facilitation tech
TRANSCRIPT
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NEUROMUSCULAR FACILITATION TECHNIQUES
Miss Rojaramani VasamshettyMPT II Yr
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NMFT• A group of techniques used to facilitate or
inhibit muscle contraction or responses.– Proprioceptive Facilitation Techniques– Extereoceptive Stimulation Techniques– Vestibular Stimulation Techniques
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Proprioceptive Facilitation Techniques:
• Quick Stretch• Prolonged Stretch• Resistance• Joint Approximation• Joint Traction• Inhibitory Pressure
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QUICK STRETCH• Stimulus:
– quick stretch is applied to a muscle
• Activates: – muscle spindles, sensitive to velocity and length changes. Muscle spindle
provides input to higher centers.
• Response: – phasic, facilitates or enhances muscle contraction due to largely peripheral
reflex effects (facilitates agonist, inhibits antagonist, facilitates synergist, reciprocal innervation effects)
• Techniques: – quick stretch, tapping over muscle belly or tendon
• Comments: – a low threshold response, relatively short lived; can add resistance to maintain
contraction. Apply resistance in the lengthened range to initiate contraction
• Adverse Effects: – may increase spasticity
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PROLONGED STRETCH • Stimulus:
– Slowly applied maintained stretch especially in lengthened ranges• Activates:
– Muscle spindles, golgi tendon organs; sensitive to length changes– Muscle spindle provides input to higher centers
• Response:– Inhibits or dampens muscle contraction and tone due to largely to peripheral
reflex effects.• Techniques:
– Manual contraction– Inhibitory splinting, casting,– Reflex inhibiting patterns– Mechanical low load weights
• Comments:– Higher threshold response– May be more effective in extensor muscles than flexors due to the added effects
of II inhibition.– To maintain inhibitory effects, activate antagonist muscles
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RESISTANCE:• Stimulus:
– A force exerted to muscle
• Activates:– Muscle spindles and golgi tendon organs; sensitive to velocity and length
changes
• Response:– Facilitates or enhances muscle contraction due to peripheral reflex effects– Suprasegmental effects: recruits both alpha and gamma motor neurons,
additional motor unit– Hypertrophies extrafusal muscle fibers– Enhances kinesthetic awareness
• Techniques:– Manual resistance– Use of body weight and gravity– Mechanical weights
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RESISTANCE
• Comments:– Light resistance is used to facilitate very weak muscles.
– With hypotonic muscles, eccentric and isometric contractions are used before concentric
– Maximal resistance may produce overflow to other muscles
• Adverse Effects:– Too much resistance can easily overpower weak, hypotonic muscle
and prevent voluntary movement, encourage substitution.
– May increase spasticity
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JOINT APPROXIMATION• Stimulus:
– Compression of joint surfaces• Activates:
– Joint receptors• Response:
– Facilitates postural extensors and stabilizes– Enhances joint awareness
• Techniques:– Joint compression, either manual or mechanical using weight cuffs or belt– Bouncing while sitting on a Swiss ball
• Comments:– Applied in extensor patterns, weight-bearing positions, in middle to
shortened ranges of extensors• Adverse Effects:
– Contraindicated in inflamed joint
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JOINT TRACTION:• Stimulus:
– Distraction of joint surfaces
• Activates:– Joint receptors
• Response:– Facilitates agonists, enhances contraction– Enhances joint awareness
• Techniques:– Manual distraction
• Comments:– Used as a facilitatory stimulus in flexor patterns, pulling action– Slow, sustained traction to joints can be used to improve mobility, relieve
muscle spasm, and reduce pain with techniques of joint mobilization
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INHIBITORY PRESSURE• Stimulus:
– Prolonged pressure to long tendon• Activates:
– Muscle receptors and tactile receptors• Response:
– Inhibition, dampens muscle tone• Techniques:
– Firm pressure can be applied manually or with body weight; positioning at end ranges
– Mechanical: firm objects in hand inhibitory splints, cast• Comments:
– Weight bearing postures are used to provide inhibitory pressure, such as• Quadruped or kneeling posture• Sitting with hand open, elbow extended and upper limb supporting body
weight• Adverse Effects:
– Sustained positioning may dampen muscle contraction and affect functional performance
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EXTEREOCEPTIVE STIMULATION TECHNIQUES
• Light touch• Maintained touch• Slow stroking• Manual contacts• Prolonged icing• Neutral warmth
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LIGHT TOUCH• Stimulus:
– Brief, light contact to skin
• Activates:– Fast adapting tactile receptors, ANS, sympathetic divisions.
