PNF philosophy

1. Positive approach: no pain, achievable tasks, set up for success, direct and indirect treatment, strong start.

2. Highest functional level: functional approach, ICF, include treatment on body structure level and activity level.

3. Mobilize potential by intensive training: active participation, motor learning, self-training.

4. Consider the total human being: whole person with his/her environmental, personal, physical, and emotional factors.

5. Use of motor control and motor learning principles: repetition in a different context; respect stages of motor control, variability of practice.

Movement is our way to interact with our environment. All sensory and cognitive processes may be viewed as inputs that determine future motor outputs. There are some aspects of motor control and learning that are important for rehabilitation (Mulder 2004). One of the key elements of any interactive situation is the exchange of information. This is also true for any form of therapy. Without information, patients are severely limited in mastering new tasks. This is particularly important in

stages of learning a

stages of learning b

□ Fig. 1.1. a Different stages of motor learning (Fitts and Posner). b Facilitation and PNF in stages of motor learning (drawing by Ben Eisermann)

stages of learning b

□ Fig. 1.1. a Different stages of motor learning (Fitts and Posner). b Facilitation and PNF in stages of motor learning (drawing by Ben Eisermann)

the first stages of motor learning (O Fig. 1.1 ) and of the rehabilitation process when, due to the damage, the patient often can no longer trust his or her internal information. In these cases the therapist, and facilitation like PNF, becomes the most important source of external information.

This positive functional approach is, we feel, the best way to stimulate patients and to attain superior results from treatment.

This book covers the procedures, techniques, and patterns within PNF. Their application to patient treatment is discussed throughout with special attention to mat activities, gait, and self-care. The emphasis within this book is twofold: developing an understanding of the principles that underlie PNF, and showing through pictures rather than with words how to perform the patterns and activities. Skill in applying the principles and practices of PNF to patient treatment cannot be learned only from a book. We recommend that the learner combines reading with classroom practice and patient treatment under the supervision of a skilled PNF practitioner.

The aims of this book are:

— To show the PNF method and, in so doing, help students and practitioners of physical therapy in their PNF training.

— To attain a uniformity in practical treatment.

— To record the most recent developments in PNF and put them into word and picture.

Basic neurophysiologic principles:

The work of Sir Charles Sherrington was important in the development of the procedures and techniques of PNF. The following useful definitions were abstracted from his work (Sherrington 1947):

— Afterdischarge: The effect of a stimulus continues after the stimulus stops. If the strength and duration of the stimulus increase, the afterdischarge increases also. The feeling of increased power that comes after a maintained static contraction is a result of afterdischarge.

— Temporal summation: A succession of weak stimuli (subliminal) occurring within a certain (short) period of time combine (summate) to cause excitation.

— Spatial summation: Weak stimuli applied simultaneously to different areas of the body re inforce each other (summate) to cause excitation. Temporal and spatial summation can combine for greater activity.

— Irradiation: This is a spreading and increased strength of a response. It occurs when either the number of stimuli or the strength of the stimuli is increased. The response may be either excitation or inhibition.

— Successive induction: An increased excitation of the agonist muscles follows stimulation (contraction) of their antagonists. Techniques involving reversal of antagonists make use of this property (Induction: stimulation, increased excitability.).

— Reciprocal innervation (reciprocal inhibition): Contraction of muscles is accompanied by simultaneous inhibition of their antagonists. Reciprocal innervation is a necessary part of coordinated motion. Relaxation techniques make use of this property.

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