Effects of Gait Training Using a Robot for Balance in Total Hip Arthroplasty Patients after Bilateral Avascular Necrosis: A Case Study

Introduction: The term Proprioceptive Neuromuscular Facilitation (PNF) was introduced in the 1950s by Dr. Kabat and Mrs. Knott. From the mid-1950s the PNF-concept has been in a progressive development clarifying the use of techniques, performances and clinical applications. The concept of PNF was originally developed by Dr. Kabat and Mrs. Knott for rehabilitation purposes. The International PNF Association (IPNFA) consider themselves to be the official successor of Dr. Kabat and Mrs. Knott.

The PNF-concept evolved towards a comprehensive rehabilitation approach for various indications. There seems to be a misunderstanding about the PNF-concept, it is often seen as a basic stretching regime for wellbeing and general fitness. This has been criticized to avoid a confusion with the PNF-concept as a comprehensive rehabilitation approach.

Purpose: Providing a background with an explanation for the essential elements of the PNF-concept, being a total and comprehensive rehabilitation approach in physiotherapy and rehabilitation. The elements from the PNF-concept facilitate treatment effects in the fields of musculoskeletal and central neurological disorders and indications with a focus on motor learning.

Implications: The clarification of the essential elements from the PNF-concept in various fields of physiotherapy and physical rehabilitation will simplify how to transfer and incorporate the elements from the PNF-concept into individual treatments.

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The Essential Elements of the PNF-concept, an Educational Narrative

Introduction Congenital dysplasia of the pelvis often occurs in isolation, however, it can also involve other pelvic components, and anomalies of the digestive system. Pelvic malformations have effects on the pelvic girdle and pelvic stability influencing the quality of gait. The condition can be treated with a total hip arthroplasty (THA). The concept of Proprioceptive Neuromuscular Facilitation (PNF) has been described as a comprehensive rehabilitation approach with a focus on motor learning. This case report seeks to illustrate the clinical reasoning and feasibility of applying the PNF-concept in a patient after a THA with multiple congenital pelvis malformations. Case description A male, 44 years of age, physically active laborer was treated with THA after hip dysplasia, with comorbid missing pubic symphysis. The patient presented with complaints in gait speed, gait distance, hip joint mobility and stability. Patient management PNF-based motor-control training, including specified PNF-pattern exercises with specific PNF-facilitation principles and techniques was provided over a period of eighteen weeks. Results showed improvements beyond the minimal detectable change and/or the minimal clinically important difference for physical functioning in gait, strength, range of motion, and personal required activities. Discussion and conclusion Gait rehabilitation training, restoring altered movement patterns in the patient's activities of daily living was provided with PNF. Besides targeting structural impairments, this approach elicited motor learning effects. PNF-patterns have been described as: "mimicking functional activities" from daily life and sports. A specified PNF-based therapy including motor learning components, was a feasible approach in this case of complex pelvic skeletal malformations.

James Keogh

Papers

PNF- based Gait Rehabilitation-training after a Total Hip Arthroplasty in congenital pelvic malformation; A case report.