Microsoft PowerPoint - CH26 PNF.ppt [相容模式]

Size: px

Start display at page:

Download "Microsoft PowerPoint - CH26 PNF.ppt [相容模式]"

哀任
6 years ago
Views:

1 Chapter Proprioceptive Neuromuscular Facilitation Approach 授課老師 : 劉倩秀 972 職能治療技術學 History PNF 的理論是根據正常動作發展的順序在 PNF 的理論中, 日常生活中所有的動作都是以一整套的動作儲存在腦中, 並且在本質上都具有可逆性與斜向性 1950 年代, 一位神經科醫師 Dr. Herman Kabat Kbt 開始治療小兒痲痺與 Multiple Sclerosis 的病患, 並且與 Margaret Knott (PT) 一同發展 PNF 的理論至 1951 年, 已運用在不同種類的病患, 包括 CVA SCI Arthritis 與 Hand Injury Chien-Hsiou Liu 972 職能治療技術學 2 PNFapproach astaught by Voss Definition Proprioceptive: Sensory receptors that give information concerning movement and position of the body Neuromuscular: Involving the nerves and muscles Facilitation: Making easier Definition by Voss A method of promoting or hastening neuromuscular mechanism response through stimulation of the proprioceptors Utilizessensory sensory toolsadditively after evaluating the functional problem and identifying the necessary diagonal patterns of movement Incorporates attention to therapeutic application of breathing Chien-Hsiou Liu 972 職能治療技術學 3 Chien-Hsiou Liu 972 職能治療技術學 4

2 The rational requirement for developed movement capacities All parts of the body, head and neck, trunk, and limbs, have two diagonal patterns based on normal motor activity, and the motor pattern itself is a method of facilitation. Stronger muscles in diagonal pattern influence weaker muscles. The skeletal, ligamentous, and muscular systems of the body support these pattern. (Diagonal patterns ) PNF Diagonal Patterns Combinations of the cardinal plane movements of flexion or extension, abduction and adduction, and internal or external rotation Inclusion of rotary component in all movement patterns. Functional reversing patterns; balance of antagonists Treatment must start with techniques that focus on agonist (lacking balance). Performed in all three planes of movement simultaneously Sagittal, Frontal, Horizontal Chien-Hsiou Liu 972 職能治療技術學 5 Chien-Hsiou Liu 972 職能治療技術學 6 The two diagonal patterns of movement for each body part 1. Head and Neck, Trunk 2. Upper Extremity (UE) 3. Lower Extremity (LE) 4. Bilateral Symmetrical (BS) D2 Pattern of the Upper Extremities Combined with Trunk Movements Head and Neck, Trunk (p216) Flexion with rotation to the right (reverse by extension with rotation to the left) Head and neck patterns are usually combined with patterns of the trunk and extremities. Chien-Hsiou Liu 972 職能治療技術學 7 Chien-Hsiou Liu 972 職能治療技術學 8

3 Upper Extremity Trunk pattern chopping trunk flexion with rotation leading arm: D1 extension following arm: D2 extension reverse chopping trunk extension with rotation leading arm: D2 flexion following arm: D1 flexion lifting trunk extension with rotation leading arm : D2 flexion following arm : D1 flexion reverse lifting trunk flexion with rotation leading arm : D1 extension following arm : D2 extension named by the direction of movement at the shoulder joint Patients are always directed to look at their hand while they move. All PNF patterns represent functional range of motion. Chopping (p.231) Bilateral asymmetrical upper extremity extension with neck flexion to the same side to exercise the trunk flexor muscles. Lifting (p.235) Bilateral asymmetrical upper extremity flexion with neck extension to the same side to exercise trunk extension. Chien-Hsiou Liu 972 職能治療技術學 9 Chien-Hsiou Liu 972 職能治療技術學 10 Upper extremity D1 flexion Scapula elevation, abduction, rotation Shoulder flexion, adduction, external rotation Elbow flexion or extension Forearm supination Wrist flexion to the radial side Finger flexion and adduction, thumb adduction D1 extension Scapula depression, adduction, rotation Shoulder extension, abduction, internal rotation Elbow flexion or extension Forearm pronation Wrist extension to the ulnar side Finger extension and abduction, thumb palmar abduction D2 flexion Scapula elevation, adduction, rotation Shoulder flexion, abduction, external rotation Elbow flexion or extension Forearm supination Wrist extension to the radial side Finger extension and abduction, thumb extension D2 extension Scapula depression, abduction, rotation Shoulder extension, adduction, internal rotation Elbow flexion or extension Forearm pronation Wrist flexion to the ulnar side Finger flexion and adduction, thumb opposition Chien-Hsiou Liu 972 職能治療技術學 11 Chien-Hsiou Liu 972 職能治療技術學 12

