Adler. Beckers. Buck PNF in PracticeAdler. Beckers. Buck PNF in Practice

Springer-Verlag Berlin Heidelberg GmbHSpringer-Verlag Berlin Heidelberg GmbH

S.S. Adler D. BeckersM. Buck

PNF in PracticeAn Illustrated Guide

Second, revised edition

With 209 Figures in 558 Separate Illustrations

Springer

s. s. Adler D. Beckers M. Buck

P F en Practice An Illustrated Guide

Second, revised edition

With 209 Figures in 558 Separate Illustrations

i Springer

SUSAN S. ADLER

161 E Chicago Ave, Apt 35EChicago, IL 60611USA

DOMINIEK BECKERS

Rehabilitation Centre HoensbroekZandbergsweg IIINL-6432 CC Hoensbroek

MATH BUCK

Rehabilitation Centre HoensbroekZandbergsweg IIINL-6432 CC Hoensbroek

2nd corr. printing 2003

Library of Congress Cataloging-in-Publication DataDie Deutsche Bibliothek - CIP-EinheitsaufnahmeAdler, Susan S.: PNF in practice: an illustrated guide/Susan S. Adler; Dominiek Beckers;Math Buck. - 2. ed. - Berlin; Heidelberg; New York; Barcelona; Hong Kong; London;Milan; Paris; Singapore; Tokyo: Springer, 1999

This work is subject to copyright. All rights are reserved, whether the whole or part ofthe material is concerned, specifically the rights of translation, reprinting, reuse of illus­trations. recitation, broadcasting, reproduction on microfilm or in any other way. andstorage in data banks. Duplication of this publication or part s thereof is permitt ed onlyunder the provisions of the German Copyright Law of September 9, 1965, in its currentversion, and permission for use must always be obtained from Springer-Verlag. Viola­tions are liable for prosecution under the German Copyright Law.

© Springer-Verlag Berlin Heidelberg 1993, 2000

Originally published by Springer-Verlag Berlin Heidelberg New York in 2000.

The use of general descript ive names, registered names. trademarks, etc. in this publica­tion does not imply, even in the absence of a specific statement, that such names areexempt from the relevant protective laws and regulations and therefore free for generaluse.

Product liability: The publishers cannot guarantee the accuracy of any information aboutthe application of operative techniques and medications contained in this book. In everyindividual case the user must check such information by consulting the relevant litera­ture.

Production : PRO EDIT GmbH, 69126 Heidelberg, GermanyTypesetting (Data conversion): K+V Fotosatz GmbH, 64743 Beerfelden, GermanyCover Design: Kunkel+ Lopka Werbeagentur, 69123 Heidelberg, Germany

Printed on acid-free paper SPIN 11402244 22/311 I/ is - 5 4 3 2

SUSAN S. ADLER

161 E Chicago Ave, Apt 35E Chicago, 1L 60611 USA

DOMINIEK BECKERS

Rehabilitation Centre Hoensbroek Zandbergsweg 111 NL-6432 CC Hoensbroek

MATH BUCK

Rehabilitation Centre Hoensbroek Zandbergsweg 111 NL-6432 CC Hoensbroek

2nd corr. printing 2003

Library of Congress Cataloging·in-Publication Data Die Deutsche Bibliothek - CIP-Einheitsaufnahme Adler, Susan S.: PNF in practice: an illustrated guide/Susan S. Adler; Dominiek Beckers; Math Buck. - 2. ed. - Berlin; Heidelberg; New York; Barcelona; Hong Kong; London; Milan; Paris; Singapore; Tokyo: Springer, 1999

This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illus­trations, recitation, broadcasting, reproduction on microfilm or in any other way, and storage in data banks. Duplication of this publication or parts thereof is permitted only under the provisions of the German Copyright Law of September 9, 1965, in its current version, and permission for use must always be obtained from Springer-Verlag. Viola­tions are liable for prosecution under the German Copyright Law.

© Springer-Verlag Berlin Heidelberg 1993, 2000

Originally published by Springer-Verlag Berlin Heidelberg New York in 2000.

The use of general descriptive names, registered names, trademarks, etc. in this publica­tion does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use.

