PNF application to Stages of Motor Control

1. PNF application to Stages of Motor Control Seung-sub Shin IPNFA Certified Therapist KPNFA

2. Contents • Definition : Motor control • Stages of Motor control • PNF application • Patient’s Demo by Video

3. Motor control • The ability to regulate or direct the mechanisms essential to movement. • The individual generates movement to meet the demands of the task being performed within a specific environment. Task M Environment Individual Movement

4. Motor control • Stability • Mobility • Manipulation • Perception • Cognition • Action • Regulatory • Nonregulatory

5. Stages of Motor control • Initial Mobility • Stability • Control Mobility • Skill

6. Initial Mobility • The ability to initiate active movement through range. • Increasing ROM • Increasing initiation of active movement • The ability to attain a certain body position to accomplish a specific goal • The ability to plan or organize the movement

7. Initial Mobility • The cause of immobility is depend on patients • Ex- Elbow jt. restriction • Hemi-patient or Fractured patient • Initial Mobility may be limited when • Tissues stiffness, muscle weakness • Sensory problem (mainly deep sensation or pain) • Problems with Ability to plan or organize the movement and Cognitive ability

8. Initial Mobility • Hypertonicity • Cognitive relaxation • Use of tone-reduction position and activities to facilitate ease of movement. • Gravity-assisted movement • Trunk rotation or elongation • Low effort and resistance • Slow stroking, Slow vestibular rocking.

9. Initial Mobility • Hypotonicity • Light resistance • Isometric holding to develop muscle spindle-stretch sensitivity • Progression from isometric to eccentric to concentric contractions • Quick stretching, tapping, Fast vestibular stimulation (fast rolling), loud verbal commend.

10. Stability • The state or quality of being stable • (Oxford University Press, 2007) • Refers to the ability to maintain a new position against gravity. • Muscles co-contraction to stabilize around a joint and ensure maintenance of upright posture against gravity.

11. Stability • Muscle • Sustained isometric contractions shortened range for increasing duration • Posture • Coordinated isometric contractions in midline or weight-bearing postures • Stabilizing reversal • Rhythmic stabilization

12. Stability • Stabilizing reversal • Rhythmic stabilization Agonist Antagonist Agonist Antagonist

13. Stability • Practical application • Isometric contraction in shortening range, progressing to midrange control • Joint approximation • Weight bearing and holding in antigravity postures

14. Control Mobility • Is the ability to move while maintaining a stable upright posture. • The combined function of both mobility and stability with smooth reversal of the antagonists • Weight shifting in weight-bearing postures

15. Control Mobility • Practical application • Smooth movement and antagonistic muscle contraction. • Carefully graded assistance using key movement • Eccentric control to concentric control • Gradually increasing ROM • Functional activities : reaching, supine-to-sitting transitions

16. Skill • Is defined as the ability to perform various tasks (environment). distally with stable proximal body parts. • Allow attainment of a goal with an economic effort. • Automatic stage. • ADL • More strengthening and endurance needed

17. Skill • Practical application • Dual tasks can be selected to develop control of simultaneous movement (Ex-walking and bouncing ball). • A variety of environment (in door or out door). • Agility or more difficult task that combine both coordination and upright postural control (balance). • Subcortical practice

18. PNF application • All of PNF philosophy, procedures and techniques can be used for facilitating the each stage based on the patient’s values and therapist’s treatment goal. Ex: Rhythmic initiation • Initiate motion • Learn a motion • Change rage of motion • Pain • Coordination and control • Relaxation Etc.

19. Patient’s demonstration

20. References • Anne Shumway-cook. Motor control 3rd Lippincott Williams & Wilkins 2007. • Adler, D.Becker, M. Buck. The Neck, Vital function. In : PNF in Practice 2nd. Springer, 2000. • O'Sullivan SB, Schmitz TJ. Physical rehabilitation laboratory manual focus onfunctional training. FA DAVIS. 1999. • Patricia E Sullivan and Prudence D. Markos. Clinical decision making in therapeutic exercise. Appleton & Lange. 1995.