4 Chien-Hsiou Liu 972 職能治療技術學 13 Chien-Hsiou Liu 972 職能治療技術學 14 Chien-Hsiou Liu 972 職能治療技術學 15 Chien-Hsiou Liu 972 職能治療技術學 16

5 Chien-Hsiou Liu 972 職能治療技術學 17 Chien-Hsiou Liu 972 職能治療技術學 18 Diagonal one (D1) flexion (reverse chop) combines flexion, adduction, and external rotation at the shoulder. D1 reverses as D1 extension (chopping), which combines extension, abduction, and internal rotation at the shoulder. Chien-Hsiou Liu 972 職能治療技術學 19 Chien-Hsiou Liu 972 職能治療技術學 20

Diagonal two (D2) flexion (lifting) combines flexion, abduction, and external rotation at the shoulder.

Chien-Hsiou Liu 972 職能治療技術學 21 Chien-Hsiou Liu 972 職能治療技術學 22 Lower Extremity Aim: Used to facilitate functional ambulation Used to retrain bowel and bladder function Lower extremity D1 flexion

,knee: flexion or extension,ankle:plantar flexion, eversion, toe:flexion Lower extremity D2 flexion hip:flexion, abduction, internal rotation.

6 Diagonal two (D2) flexion (lifting) combines flexion, abduction, and external rotation at the shoulder. Diagonal two (D2) reverses as D2 extension (reverse lift), combining i extension, adduction, and internal rotation at the shoulder. Chien-Hsiou Liu 972 職能治療技術學 21 Chien-Hsiou Liu 972 職能治療技術學 22 Lower Extremity Aim: Used to facilitate functional ambulation Used to retrain bowel and bladder function Lower extremity D1 flexion hip:flexion, adduction, external rotation.,knee: flexion or extension,ankle:dorsiflexion, inversion, toe:extension Lower extremity D1 extension hip:extension, abduction, internal rotation.,knee: flexion or extension,ankle:plantar flexion, eversion, toe:flexion Lower extremity D2 flexion hip:flexion, abduction, internal rotation.,knee: flexion or extension,ankle:dorsiflexion, ifl i eversion,toe: : extension Lower extremity D2 extension hip:extension, adduction, external rotation.,knee: flexion or extension,ankle:plantar flexion, inversion, toe:flexion Chien-Hsiou Liu 972 職能治療技術學 23 Bilateral Patterns Symmetric patterns 左右兩邊的上 ( 下 ) 肢同時作相同型態的動作例如上肢同時做出 D1 flexion 的動作, 如同要從椅子上坐起時, 兩手同時推椅子的動作 Asymmetric patterns 左右兩邊的上 ( 下 ) 肢同時作出朝向軀幹某側的動作, 使軀幹旋轉例如右手作 D1 flexion, 而左手作 D2 flexion 的動作當一手握住另一手作不對稱十的洞坐時, 會出現所位的砍 (Chopping) 與抬 (Lifting) 的動作, 如同網球選手兩手同時握拍, 並作反手拉拍時的動作 Reciprocal patterns 左右兩側的上 ( 下 ) 肢同時作相反的動作, 使軀幹容易維持在中線例如左手作 D1 flexion 的動作, 而右手作 D2 extension 的動作如同, 投擲棒球時, 最先的準備動作一般 Chien-Hsiou Liu 972 職能治療技術學 24