Product liability: The publishers cannot guarantee the accuracy of any information about the application of operative techniques and medications contained in this book. In every individual case the user must check such information by consulting the relevant litera­ture.

Production: PRO EDIT GmbH, 69126 Heidelberg, Germany Typesetting (Data conversion): K+V Fotosatz GmbH, 64743 Beerfelden, Germany Cover Design: Kiinkel + Lopka Werbeagentur, 69123 Heidelberg, Germany

Printed on acid-free paper SPIN 11402244 22/3111/is - 5 4 3 2

ISBN 978-3-540-66395-9 ISBN 978-3-662-04134-5 (eBook)DOI 10.1007/978-3-662-04134-5

To Maggie Knott, teacher and friend.

Devoted to her patients,dedicated to her students,

a pioneer in profession

To Maggie Knott, teacher and friend.

Devoted to her patients, dedicated to her students,

a pioneer in profession

Preface

Proprioceptive neuromuscular facilitation (PNF) is a philosophyand a method of treatment. It was started by Dr. Herman Kabatin the 1940s. Dr. Kabat and Margaret (Maggie) Knott continuedto expand and develop the treatment techniques and proceduresafter their move to Vallejo, California in 1947. After Dorothy Vossjoined the team in 1953, Maggie and Dorothy wrote the first PNFbook, published in 1956. Dr. Sedgewick Mead, who replaced Dr.Kabat, supported the continued growth of the PNF concept. Atfirst PNF was used as treatment for patients with poliomyelitis .With experience it became clear that this treatment approachwas effective for patients with a wide range of diagnoses .

The three- and six-month PNF courses in Vallejo began in the1950s. Physical therapists from all over the world have journeyedto Vallejo to learn the theoretical and practical aspects of thePNF concept. In addition, Knott and Voss traveled in the UnitedStates and abroad to give introductory courses in the concept.

When Maggie Knott died in 1978 her work at Vallejo was carriedon by Carolyn Oei Hvistendahl, who is now living in Norway.Carolyn was succeeded by Hink Mangold as director of the PNFprogram until her retirement in 1998. Tim Josten is the presentprogram director. Sue Adler, Gregg Johnson, and Vicky Salibahave also continued Maggie's work as teachers of the PNFconcept. Sue Adler designed the Advanced and Instructor courseprograms of the International PNF Association (IPNFA).

Developments in the PNF concept are closely followed through­out the world. It is now possible to take recognized trainingcourses in many countries given by qualified PNF instructors.

The material in this book is based on treatment innovationsbegun by Dr. Herman Kabat and expanded by Margaret Knott,Dorothy Voss, and others, both therapists and patients. Theauthors acknowledge their debt to these outstanding people, andalso to all members of the IPNFA, and hope that this book willencourage others to carryon the work.

Preface

Proprioceptive neuromuscular facilitation (PNF) is a philosophy and a method of treatment. It was started by Dr. Herman Kabat in the 1940s. Dr. Kabat and Margaret (Maggie) Knott continued to expand and develop the treatment techniques and procedures after their move to Vallejo, California in 1947. After Dorothy Voss joined the team in 1953, Maggie and Dorothy wrote the first PNF book, published in 1956. Dr. Sedgewick Mead, who replaced Dr. Kabat, supported the continued growth of the PNF concept. At first PNF was used as treatment for patients with poliomyelitis. With experience it became clear that this treatment approach was effective for patients with a wide range of diagnoses.

The three- and six-month PNF courses in Vallejo began in the 1950s. Physical therapists from all over the world have journeyed to Vallejo to learn the theoretical and practical aspects of the PNF concept. In addition, Knott and Voss traveled in the United States and abroad to give introductory courses in the concept.

When Maggie Knott died in 1978 her work at Vallejo was carried on by Carolyn Oei Hvistendahl, who is now living in Norway. Carolyn was succeeded by Hink Mangold as director of the PNF program until her retirement in 1998. Tim Josten is the present program director. Sue Adler, Gregg Johnson, and Vicky Saliba have also continued Maggie's work as teachers of the PNF concept. Sue Adler designed the Advanced and Instructor course programs of the International PNF Association (IPNFA).

Developments in the PNF concept are closely followed through­out the world. It is now possible to take recognized training courses in many countries given by qualified PNF instructors.

