FACILITATORY & INHIBITORY
TECHNIQUES
Dr Khushboo Mehta (PT)
1st year MPT
● Introduction
● Manual facilitatory & inhibitory
techniques
● Rood’s Approach
● References
FACILITATION:-
The response is The
dependent on enhancement
To improve the frequency of the
motor control of stimulation response of a
& on neuron to a
neuromuscular stimulus
facilitation following
To encourage prior
certain stimulation
movements
INHIBITION:-
STOP/ The slowing
A feeling that PREVENT/
or
makes one SLOW
prevention
self-conscio
of a
us &
process,
unable to
reaction or
act in a
function by
relaxed &
a
natural
particular
way
substance
MANUAL
FACILITATORY
& INHIBITORY
TECHNIQUES:-
TECHNIQUE & STRATERGIES:-
FACILITATORY TECHNIQUE:-
PROPRIOCEPTIVE
FACILITATION:-
CUTANEOUS THERMAL
• Quick stretch
FACILITATION:- FACILITATION:-
• Heavy joint
• Light moving • Icing compression
touch • Resistance
• Fast brushing • Tapping
• Vestibular stimulation
• Vibration
• Traction
INHIBITORY TECHNIQUE:-
• Neutral warmth
• Slow rolling
• Inhibitory pressure
• Light joint
compression
• Prolonged stretch
• slow vestibular
stimulation
• Slow stroking
1) QUICK STRETCH:-
Response is temporary; can add resistance to augment response
RECEPTOR RESPONSE
• Muscle spindle STIMULUS
• Activates
endings • Quick stretch agonist to
• Detecting length & over muscle contract
velocity changes belly or • Reciprocal
tendon innervation
ADVERSE EFFECT:-
effect will
• May increase
inhibit the
spasiticity when
antagonist;
applie to spastic
activates
muscle
synergists
2) PROLONGED STRETCH:-
Rationale for serial casting & splinting to increase the effect
RECEPTOR STIMULUS RESPONSE
• Muscle • Maintained • Dampens
spindle stretch in a muscle
endings lengthened contraction
• Golgi tendon range
organ
3) RESISTENCE:-
Resistance needs to be graded dependent on the patient
response & goal
RECEPTOR RESPONSE
STIMULUS
• Muscle spindle • Enhances
• Given
muscle
manually or
ADVERSE EFFECT:- contraction
with body
• Too much resistance can through
weight/
easily over power weak, recruitment
gravity or
hypotonic muscles & prevent • Facilitates
mechanical
vol mov synergists
weights
• Encouraging spasticity • enhances
• Increase spasticity in kinesthetic
spasatic muscle awareness
4) APPROXIMATION:-
DOSAGE:- 10-15 sec
RESPONSE
STIMULUS • Enhances
RECEPTOR • Compression muscle
of joint contraction,
• Joint receptors proximal
surfaces
• manual or stability
ADVERSE EFFECT:- • Increases
mechanical
• Contraindicated kinesthetic
• Applied in
with inflamed awareness &
weight
joint postural
bearing
stability
5) TRACTION:-
Useful to activate initial mobility, also used as part of
mobilization
STIMULUS
• Joint
RECEPTORS surfaces
RESPONSE
distracted
• Joint receptors • Facilitates
• Usually
muscle
manually &
ADVERSE EFFECT:- activation to
at the
Contraindicated improve
beginning of
in hypermobile or mobility and
movement
unstable joints movement
initiation
6) INHIBITORY PRESSURE:-
Equipment can be used to achieve effect; casts & splints,
weight bearing activities can provide inhibitory pressure
RESPONSE
• Inhibits muscle
STIMULUS
activity
RECEPTOR Damping effect
• Firm •
pressure
• Golgi tendon ADVERSE EFFECT
manually or
organ • Sustained
with body
• muscle positioning may
weight over
spindles dampen muscle
muscle belly
• tactile contraction enough
or tendon
receptors to affect functional
performance
7) LIGHT TOUCH:-
Effective in initiating a generalized movement response to
elicit arousal
Contraindicated with agitated patients or where ANS is
unstable
RESPONSE
RECEPTOR
• Increased
• Rapidly adapting STIMULUS arousal
tactile receptors,
ANS(sympathetic • Brief, light
