Ther 52 840-853 Prentice WE Jr (1982) An electromyographic analysis of the effectiveness of heat or cold...

Pelvic Diagonals

Patient with right hemiplegia. a Combination of scapula (posterior depression) with arm motion. b Combination of scapula (anterior elevation) with arm motion The pelvis is part of the trunk, so the range of motion in the pelvic patterns depends on the amount of motion in the lower spine. We treat pelvic patterns as isolated from the trunk if no great increased lumbar flexion or extension occurs. Bio-mechanically, it is impossible to move the pelvis without motion in the spine...

Extension Adduction External Rotation

Abductor Flexed Position

Muscles principal components (Kendall and McCreary 1993) Extension, adduction, external rotation Adductor magnus, gluteus maximus, hamstrings, lateral rotators Gastrocnemius, soleus, tibialis posterior Hold the plantar surface of the foot with the palm of your left hand. Your thumb is at the base of the toes to facilitate toe flexion. Be careful not to block the flexion of the toes. Your fingers hold the medial border of the foot, the heel of your hand gives counter-pressure along the lateral...

Anterior Elevation and Posterior Depression O Fig 64 ac

Resisted Protraction Scapula

The therapist stands behind the patient, facing up toward the patient's head. Anterior Elevation (O Fig. 6.4 b, 6.5) Grip. Place one hand on the anterior aspect of the glenohumeral joint and the acromion with your fingers cupped. The other hand covers and supports the first. Contact is with the fingers and not the palm of the hand. D Fig. 6.3a,b. The direction of the resistance is an arc (posterior depression of the scapula) Levator scapulae, rhomboids, serratus anterior Serratus anterior...

Flexion Adduction External Rotation d

Traction And Internal Rotation

Muscles principal components Kendall and McCreary 1993 Flexion, adduction, External rotation Psoas major, iliacus, adductor muscles, sartorius, pectineus, rectus femoris Extensor hallucis, extensor digitorum Your left hand grips the patient's foot with the fingers on the medial border and the thumb giving counter-pressure on the lateral border. Hold the sides of the foot but do not put any contact on the plantar surface. To avoid blocking toe motion, keep your grip proximal to the...

The Theory of Gait Training

Gait Training Hemiplegia Patient

We use all the basic procedures and many of the techniques when working with our patients in standing and walking. Resistance, appropriately used, increases the patient's ability to balance and move. When the strong motions are resisted in standing and walking, irradiation will facilitate contraction of weaker trunk and lower extremity muscles. These weaker muscles will contract whether or not braces or other supports are used. There are occasions, however, when the patient's medical or...

Bilateral Leg Patterns

Hip Abduction Supine

When you exercise both legs at the same time there is always more demand on the trunk muscles than when only one leg is exercising. To exercise the trunk specifically you hold both the legs together. The leg patterns for trunk exercise are discussed in 7 Chapter 10. When you hold the legs separately the emphasis of the exercise is on the legs. Bilateral leg work allows you to use irradiation from the patient's strong leg to facilitate weak motions or muscles in the involved leg. You can use any...

Patient Cases in Gait Training

Amputee Knee Women

Patient I Patient with right hemiplegia Fig. 12.29. Patient with hemiplegia. a Getting to standing b transfer from wheelchair to table Fig. 12.29. Patient with hemiplegia. a Getting to standing b transfer from wheelchair to table Fig. 12.29. Patient with hemiplegia. c, d facilitation of the stance phase on the hemiplegic leg e, f stance on the involved leg with emphasis on hip extension and knee control Patient II Patient with ankylosing spondylitis O Fig. 12.30 a-c . Patient III Patient with...

Susan Adler

Certified as Physical Therapist at Northwestern University, Chicago, Illinois Master of Science in Physical Therapy at the University of Southern California, Los Angeles PNF education in 1962 at the Kaiser Foundation Rehabilitation Center in Vallejo, California Worked and taught with Maggie Knott International PNF senior instructor of the IPNFA. Developed and led PNF courses in the USA and Europe

Symmetrical Reciprocal and Asymmetrical Exercises

In addition to the exercises carried out with one body part in one direction the scapula moving into anterior elevation and in both directions the scapula moving back and forth between anterior elevation and posterior depression , both scapulae or the scapula and pelvis can be exercised simultaneously. Any combination of scapular and pelvic patterns may be used, depending on the goal of the treatment and the abilities of the patient. Here we describe and illustrate two combinations. Use the...

Stabilizing Reversals

Stabilizing Reversals

Stand in a diagonal in front of the leg that is to take the patient's weight initially. Guide the patient to that side and use approximation and stabilizing resistance at the pelvis to promote weight-bearing on that leg O Fig. 12.17 b O Fig. 12.16 c . If weight is to be borne equally on both legs stand directly in front of the patient. Combine approximation through the pelvis on the strong side with stabilizing resistance at the pelvis. Combine approximation through the pelvis on the weaker...

Bilateral Arm Patterns

Bilateral arm work allows you to use irradiation from the patient's strong arm to facilitate weak motions or muscles in the involved arm. You can use any combination of patterns in any position. Work with those that give you and the patient the greatest advantage in strength and control. When you exercise both arms at the same time there is always more demand on the trunk muscles than when only one arm is exercising. You can in crease this demand on the trunk by putting your patient in less...