The material in this book is based on treatment innovations begun by Dr. Herman Kabat and expanded by Margaret Knott, Dorothy Voss, and others, both therapists and patients. The authors acknowledge their debt to these outstanding people, and also to all members of the IPNFA, and hope that this book will encourage others to carryon the work.

VIII Preface

There are other excellent books dealing with the PNF method,but they are all general works providing an extensive theoreticaldescription of the treatment. We felt there was a need for acomprehensive coverage of the practical techniques in text andillustrations. This book should thus be seen as a practical guideand used in combination with existing textbooks. Werecommend further reading in both the second and thirdeditions of the book "Proprioceptive Neuromuscular Facilitation:Patterns and Techniques" by Knott and Voss (1968), and Voss,Ionta and Meyers (1985), respectively, as well as the works bySullivan et al. (1982), Sullivan and Marcos (1995), and by Hedin­Anden (1994).

This book would not have been possible without the cooperationof the Stichting voor Revalidatie Limburg in Hoensbroek (TheNetherlands) . A special note of thanks goes to the following: F.Somers for the photography, colleague Jose van Oppen for actingas a model, Jan Albers for assistance in organization and BenEisermann for the drawings. We also wish to thank ChristinaKessler and Morgan Rose for acting as models for the scapulaand pelvis pictures, and Erwin Punz for the photography.

And, finally, we are grateful to all our patients. A special word ofappreciation is owed the patients acting as model in this newedition.

Autumn 1999

References

S.S. Adler, D. Beckers, M. Buck

Hedin-Andert S (l994) PNF-Grundverfahren und Funktionelles Training.Bank und Mattentraining, Gangschulung. Gustav Fischer, Stuttgart

Knott M, Voss DE (l968) Proprioceptive Neuromuscular Facilitation, patternsand techniques , 2nd edn. Harper and Row, New York

Sullivan PE, Markos PD (1995) Clinical decision making in therapeuticexercise. Appleton and Lange, Norwalk, CT

Sullivan PE, Markos PD, Minor MAD (l982) An integrated approach totherapeutic exercise, theory and clinical application . Reston PublishingCompany, Reston, Va

Voss DE, Ionta M, Meyers B (l985) Proprioceptive NeuromuscularFacilitation, patterns and techniques, 3rd edn. Harper and Row, New York

VIII Preface

There are other excellent books dealing with the PNF method, but they are all general works providing an extensive theoretical description of the treatment. We felt there was a need for a comprehensive coverage of the practical techniques in text and illustrations. This book should thus be seen as a practical guide and used in combination with existing textbooks. We recommend further reading in both the second and third editions of the book "Proprioceptive Neuromuscular Facilitation: Patterns and Techniques" by Knott and Voss (1968), and Voss, Ionta and Meyers (1985), respectively, as well as the works by Sullivan et al. (1982), Sullivan and Marcos (1995), and by Hedin­Anden (1994).

This book would not have been possible without the cooperation of the Stichting voor Revalidatie Limburg in Hoensbroek (The Netherlands). A special note of thanks goes to the following: F. Somers for the photography, colleague Jose van Oppen for acting as a model, Jan Albers for assistance in organization and Ben Eisermann for the drawings. We also wish to thank Christina Kessler and Morgan Rose for acting as models for the scapula and pelvis pictures, and Erwin Punz for the photography.

And, finally, we are grateful to all our patients. A special word of appreciation is owed the patients acting as model in this new edition.

Autumn 1999 S. S. Adler, D. Beckers, M. Buck

References

Hedin-Anden S (1994) PNF-Grundverfahren und Funktionelles Training. Bank und Mattentraining, Gangschulung. Gustav Fischer, Stuttgart

Knott M, Voss DE (1968) Proprioceptive Neuromuscular Facilitation, patterns and techniques, 2nd edn. Harper and Row, New York

Sullivan PE, Markos PD (1995) Clinical decision making in therapeutic exercise. Appleton and Lange, Norwalk, CT

Sullivan PE, Markos PD, Minor MAD (1982) An integrated approach to therapeutic exercise, theory and clinical application. Reston Publishing Company, Reston, Va

Voss DE, lonta M, Meyers B (1985) Proprioceptive Neuromuscular Facilitation, patterns and techniques, 3rd edn. Harper and Row, New York

Contents

1 Introduction to Proprioceptive NeuromuscularFacilitation .

22.12.22.32.42.52.62.72.82.92.10

33.13.23.33.3 .13.3.23.3.33.43.4.13.4 .23.53.5.13.5.23.63.6 .13.6.23.73.8

Basic Procedures for Facilitation .Resistance .Irradiation and Reinforcement .Manual Contact .Body Position and Body Mechanics .Verbal Stimulation (Commands) .Vision .Traction and Approximation .Stretch .Timing .Patterns .

