THE ROLE OF PROPRIOCEPTIVE NEUROMUSCULAR FACILITATION (PNMF) TECHNIQUES IN REHABILITATION OF PATIENTS WITH STROKE

The brain insult is an acute disruption of circulation in the brain, which flows with local and general brain symptoms. It can be ischemic, haemorrhagic or in the form of Transient Ischemic Attack (TIA).Etiologic factors include: atherosclerosis, high blood pressure, heart disease, malformation of brain blood vessels and others.In the acute stage, physical therapy is directed towards the prophylaxis of the complications of the locomotor apparatus (contractures, muscle and tendon retractions, ossifications), the respiratory system (hypostatic pneumonia) and the skin (decubitus). All this is achieved through treatment with a position: a frequent change in the position of the body in the bed, passive exercises performed according to strictly defined rules, breathing exercises, exercises for healthy limbs and intense skin care. The resulting trophic changes of the skin are treated with ultraviolet radiation at the sublimate doses or with high frequency currents at D'Arsonval.After the acute period, physical therapy has a decisive role for the optimal physical recovery of patients, for their adaptation and re-socialization. The leading role in this stage has kinesitherapy through the special methods of Bobath, Brunustrom and Kabat. The choice of a particular kinesitherapy technique is performed individually for every sick person, after a precise kinesiological analysis of the spastic syndrome and a functional assessment.Depending on the extent of the consequences, the treatment tasks and the specific techniques used to treat the patient are very different. Care should be taken to achieve maximum adequate load for training of the nerve muscle apparatus of the patient. In addition, the following sequence of treatment stages must be applied: Removing spasticity by relaxing and suppressing kinesitherapy techniques; Termination of the primitive driving patterns after the achieved relaxation of the spasticity and the adoption of new movements outside the primitive schemes; Automating newly adopted correct movements from the kinesiological point of view;During the preparation of the kinesitherapy program, the following basic principles are preserved: The first healing task is to normalize the muscle tone; Active movements are trained after the patient has adopted a good static control of the pose; Alternating active (volitional) efforts and returning to passive suppression techniques, all the time in the kinesitherapy procedure; Successive and rapid change of diametrically oppressive positions, thus achieving relaxation; Facilitation techniques are applied in succession, which monitors the spontaneous healing of the patient. It is necessary that they be proportionate to the patient's ability. The achieved active movements with the correct trajectory are automated by means of multiple repeats of the movements involved in the driving models with practical application;In the early healing stage, when the patient starts kinesitherapy, the first ergotherapy exercises are started, which are aimed at training the patient for the activities of everyday life.Before starting the kinesitherapy procedure, relaxing procedures are mandatory. In the initial stages of moderate spasticity, soft heat is used (solux and IC light). In strong spasticity, paraffin applications, Kenny compresses, or partial warm baths are used. Of the cryotherapy methods, the most suitable for these conditions is the method of application of frozen towels, three times a minute, with passive relaxation exercises between each application.Proprioceptive Neuromuscular Facilitation Techniques (PNMF) aim to improve the patient's functional ability by facilitating, inhibiting, enhancing and relaxing muscle groups. Techniques use, concentric, eccentric and static muscular contraction. These muscular contractions, with properly dosed resistance and appropriate relief techniques, can be combined and adapted to meet the needs and capabilities of each patient.