division) contact to skin
Dosage
Rate of twice per
sec for approx. 10
sec
Can be repeated
for 3-5 times
8) MAINTAINED TOUCH:-
Useful for patients with high level of arousal or hypersensitivity
RECEPTOR STIMULUS RESPONSE
• Slowly adapting • Maintained • Calming
tactile receptors, contact effect,
ANS(parasympathetic desensitizes
division) skin,
provides
general
inhibition
9) MANUAL CONTACTS:-
Activates muscle response; enhances sensory & kinesthetic
awareness
Provides security & support
RESPONSE
• Facilitates
RECEPTOR STIMULUS contraction of
muscle
• Tactile • Firm, deep underneath hands
receptors pressure of
• Muscle hands over ADVERSE EFFECT
proprioceptors body area • Contraindicated
over spastic
muscles & open
wounds
10) SLOW STROCKING:-
Appropriate for overly aroused patients
RECEPTOR STIMULUS
• Tactile receptors • Slow, firm
RESPONSE
ANS strocking
(parasympathetic • Produces
with flat
division) calming
hand over
effect,
neck or
Dosage:- general
trunk
• 3-5 mins inhibition
extensors
• Induces
feeling of
security
11) NEUTRAL WARMTH:-
Use for 10-15 mins
Avoid over heating
Appropriate for highly agitated patients or individuals with
increased sympathetic response
RESPONSE
• Provides general
RECEPTOR STIMULUS relaxation &
inhibition
• Thermo receptors • Towel or • Decreased muscle
ANS elastic wrap tone, agitation,
(parasympathetic of body or pain
division) body parts
(warm)
12) SLOW VETIBULAR STIMULATION:-
Useful for patients who are defensive to sensory stimulation,
hyper-reactive to stimulation, hyper-tonic to agitated
STIMULUS
RECEPTOR • Slow
• Tonic rocking, slow RESPONSE
vestibular movement
receptors on ball, in • Produces
hammock, in calming
rocking effect
chair • Decreased
arousal
13) FAST VESTIBULAR STIMULATION:-
Used in patients with hypotonia (CP, Down syndrome)
Used to promote sensory integration
STIMULUS
• Fast or irregular
movement with
RECEPTOR acceleration & RESPONSE
deceleration
• Semi-circular • Facilitates
component
canals general
• Such as spinning,
muscle tone
use of a scooter
• Promotes
board, fast rolling
postural
responses to
movement
14) QUICK ICING:-
● Use of ice as a stimulus to elicit
desired motor pattern
● Ice cube is rubbed or used in a
quick sweep motion over the
muscle belly to be facilitated
● Evokes phasic withdrawal
response, activates both
exteroceptors & proprioceptors
causing brief arousal of cortex
15) FAST BRUSHING:-
● BRUSHING of the skin over a
muscle belly
● Soft camel hair paint brush or
electrically powered brush can
be used
● Treatment time:- 5 sec for each
area, followed by rest period
● If no response after 30 sec:-
must be repeated 3-5 times with
a rest period of 30 sec
● Precautions
16) TAPPING:-
● Tapping:- It is the use of a light manual
force applied over a tendon or muscle
belly to facilitate a voluntary
contraction.
● Techniques:- Tapping of the tendon
normal response would be a brisk
muscle contraction.
● Tapping over the belly of a muscle with
the fingertips
● Therapist percusses 3 to 5 times
● Done before or during the time when
patient is voluntarily contracting the
muscle
17) VIBRATION:-
● Another effective modality to evoke a consistent motor
response.
● Vibratory stimuli applied over a muscle belly activates the Ia
afferents of muscle spindle, thereby causing contraction of that
muscle & inhibition of its antagonist muscle, termed as Tonic
Vibratory Response ( TVR )
● TVR best elicited when a high frequency of 100-300Hz –
mechanical vibrator is used
● Response is sustained for the duration of stimulus applied and
has short latency period.
● Stimulus is applied parallel to fibers of the contracting agonist
to assist contraction.