Techniques .Rhythmic Initiation .Combination of Isotonics .Reversal of Antagonists .Dynamic Reversals .Stabilizing Reversals .Rhythmic Stabilization .Repeated Stretch (Repeated Contractions) .Repeated Stretch from Beginning of Range .Repeated Stretch Through Range .Contract-Relax .Contract-Relax: Direct Treatment .Contract-Relax: Indirect Treatment .Hold-Relax .Hold-Relax: Direct Treatment .Hold-Relax: Indirect Treatment .Replication .PNF Techniques and Their Goals .

3468

10101112131517

192022242428313333353838404040424344

Contents

1 Introduction to Proprioceptive Neuromuscular

2 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 2.9 2.10

3 3.1 3.2 3.3 3.3.1 3.3.2 3.3.3 3.4 3.4.1 3.4.2 3.5 3.5.1 3.5.2 3.6 3.6.1 3.6.2 3.7 3.8

Facilitation ........................... .

Basic Procedures for Facilitation .......... . Resistance ............................ . Irradiation and Reinforcement ... , ......... . Manual Contact .............. , ......... . Body Position and Body Mechanics ......... . Verbal Stimulation (Commands) .. , ......... . Vision ..................... , ......... . Traction and Approximation ............... . Stretch ............................... . Timing ............................... . Patterns .............................. .

Techniques ........................... . Rhythmic Initiation ..................... . Combination of Isotonics ................. . Reversal of Antagonists .................. . Dynamic Reversals ...................... . Stabilizing Reversals ..................... . Rhythmic Stabilization ................... . Repeated Stretch (Repeated Contractions) ..... . Repeated Stretch from Beginning of Range .... . Repeated Stretch Through Range ........... . Contract -Relax ......................... . Contract -Relax: Direct Treatment ........... . Contract -Relax: Indirect Treatment .......... . Hold-Relax ............................ . Hold-Relax: Direct Treatment .............. . Hold-Relax: Indirect Treatment ............. . Replication ............................ . PNF Techniques and Their Goals ........... .

3 4 6 8

10 10 11 12 13 15 17

19 20 22 24 24 28 31 33 33 35 38 38 40 40 40 42 43 44

x Contents

4 Patient Treatment 474.1 Evaluation 474.2 Treatment Goals . . . . . . . . . . . . . . . . . . . . . . . . . 484.3 Treatment Planning and Treatment Design 494.3.1 Specific Patient Needs 494.3.2 Designing the Treatment 494.4 Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . 504.5 Direct and Indirect Treatment 504.5.1 Direct Treatment 504.5.2 Indirect Treatment 504.6 Treatment Examples . . . . . . . . . . . . . . . . . . . . . . 51

5 Patterns of Facilitation . . . . . . . . . . . . . . . . . . . 57

6 The Scapula and Pelvis 636.1 Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . 636.2 Applications . . . . . . . . . . . . . . . . . . . . . . . . . . . . 636.3 Basic Procedures 646.4 Scapular Diagonals . . . . . . . . . . . . . . . . . . . . . . . 676.4.1 Specific Scapular Patterns . . . . . . . . . . . . . . . . . . 676.4.2 Specific Uses for Scapular Patterns . . . . . . . . . . . 746.5 Pelvic Diagonals . . . . . . . . . . . . . . . . . . . . . . . . . 766.5.1 Specific Pelvic Patterns. . . . . . . . . . . . . . . . . . . . 766.5.2 Specific Uses for Pelvic Patterns . . . 886.6 Symmetr ical, Reciprocal

and Asymmetrical Exercises . . . . . . . . . . . . . . . . 896.6.1 Symmetrical-Reciprocal Exercise 896.6.2 Asymmetrical Exercise . . . . . . . . . . . . . . . . . . . . 91

