The document discusses proprioceptive neuromuscular facilitation (PNF), a technique developed by Herman Kabat that uses movements and patterns to improve neuromuscular function. It defines key PNF terms and outlines principles such as motor development occurring from head to toe. The basic procedures are described, including manual contacts, stretch, and maximal resistance. Upper and lower extremity diagonal patterns are explained along with their component motions. Rhythmic initiation is also summarized.

1. Bhawna
MPT (pediatrics)

2. Proprioceptive, means receiving stimulation
within the tissues of the body.
Neuromuscular, means pertaining to the nerves and
muscles.
Facilitation, means the effect produced in nerve tissue
by the passage of an impulse.

3. INTRODUCTION:
 HERMAN KABAT ► Developed a method of PNF.
 SHERRRINGTON ► Provided Neurophysiological
principles.
 GELLHORN ► Studied Proprioception and Cortically
induced movement.
 GESSEL ► Studied the development of motor
behavior.
 MCGRAW ► Studied the development of behavior
and maturation of Neural structures.
 HELLEBRANDT ► Studied the combination of movements
and mass movements

4. In 1956 the first edition of PNF text book was written
by the two Physical therapists who worked with
Dr.Kabat, Margaret Knott and Dorothy Voss. The book
was revised in 1968 and 1985.

5. Definition:
 Techniques of proprioceptive neuromuscular
facilitation may be defined as “ Methods of promoting
or hastening the response of the neuromuscular
mechanism through stimulation of the
proprioceptors”.

6. PRINCIPLES:
 All human beings have potentials that are not fully developed.
 Motor development takes place in cerviocaudal sequence or proximodistal
direction.
 Early motor behavior is dominated by reflex activity whereas mature motor
behavior is supported or reinforced by postural reflex.
 The growth of motor behavior has cyclic trends as evidenced by shifts between
flexor and extensor dominance.
 The goal directed activity is made up of reversing movements.
 Normal movement and posture are dependent upon synergism and a balanced
interaction of antagonist.
 Developing motor behavior is expressed in an orderly sequence of total patterns
of movements and posture.
 Normal development has an orderly sequence but lacks a step by step quality
and generally shows overlap.
 Improvement in motor ability depends upon motor learning.
 Frequency of stimulation and repetitive activity are used to promote
and retain motor learning as well as for the development of strength and
endurance.

7. The Basic Procedures For Facilitation Are:
 Manual contacts
 Traction
 Approximation
 Stretch
 Timing for emphasis
 Maximal Resistance
 Verbal (commands)
 Vision
 Timing
 Body position and mechanics
 Patterns

8. MANUAL CONTACTS
 The therapist’s grip stimulates the patient’s skin
receptors and other pressure receptors.
 The therapist’s hand should be placed to apply the
pressure opposite the direction of motion.
 To stimulate proprioceptors in muscles, tendons and
joints.
 May be used with or without resistance.

9. TRACTION AND APPROXIMATION
 Traction is elongation of trunk or an extremity.
 It is used to facilitate motion and aid in elongation of
muscle when using stretch reflex.
 Approximation is the compression of the trunk or
extremity. It promotes stabilization, facilitates weight
bearing and facilitates upright reactions.

10. STRETCH
 Stretch stimulus: Occurs when the muscle is
elongated.
 It facilitates muscle contraction.
Precaution :-
use of stretch reflex is not advisable during the
early stage of soft tissue healing after injury or surgery.

11. TIMING
 Timing is a sequencing of motions. Normal timing
provides continuous coordinated motion until the task is
accomplished.
 Timing for emphasis involves changing the normal
sequencing of motions to emphasize a particular muscle or
desired activity.

12. MAXIMAL RESISTANCE
 The amount of resistance provided during an activity must
be appropriate for the patients condition and the goal of
the activity.
1. Facilitates muscle contraction.
2. Increases motor control and learning.
3. Increases strength.

13. BODY POSITION AND MECHANICS
 The therapist’s body should be in line with desired motion
or force.
 The resistance comes from the therapist’s body, while the
hands and arms stay comparatively relaxed.
 By using body weight, the therapist can give prolonged
resistance without fatigue.

14. VERBAL STIMULATION
(COMMANDS)
 The verbal command tells the patient what to do and
when to do it.
 The command is divided into three parts .
a. Preparation
b. Action
c. Correction

15. VISION
 The feedback from the visual sensory system can
promote a more powerful contraction.
 It helps the patient to correct position and motion.
 It provides another avenue of communication and
helps to ensure co-operative interaction.

16. Patterns

17. Diagonal patterns
 The patterns of movement associated with PNF are
composed of multijoint, multiplanar, diagonal and
rotational movements of extremities, trunk and neck.
 There are two pairs of diagonal patterns for upper and
lower extremities.
1. Diagonal 1
2. Diagonal 2
 Each of these pattern patterns can be performed in either
flexion or extension.

18.  D1 flexion
 D1 extension
 D2 flexion
 D2 extension
of the upper and lower extremities

19. D1 flexion
D2 flexion
D1 extension
D2 extension

20. Upper Extremity Component
Motions

21. Shoulder
 D1 flexion:-
flexion, adduction, external rotation
 D1 extension:-
extension, abduction, internal rotation
 D2 flexion:-
flexion, abduction, external rotation
 D2 extension:-
extension, adduction, internal rotation

22. Elbow
 D1 flexion:-
flexion or extension
 D1 extension:-
flexion or extension
 D2 flexion:-
flexion or extension
 D2 extension:-
flexion or extension

23. Forearm
 D1 flexion:-
Supination
 D1 extension:-
Pronation
 D2 flexion:-
Supination
 D2 extension:-
Pronation

24. Wrist
 D1 flexion:-
flexion, radial deviation
 D1 extension:-
extension, ulnar deviation
 D2 flexion:-
extension, radial deviation
 D2 extension:-
flexion, ulnar deviation

25. Fingers and Thumb
 D1 flexion:-
flexion, adduction
 D1 extension:-
extension, abduction
 D2 flexion:-
extension, abduction
 D2 extension:-
flexion, adduction

26. Lower Extremity Component
Motions

27. Hip
 D1 flexion:-
flexion, adduction, external rotation
 D1 extension:-
extension, abduction, internal rotation
 D2 flexion:-
flexion, abduction, internal rotation
 D2 extension:-
extension, adduction, external rotation

28. Knee
 D1 flexion:-
flexion or extension
 D1 extension:-
flexion or extension
 D2 flexion:-
flexion or extension
 D2 extension:-
flexion or extension

29. Ankle
 D1 flexion:-
dorsiflexion, inversion
 D1 extension:-
plantarflexion, eversion
 D2 flexion:-
extension, eversion
 D2 extension:-
plantarflexion, inversion

30. Toes
 D1 flexion:-
extension
 D1 extension:-
flexion
 D2 flexion:-
extension
 D2 extension:-
flexion

37. Rhythmic Initiation
 Rhythmic motion of the limb or body through the
desired range, starting with passive motion and
progressing to active resisted movement.
 Goals:-
1. Improve coordination and sense of motion.
2. Teach the motion
3. Help the patient to relax
4. Normalize the rate of motion, either increasing or
decreasing it

38.  Indications:-
1. Difficulties in initiating motion
2. Movement too slow or too fast
3. Uncoordinated or dysrhythmic motion, i.e.,ataxia
and rigidity
4. Regulate or normalize muscle tone