7 Applications of Controlled Sensory Input in PNF Proprioceptive Stimuli Traction and Approximation Quick Stretch Resistance Tactile Stimuli Auditory Stimuli Visual Stimuli Chien-Hsiou Liu 972 職能治療技術學 25 Proprioceptive Stimuli Traction and Approximation Traction promotes stability by stimulating joint receptors sensitive to stretch. Approximation promotes joint stability by compression of the joint surfaces. Quick stretch t Similar to Rood Approach, but manual contacts to muscles are administered in lengthened range. Always applied to all three components of the diagonal pattern Emphasis on rotational tti components Therapist s entire body is involved in application of quick stretch rather than just hands or arms For example: D2 extension pattern and QS (F26 7) Chien-Hsiou Liu 972 職能治療技術學 26 For example: D2 extension pattern and QS (F26 7) Resistance Usedto improve musclecontractioncontraction Therapistresists resists movement while still beingpart of the overall diagonal movement pattern of the patient. Can be applied in many different ways End of ROM in a pattern Intermittently while patient moves through pattern Continuously throughout range of pattern Chien-Hsiou Liu 972 職能治療技術學 27 Chien-Hsiou Liu 972 職能治療技術學 28

8 Tactile Stimuli 兩種主要的觸覺提供路徑 1. Patient self touch 2. Therapist s manual contacts Always applied in the necessary diagonal pattern ( 引導個案瞭解動作的方向 ) Auditory Stimuli Tone of Voice Sharp used for maximum stimulation Moderate used to reinforce patient s best effort Soft when patient has pain or is in aroused state Commands Prepare patient for what is going to happen Timed to provide maximum stimulation Visual Stimuli Used to facilitate movement Gaze is in direction of movement Timed congruent with ihother facilitory stimuli at initiation i i i of movement Chien-Hsiou Liu 972 職能治療技術學 29 Chien-Hsiou Liu 972 職能治療技術學 30 Basic Techniques Slow Reversal Rhythmic Initiation Rhythmic Stabilization Contract relax Hold relax Slow Reversal Active motion changing from one direction (agonist) to the opposite (antagonist) without pause or relaxation. Throwing a ball, bicycling, walking.. 利用拮抗肌的收縮之後的放鬆, 促進目標肌肉的收縮 Antagonist isotonic contraction (against resistance) agonist isotonic contraction Chien-Hsiou Liu 972 職能治療技術學 31 Chien-Hsiou Liu 972 職能治療技術學 32

9 Rhythmic Initiation (RI) Description Rhythmic motion of the limb or bodythrough the desired range, starting with passive motion and progressing to active resisted movement. To teach patient motion through passive active assist and resist movement in the same direction Rhythm is solely uni direction, effort is focused on the agonist group alone for patient who have trouble initiating movement (Parkinson ss disease) 1. PROM rhythmically 2. AROMinthe desired direction, PROM for return motion 3. Resist to active movement by T s 4. Finish motion independently Rhythmic Stabilization Alternative isometric contraction against resistance, no motion intended. Muscle activity: agonistic and antagonistic activity (possible co contraction) For developing stability Chien-Hsiou Liu 972 職能治療技術學 33 Chien-Hsiou Liu 972 職能治療技術學 34 Contract relax When pain does not present Increase PROM Intent of movement ( isotonic hold ) Work antagonist of desired movement Allow a slight bit of rotation (12 ~20 ) Wait for relax Passive or active into new range Actively to increase strength of agonist into new ROM Hold relax Pain with the patient Increase ROM Decrease pain No intent of movement of patient ( isometric hold ) Work antagonist or agonist (12 ~20 ) No movement ( even rotation ) Chien-Hsiou Liu 972 職能治療技術學 35 Chien-Hsiou Liu 972 職能治療技術學 36

10 Primaryramus ramus, posterior Anti spasticity splint meninges.jpg 職能治療技術學 97-2 劉倩秀老師 37 es/upper_limb/progress_individual_finger_ball_splint_(pro)_ 562.jpg s/94a1293.jpg 職能治療技術學 97-2 劉倩秀老師 38 side lying Prone extension p g y Neck cocontraction ti Prone on elbow Chien-Hsiou Liu 972 職能治療技術學 39 職能治療技術學 97-2 劉倩秀老師 40



 94 年第二次專門職業及技術人員高等暨普通考試醫事人員中醫師心理師呼吸治療師營養師獸醫人員考試試題等別 : 高等考試類科 : 物理治療師科目 : 神經疾病物理治療學考試時間 :1 小時座號 : 代號 :4109 頁次 :7-1 注意 : 本試題