7 The Upper Extremity 937.1 Introduction and Basic Procedures . . . . . . . . . . . 937.2 Flexion-Abduction-External Rotation. . . . . . . . . 977.2.1 Flexion-Abduction-External Rotation

with Elbow Flexion 1017.2.2 Flexion-Abduction-Extern al Rotation

with Elbow Extension . . . . . . . . . . . . . . . . . . . . . 1067.3 Extension-Adduction-Internal Rotation 1097.3.1 Extension-Adduction-Internal Rotation

with Elbow Extension . . . . . . . . . . . . . . . . . . . . . 1127.3.2 Extension-Adduction-Internal Rotation

with Elbow Flexion 1157.4 Flexion-Adduction-External Rotation . . . . . . . . . 1197.4.1 Flexion-Adduction-External Rotation

with Elbow Flexion 1227.4.2 Flexion-Adduction-Extern al Rotation

with Elbow Extension . . . . . . . . . . . . . . . . . . . . . 125

x Contents

4 Patient Treatment ...................... 47 4.1 Evaluation ............................. 47 4.2 Treatment Goals . . . . . . . . . . . . . . . . . . . . . . . . . 48 4.3 Treatment Planning and Treatment Design ..... 49 4.3.1 Specific Patient Needs .................... 49 4.3.2 Designing the Treatment .................. 49 4.4 Assessment. . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 4.5 Direct and Indirect Treatment .............. 50 4.5.1 Direct Treatment ........................ 50 4.5.2 Indirect Treatment ............ . . . . . . . . . . . 50 4.6 Treatment Examples . . . . . . . . . . . . . . . . . . . . . . 51

5 Patterns of Facilitation. . . . . . . . . . . . . . . . . . . 57

6 The Scapula and Pelvis .................. 63 6.1 Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . 63 6.2 Applications . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 6.3 Basic Procedures ........................ 64 6.4 Scapular Diagonals . . . . . . . . . . . . . . . . . . . . . . . 67 6.4.1 Specific Scapular Patterns. . . . . . . . . . . . . . . . . . 67 6.4.2 Specific Uses for Scapular Patterns . . . . . . . . . . . 74 6.5 Pelvic Diagonals. . . . . . . . . . . . . . . . . . . . . . . . . 76 6.5.1 Specific Pelvic Patterns. . . . . . . . . . . . . . . . . . . . 76 6.5.2 Specific Uses for Pelvic Patterns . . . . . . . . . . . . . 88 6.6 Symmetrical, Reciprocal

and Asymmetrical Exercises . . . . . . . . . . . . . . . . 89 6.6.1 Symmetrical-Reciprocal Exercise ............ 89 6.6.2 Asymmetrical Exercise . . . . . . . . . . . . . . . . . . . . 91

7 The Upper Extremity .................... 93 7.1 Introduction and Basic Procedures . . . . . . . . . . . 93 7.2 Flexion-Abduction-External Rotation. . . . . . . . . 97 7.2.1 Flexion-Abduction-External Rotation

with Elbow Flexion ...................... 101 7.2.2 Flexion-Abduction-External Rotation

with Elbow Extension . . . . . . . . . . . . . . . . . . . . . 106 7.3 Extension-Adduction-Internal Rotation ....... 109 7.3.1 Extension-Adduction-Internal Rotation

with Elbow Extension. . . . . . . . . . . . . . . . . . . . . 112 7.3.2 Extension-Adduction-Internal Rotation

with Elbow Flexion ...................... 115 7.4 Flexion-Adduction-External Rotation. . . . . . . . . 119 7.4.1 Flexion-Adduction-External Rotation

with Elbow Flexion ...................... 122 7.4.2 Flexion-Adduction-External Rotation

with Elbow Extension. . . . . . . . . . . . . . . . . . . . . 125

Contents XI

7.5 Extension-Abduction-Internal Rotation 1297.5.1 Extension-Abduction-Internal Rotation

with Elbow Extension . . . . . . . . . . . . . . . . . . . . . 1337.5.2 Extension-Abduction-Internal Rotation