• Response:– Phasic withdrawal responses, flexion and adduction of the extremities
withdrawing away from the stimulus; increased arousal
• Techniques:– Brief, light stroke of the fingertips– Brief swipe with ice cubes– Light pinch or squeezing– Applied to areas of high tactile receptor density that are more sensitive to
stimulation
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Light touch:
• Comments:– Low threshold response, accommodates rapidly– Effective in initially mobilizing patients with low response levels, for
example, the patient with TBI during early recovery
• Adverse effects:– Increased sympathetic arousal, may produce fight or flight responses– Contraindicated in patient with generalized arousal or autonomic
instability, for example, the patient with TBI who is agitated and combative
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MAINTAINED TOUCH• Stimulus:
– Maintained contact or pressure• Activates:
– Tactile receptors, ANS, parasympathetics• Response:
– Calming effects, generalized inhibition, desensitized skin• Techniques:
– Firm manual contacts– Firm pressure to midline abdomen, back, lips, palms, and/or soles of feet.– Firm rubbing
• Comments:– Useful for patients with high arousal, patient with a hypersensitivity to sensory
stimulation– Can be applied to hypersensitive areas to normalize responses: patients with
peripheral nerve injury or paresthesias.– Brief touch stimuli should be avoided.– Can be used in combination with other maintained stimuli.
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SLOW STROKING• Stimulus:
– Slow stroking, applied to paravertebral spinal region
• Activates:– Tactile receptors, ANS, parasympathetics
• Response:– Calming effects, generalized inhibition
• Techniques:– The patient is placed in a supported position such as prone, or sitting head
and arms supported and resting forward on a table top. A flat hand is used to apply firm, alternate strokes downward to paravertebral region for approximately 3-5 minutes
• Comments:– Useful with patients who demonstrate high arousal, increased sympathetic
responses.
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MANUAL CONTACT:• Stimulus:
– Firm, deep pressure of the hand in contact with the body
• Activates:– Tactile receptors, muscle proprioceptors
• Response:– Facilitates contraction in muscle directly under the hands– Provide sensory awareness, directional cues to movement– Provide security and support unstable body segments
• Comments:– Can be used with or without resistance.
• Adverse effects:– contraindicated over spastic muscles and open wounds
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PROLONGED ICING:• Stimulus:
– Cold application • Activates:
– thermoreceptors• Response:
– Decreases neural, muscle spindle firing– Provide inhibition of muscle tone and painful muscle spasm– Decreases metabolic rate of tissues
• Techniques:– Immersion in cold water, ice chips– Ice towel wrap, ice packs, ice massage
• Comments:– Monitor effects carefully
• Adverse effects:– Sympathetic nervous system arousal, protective withdrawal responses, fight or
flight responses.– Contraindicated in patients with sensory deficits, generalized arousal, autonomic
instability, vascular problems
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NEUTRAL WARMTH• Stimulus:
– Retention of body heat• Activates:
– Thermoreceptors, ANS, parasympathetics• Response:
– Generalized inhibition of tone; produces a calming effect, relaxation, decreases pain
• Techniques:– Wrapping body or body parts: ace wraps, towel wraps– Application of snug fitting clothing or air splints– Tepid baths,– Applied for aproximately 10-20 minutes
• Comments:– Useful for patients with high arousal, or increased sympathetic activity;
spasticity• Adverse effects:
– Overheating should be avoided, may produce rebound effects
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VESTIBULAR STIMULATION TECHNIQUES:
• Slow maintained vestibular stimulation• Fast vestibular stimulation
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SLOW MAINTAINED VESTIBULAR STIMULATION
• Stimulus: – Low-intensity vestibular stimulation, for example slow rocking
• Activates:– Facilitates primarily otolith organs; less effects on semicircular canals
• Response:– Generalized inhibition of tone– Decreased arousal, calming effects
• Techniques:– Slow, repetitive rocking movements; assisted rocking in a weight bearing
position, for example, rocking with equipments: rocking chair, Swiss ball, equilibrium board, hammock
– Slow rolling movements.• Comments:
– Useful with patients who are hypertonic, hyperactive, or who demonstrate high arousal, or tactile defensiveness
– Combine with cognitive relaxation techniques
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FAST VESTIBULAR STIMULATION:• Stimulus:
– High intensity vestibular stimulation, for example, fast spinning, irregular movements with acceleration and deceleration components
• Activates:– Facilitates semicircular canals, less effects on otoliths
• Response:– Generalized facilitation of tone– Improves motor co-ordination– Improves retinal image stability, decrease post-rotatory nystagmus
• Techniques:– Fast spinning, for example, spinning in a chair, mesh net or hammock– Fast acceleration /deceleration movements, for example, prone on a
scooter board– Fast rolling movements
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• Comments:Useful with:– Hypotonic patients (down’s syndrome)– Patients with sensory integrative dysfunction– Patients with co-ordination problems (stroke, CP child)– Helpful in overcoming the effects of akinesia or bradykinesia in
patients with Parkinson’s disease
• Adverse effects:– Behavioral changes, seizures, sleep disturbances may occur– Contraindicated for patients with recurrent seizures or who are
intolerant to sensory stimulation
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