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Old 10-02-2007, 08:40 PM
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Re: PNF in hemiplegic gait

Coordinated movement can also be promoted using proprioceptive neuromuscular patterns and techniques described by Knott and Kabat.

Patterns are selected to reinforce and develop selective movement control while avoiding synergistic patterns. For example, lower extremity D1 extension with knee flexing would be an appropriate pattern to practice if patients were experiencing incomplete knee flexion with hip extension with toe off. Lower extremity D1 extension promotes the necessary combination of hip extension and abduction needed to regain the stance phase stability and reduce the trendelenburg's gait pattern. Bilateral symmetrical patterns are also very useful to achieve overflow from sound side to the affected side. For example bilateral lower extremity D2 flexion with knee extension enhances knee stability needed for transfer, standing and gait.

Appropraite PNF techniques include slow reversals, timing for emphasis with repeated contractions if components are weak. Rhythmic initiation particularly works well in assisting motor learning. Hold- relax active movements can be used if initiation of movement is difficult. The technique of agonistic reversal is effective in developing the eccentric control necessary for normal function. Thus functional activities of bridging, sit to stand, or kneeling to kneel sitting might be practised using agonist reversal technique. In the PNF approach, there is a large emphasis on effective motor learning using strategies such as practice, repetition, visual guidance of movement, and so forth.
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