with Elbow Flexion 1377.6 Thrust and Withdrawal Patterns. . . . . . . . . . . . . 1417.6.1 Ulnar Thrust and Withdrawal. . . . . . . . . . . . . . . 1437.6.2 Radial Thrust and Withdrawal 1457.7 Bilateral Arm Patterns 1477.8 Changing the Patient's Position 1507.8.1 Arm Patterns in a Side Lying Position 1507.8.2 Arm Patterns Lying Prone on Elbows 1517.8.3 Arm Patterns in a Sitting Position 1527.8.4 Arm Patterns in the Quadruped Position 1537.8.5 Arm Patterns in a Kneeling Position . . . . . . . . . . 154

8 The Lower Extremity 1558.1 Introduction and Basic Procedures. . . . . . . . . . . 1558.2 Flexion-Abduction-Internal Rotation 1598.2.1 Flexion-Abduction-Internal Rotation

with Knee Flexion 1628.2.2 Flexion-Abduction-Internal Rotation

with Knee Extension 1658.3 Extension-Adduction-External Rotation . . . . . . . 1698.3.1 Extension-Adduction-External Rotation

with Knee Extension 1748.3.2 Extension-Adduction-External Rotation

with Knee Flexion 1778.4 Flexion-Adduction-External Rotation . . . . . . . . . 1808.4.1 Flexion-Adduction-External Rotation

with Knee Flexion 1848.4.2 Flexion-Adduction-External Rotation

with Knee Extension 1878.5 Extension-Abduction-Internal Rotation 1908.5.1 Extension-Abduction-Internal Rotation

with Knee Extension 1938.5.2 Extension-Abduction-Internal Rotation

with Knee Flexion 1968.6 Bilateral Leg Patterns 1998.7 Changing the Patient's Position 2038.7.1 Leg Patterns in a Sitting Position 2038.7.2 Leg Patterns in a Prone Position. . . . . . . . . . . . . 2058.7.3 Leg Patterns in a Side Lying Position 2078.7.4 Leg Patterns in a Quadruped Position . . . . . . . . . 2088.7.5 Leg Patterns in a Standing Position 210

Contents XI

7.5 Extension-Abduction-Internal Rotation ....... 129 7.5.1 Extension-Abduction-Internal Rotation

with Elbow Extension. . . . . . . . . . . . . . . . . . . . . 133 7.5.2 Extension-Abduction-Internal Rotation

with Elbow Flexion ...................... 137 7.6 Thrust and Withdrawal Patterns. . . . . . . . . . . . . 141 7.6.1 Ulnar Thrust and Withdrawal. . . . . . . . . . . . . . . 143 7.6.2 Radial Thrust and Withdrawal .............. 145 7.7 Bilateral Arm Patterns .................... 147 7.8 Changing the Patient's Position ............. 150 7.8.1 Arm Patterns in a Side Lying Position ........ 150 7.8.2 Arm Patterns Lying Prone on Elbows . . . . . . . . . 151 7.8.3 Arm Patterns in a Sitting Position ........... 152 7.8.4 Arm Patterns in the Quadruped Position ...... 153 7.8.5 Arm Patterns in a Kneeling Position . . . . . . . . . . 154

8 The Lower Extremity .................... 155 8.1 Introduction and Basic Procedures . . . . . . . . . . . 155 8.2 Flexion-Abduction-Internal Rotation ......... 159 8.2.1 Flexion-Abduction-Internal Rotation

with Knee Flexion ....................... 162 8.2.2 Flexion-Abduction-Internal Rotation

with Knee Extension ..................... 165 8.3 Extension - Adduction-External Rotation 169 8.3.1 Extension-Adduction-External Rotation

with Knee Extension ..................... 174 8.3.2 Extension-Adduction-External Rotation

with Knee Flexion ....................... 177 8.4 Flexion-Adduction-External Rotation. . . . . . . . . 180 8.4.1 Flexion-Adduction-External Rotation

with Knee Flexion ....................... 184 8.4.2 Flexion-Adduction-External Rotation

with Knee Extension ..................... 187 8.5 Extension-Abduction-Internal Rotation ....... 190 8.5.1 Extension-Abduction-Internal Rotation

with Knee Extension ..................... 193 8.5.2 Extension-Abduction-Internal Rotation

with Knee Flexion ....................... 196 8.6 Bilateral Leg Patterns ..................... 199 8.7 Changing the Patient's Position ............. 203 8.7.1 Leg Patterns in a Sitting Position ............ 203 8.7.2 Leg Patterns in a Prone Position. . . . . . . . . . . . . 205 8.7.3 Leg Patterns in a Side Lying Position ......... 207 8.7.4 Leg Patterns in a Quadruped Position. . . . . . . . . 208 8.7.5 Leg Patterns in a Standing Position .......... 210

