MUHAMMED KOCABIYIK PHYSICAL MEDICINE & REHABILITATION IV. CLASS V.

GROUP

The method:

Patient contract isometrically resulted in increased response of the agonist, this was named rhythmic stabilization. Following using this stabilization, it was found slow reversal technique, alternate resistance to isotonic contractions of antagonist and agonist also had a facilitating effect.

Definitions of PNF:

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. Therefore, PNF can be defined as, methods of promoting or hastening the response of the neuromuscular mechanism through stimulation of the proprioceptors.

To perform PNF exercises, it is important to remember the following Principles: Patient must be taught the pattern. Have the patient watch the moving limb moved passively. The patient must give proper verbal command. Manual contact with appropriate pressure is very important. Contraction of the muscle group is facilitated by hand placement. Apply maximal resistance throughout ROM. Resistance will change. Rotation of movement will change throughout ROM. Distal movement should occur first .

Plan of volume: 1. Patterns of motion 2. Various techniques used to promote the desired response 3. Application of the method for improvement of vital and related functions. 4. Suggestions for evaluation of the patient performance and for planning treatment program.

The upper extremity has two diagonals: 1. Flexionabductionexternal rotation and extensionadductioninternal rotation 2. Flexionadductionexternal rotation and extensionabductioninternal rotation

Shoulder

Flexion
External Rotation Adduction

Forearm Wrist Fingers

Supination Radial Deviation Flexion

Shoulder

Extension Internal Rotation

Abduction
Forearm Wrist Fingers Pronation Ulnar Deviation Extension

Shoulder

Forearm Wrist Fingers

Flexion External Rotation Abduction Supination Radial Deviation Extension

Shoulder

Extension Internal Rotation Adduction

Forearm Wrist Fingers

Pronation Ulnar Deviation Flexion

1.

2.

Types of exercises used for upper extremity proprioceptive training: Balance training. One major category of proprioceptive exercise is balance training. These exercises help to train the proprioceptive system in a mostly static activity. Activities or exercises in weight bearing using unstable supporting surface, profitter, swiss ball, balance board are example of balance training in the upper extremity. Kinetic chain exercises . Open-chain manual resistance exercises with rhythmic stabilization are also considered proprioceptively enriched. In either case, resistance can be modified, depending on pain, as the patient progresses

Quadruped stabilization on a balance Four closed-chain exercises have been described to stimulate co-activation in the shoulder: pushups, horizontal abduction on a slide board, and tracing circular motions on a slide board with the dominant and non-dominant arms. These exercises accommodate for the individual's tolerance to joint loads by progressing from a quadruped to a push-up position. Wall push-ups are also useful and can be proprioceptively enhanced by having a physical therapist or resistance band provide resistance to the patient's back.

3. Sport-specific maneuvers. Rehabilitation is incomplete until maneuvers specific to the sport and the athlete's position in the sport can be performed maximally and without pain or loss of function. Starting sport-specific maneuvers with weighted resistance (eg, swinging a weighted tennis racket or baseball bat), Functional positions, such as overhead throwing, should be incorporated and are more sport-specific.

4. PNF (Proprioceptive neuromuscular facilitation): These techniques may be defined as methods of promoting or hastening the response of the neuromuscular mechanism through stimulation of the proprioceptors. Emphasis is placed on the application of maximal resistance through out the range of motion, using many combinations of motions in a pattern format. Motion is first performed in the strongest part of the range, with progression toward the weaker parts of the range of motion. The patterns used are spiral and diagonal in character and closely resemble the movements used in sports and in occupational activities.

5. Plyometrics. It is a quick powerful movement involving pre-stretching of a muscle, followed by a shortening cycle. The stretch shortening cycle occurs when elastic loading, through a quick eccentric muscular contraction, is followed by a burst of concentric muscular contraction.
6. Ballistic stretching uses the momentum of a moving body or a limb in an attempt to force it beyond its normal range of motion. This is stretching, or "warming up", by bouncing into (or out of) a stretched position, using the stretched muscles as a spring which pulls you out of the stretched position.