● Treatment: Facilitatory purpose: Frequency- 100 & 200 Hz;
Amplitude: 150 μm
● PRECAUTIONS
FACILITATORY & INHIBITORY
APPROACHES
Dr Khushboo Mehta(PT)
1st year MPT
CONTENTS:-
● Approaches
● References
What are the sensory motor
approaches?
Neuro-develo Sensory
Rood’s
approach PNF pmental
approach integration
Brunnstrom’s
movement
therapy
1) ROOD’S APPROACH:-
Margarate Rood (1956)
INTRODUCTION:- • Motor functions
to be
• originally inseparable
designed for from sensory
cerebral palsy mechanisms.
• The approach of Rood to neurological
dysfunction represented her philosophy of
treatment, which was concerned with the
interactions of somatic, autonomic,
psychological factors and their interactions
with motor activities.
PRINCIPLES:-
• Normalize • Mov is directed
muscle tone toward
functional goals
• Repetition is
• Use of developmental necessary
sequence
FACILITATORY INHIBITORY
TECH:- TECH:-
• Quick icing • Neutral
• Light moving warmth
touch • Prolonged
• Fast brushing icing
• Heavy joint • Slow
compression strocking
• Quick stretch • Serial casting
• Tapping • Positioning
• Vibration • Passive
• Resistance stretching
• Weight
bearing
• Depp
inhibitory
pressure
2) PNF technique
Herman kabat & Maggie knott
(1940-1956)
Expanded by Voss & Meyers
● Rehab tech that was initiated over 50 yrs ago
● Used to stimulate neuro-muscular system in an
effort to excite proprioceptors
( sensory organs in muscles, tendons, bones &
joints)
● Knott & Voss defined facilitation as the promotion
of any natural process; specifically, the effect
produced in nerve tissue by the passage of an
impulse
● The term proprioceptive means sensory
stimulation i.e. received from receptors within the
body’s own muscles, tendon & joints
● Neuro-muscular means this tech. applies to nerve
and muscle
● Therefore, PNF is defined as an approach that
includes methods of promoting or hastening the
response of neuro-muscular mech. through
stimulation of proprioceptors
BASIC NEURO-PHYSIOLOGICAL
PRINCIPLES:-
1) AFTER DISCHARGE:- The effect of stimulus continues after the stimulus stops.
● If the strength & duration of the stimulus increase, the after discharge increases also.
● The feeling of increased power that comes after a maintained static contraction is a
result of after discharge.
2) TEMPORAL SUMMATION:- A succession of weak stimuli ( subliminal ) occurring
within a certain ( short ) period of time combine to cause excitation.
3) SPATIAL SUMMATION:- Weak stimuli applied simultaneously to different areas of the
body reinforce each other to cause excitation.
● Temporal & spatial summation can combine for greater activity.
4) IRRADIATION:- This is a spreading & increased strength of a response.
● It occurs when either the number of stimuli or the strength of the stimuli is increased.
● The response may be either excitation or inhibition.
5) SUCCESSIVE INDUCTION:- An increased excitation of the agonist muscles follows
stimulation ( contraction ) of their antagonists.
● Tech involving reversal of antagonists make use of this property.
6) RECIPROCAL INNERVATION:- Contraction of muscle is accompanied by simultaneous
inhibition of their antagonists.
● Necessary part of coordinated motion
Stimulation tech used during
PNF:-
Manual Traction Verbal Rhythmic
contact commands stabilization
Vision Approximation Stretch
• Repeated contractions ,RC
PNF Tech:- ( repeated stretch )
• Reversal of • Combination of
antagonists:- isotonics ( agonist
✔ Dynamic reversals, AR )
reversals ( slow
reversals ) • Rhythmic initiation
✔ Stabilizing ( RI )
reversals
✔ Rhythmic
• Contract relax ( CR )
stabilization
• Hold- relax ( HR )
3) NDT:-
Dr karl & Berta bobath ( 1950s )
● Its basic concept is that motor function
can be improved by modifying abnormal
mov. patterns & mov is a changeable,
dynamic phenomenon that can be
affected by external sensory inputs.