XII

99.19.29.39.3.19.3.29.49.4.19.4.2

1010.110.210.2.110.2.210.310.3.1

10.3.2

10.3.310.4

1111.111.211.311.4ll.s11.5.111.5.211.5.311.5.411.5.511.5.611.5.7

11.5.811.5.911.6

1212.112.212.2.1

Contents

The Neck 211Introduction and Basic Procedures . . . . . . . . . . . 211Indications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 214Flexion to the Left, Extension to the Right 215Flexion/Left Lateral Flexion/Left Rotation 215Extension/Right Lateral Flexion/Right Rotation . . 219Neck for Trunk 221Neck for Trunk Flexion and Extension 222Neck for Trunk Lateral Flexion . . . . . . . . . . . . . . 223

The Trunk . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227Introduction and Basic Procedures . . . . . . . . . . . 227Chopping and Lifting . . . . . . . . . . . . . . . . . . . . . 230Chopping . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 230Lifting 234Bilateral Leg Patterns for the Trunk 238Bilateral Lower Extremity Flexion, with KneeFlexion, for Lower Trunk Flexion (Right) 238Bilateral Lower Extremity Extension, with KneeExtension, for Lower Trunk Extension (Left) . . . . 242Trunk Lateral Flexion . . . . . . . . . . . . . . . . . . . .. 246Combining Patterns for the Trunk 249

Mat Activities . . . . . . . . . . . . . . . . . . . . . . . . .. 253Introduction: Why Do Mat Activities? . . . . . . . . . 253Treatment Goals . . . . . . . . . . . . . . . . . . . . . . . . . 254Basic Procedures 254Techniques . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 254Mat Activities 255Rolling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 255Prone on Elbows (Forearm Support) . . . . . . . . .. 268Side-Sitting 272Quadruped. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 278Kneeling 286Half-Kneeling. . . . . . . . . . . . . . . . . . . . . . . . . . . 292From Hands-and-Feet Position (ArchedPosition on All Fours) to Standing Positionand Back to Hands-and-Feet Position. . . . . . . . . 295Exercise in a Sitting Position 296Bridging 303Patient Cases in Mat Activities 308

Gait Training 319The Importance of Walking 319Introduction: Basics of Normal Gait . . . . . . . . . . 319The Gait Cycle . . . . . . . . . . . . . . . . . . . . . . . . . . 319

XII

9 9.1 9.2 9.3 9.3.1 9.3.2 904 904.1 904.2

10 10.1 10.2 10.2.1 10.2.2 10.3 10.3.1

10.3.2

10.3.3 lOA

11 ILl 11.2 11.3 11.4 11.s 11.5.1 11.5.2 11.5.3 11.504 11.5.5 11.5.6 11.5.7

11.5.8 11.5.9 11.6

12 12.1 12.2 12.2.1

Contents

The Neck ............................. 211 Introduction and Basic Procedures . . . . . . . . . . . 211 Indications . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 214 Flexion to the Left, Extension to the Right ..... 215 Flexion/Left Lateral Flexion/Left Rotation ...... 215 Extension/Right Lateral Flexion/Right Rotation .. 219 Neck for Trunk ......................... 221 Neck for Trunk Flexion and Extension ........ 222 Neck for Trunk Lateral Flexion. . . . . . . . . . . . . . 223

The Trunk . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227 Introduction and Basic Procedures . . . . . . . . . . . 227 Chopping and Lifting . . . . . . . . . . . . . . . . . . . . . 230 Chopping . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 230 Lifting ................................ 234 Bilateral Leg Patterns for the Trunk .......... 238 Bilateral Lower Extremity Flexion, with Knee Flexion, for Lower Trunk Flexion (Right) ...... 238 Bilateral Lower Extremity Extension, with Knee Extension, for Lower Trunk Extension (Left) . . . . 242 Trunk Lateral Flexion . . . . . . . . . . . . . . . . . . . . . 246 Combining Patterns for the Trunk ........... 249

Mat Activities . . . . . . . . . . . . . . . . . . . . . . . . .. 253 Introduction: Why Do Mat Activities? . . . . . . . .. 253 Treatment Goals . . . . . . . . . . . . . . . . . . . . . . . .. 254 Basic Procedures ........................ 254 Techniques . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 254 Mat Activities .......................... 255 Rolling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 255 Prone on Elbows (Forearm Support) . . . . . . . . . . 268 Side-Sitting ............................ 272 Quadruped. . . . . . . . . . . . . . . . . . . . . . . . . . . .. 278 Kneeling .............................. 286 Half-Kneeling. . . . . . . . . . . . . . . . . . . . . . . . . . . 292 From Hands-and-Feet Position (Arched Position on All Fours) to Standing Position and Back to Hands-and-Feet Position. . . . . . . . . 295 Exercise in a Sitting Position ............... 296 Bridging .............................. 303 Patient Cases in Mat Activities ..... . . . . . . . . . 308

Gait Training .......................... 319 The Importance of Walking ................ 319 Introduction: Basics of Normal Gait . . . . . . . . . . 319 The Gait Cycle . . . . . . . . . . . . . . . . . . . . . . . . .. 319

Contents

12.2.2

12.2.312.3

12.412.512.5.112.5.212.612.6.112.6.212.6.312.6.412.6.512.7

1313.113.1.113.213.313.413.513.6

14

15

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Trunk and Lower Extremity Joint Motionin Normal Gait . . . . . . . . . . . . . . . . . . . . . . . . . . 320Muscle Activity During Normal Gait . . . . . . . . . . 323Gait Analysis : Observation and ManualEvaluation 324The Theory of Gait Training . . . . . . . . . . . . . . . . 327The Procedures of Gait Training . . . . . . . . . . . . . 327Approximation and Stretch . . . . . . . . . . . . . . . . . 328Using Approximation and Stretch Reflex . . . . . . . 329Practical Gait Training 331Preparatory Phase 331Standing Up and Sitting Down . . . . . . . . . . . . . . 338Standing 341Walking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 348Other Activities 353Patient Cases in Gait Training 357

Vital Functions . . . . . . . . . . . . . . . . . . . . . . . . . 365Introduction 365Stimulation and Facilitation 365Facial Muscles 365Tongue Movements 382Swallowing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 383Speech Disorders 384Breathing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 385

Activities of Daily Living 391

Glossary 397

Contents

12.2.2

l2.2.3 12.3

12.4 l2.5 12.5.1 12.5.2 12.6 12.6.1 12.6.2 12.6.3 12.6.4 12.6.5 12.7

13 13.1 13.1.1 13.2 13.3 13.4 13.5 13.6

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Trunk and Lower Extremity Joint Motion in Normal Gait. . . . . . . . . . . . . . . . . . . . . . . . . . 320 Muscle Activity During Normal Gait. . . . . . . . . . 323 Gait Analysis: Observation and Manual Evaluation ............................. 324 The Theory of Gait Training . . . . . . . . . . . . . . . . 327 The Procedures of Gait Training. . . . . . . . . . . . . 327 Approximation and Stretch. . . . . . . . . . . . . . . . . 328 Using Approximation and Stretch Reflex. . . . . . . 329 Practical Gait Training ... . . . . . . . . . . . . . . . . . 331 Preparatory Phase ....................... 331 Standing Up and Sitting Down . . . . . . . . . . . . .. 338 Standing .............................. 341 Walking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 348 Other Activities ......................... 353 Patient Cases in Gait Training .............. 357

Vital Functions . . . . . . . . . . . . . . . . . . . . . . . . . 365 Introduction ........................... 365 Stimulation and Facilitation ................ 365 Facial Muscles .......................... 365 Tongue Movements ...................... 382 Swallowing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 383 Speech Disorders ........................ 384 Breathing . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 385

Activities of Daily Living ................. 391

Glossary .............................. 397