(Bobath & bobath, 1984; valvano & Long,
1991)
● The bobath developed this approach for
evaluation & treatment of CP & hemi
PRINCIPLES:-
●
NDT Tech:-
Application:-
1) Handling:- • Use of hands; light
touch;
intermittent
touch/ firm
manual contact to
Clinical use:- guide & assist
with mov
• Hands are used
to support &
assist mov from
one position to
another
• Active assisted
mov is always
encouraged
2) positioning:-
Application:-
• Positioning for support
Clinical use:- is used to provide
stability & alignment
• prevent deformity
• Used to provide
alignment,
comfort, support
• prevent deformity
• provide readiness
to support or
enhance
independent mov
3) Use of adaptive equipment:-
Clinical use:-
Application:-
• Used to provide
postural support
• Equipment can be used
• prevent deformity
dynamically to assist in
• promote alignment
mov control
• enhance function &
offer mobility
• A common adjunct to
intervention for
children with
neurological
impairment
4) Key points of control:-
Application:-
• Proximal key points of
control includes trunk,
shoulder & pelvis; distal
points are hands & feet
Clinical use:-
• Parts of body
are chosen as
optimal from
which to guide
person’s mov
5) Facilitating transitional mov:-
Application:-
• Provides facilitation of
antigravity control, weight
bearing, weight shifting,
Clinical use:- response to mov such as
• Facilitates key automatic postural
mov responses, rotation &
components dissociation
during active
transitional
mov
6) Use of sensory input:-
Application:-
• Proprioceptive
inputs include
weight bearing,
Clinical use:- approximation,
• Voluntary mov stretching &
control is traction or
facilitated tapping
through use of • Exteroceptive
proprioceptive inputs includes
inputs, manual
extroceptive guidance &
inputs, visual, therapeutic use
vestibular & of hands
verbal inputs
7) Motor learning strategies:-
Application
• Use of variable
practice &
problem
solving in
Clinical use natural
environment
• Active mov is promotes
encouraged motor learning
through
practice,
repetition,
feedback & use
of functional
activities
4) BRUNNSTROM ‘S
APPROACH:-
Brunnstrom ( 1970s)
●
●
●
●
●
STAGES OF
MOTOR
RECOVERY:
SYNERGY PATTERNS:
5) SENSORY INTEGRATION:-
Jean Ayres (1973)
● It is a neurological process that dependent
on the patient’s ability to take in sensory
information from the body (sensory intake) &
environment, process it & use it to plan &
organize behaviour (output).
● SI is founded on the senses which include :
visual, auditory, touch, smell, taste, vestibular
& proprioception.
● The normal process of SI development
begins before birth & continues throughout
life as the individual interacts with the
environment.
● SI is often associated the disabilities &
disorders like:
Autism, language disorders, anxiety disorders
& depression.
• It makes the child want to run, play & explore.
• During therapy child works with therapist & sometimes
other peers, in order to perform activities that combine
sensory input with motion. Such as,
Swinging
Dance to music (sound)
Playing with boxes filled with beans(touch)
Spinning on a chair( balance & vision)
Crawling through tunnels
Balancing on a beam
ADVERSE EFFECT:-
Sensory overload may produce prolonged after-effects
e.g. Pupil dilation, changes in respiratory rate, flushing or
pallor, nausea, sleep disturbance
REFERENCES:-
● Physical rehabilitation Assessment & treatment fifth edition. Susan
B.O’Sullivan,EdD,PT , Thomas J Schmitz,PhD,PT
● Darcy A.Umphred-Rolando T. Lazaro Margaret L. roller
● Effect of Rood’s approach in diabetic polyneuropathy.( Brinda R Patel1*, Namrata
Kadam2 , Pratik Pawar, 2019)
● The immediate effect of PNF pattern on muscle tone and muscle stiffness in chronic
stroke patient (Joong-San Wang, Sang-Bin Lee, Sang-Hyun Moon, 2016)
● Effects of Proprioceptive Neuromuscular Facilitation Technique on the Functional
Ambulation of Stroke Survivors (CO AKOSILE, 2011 )
● Physiotherapy based on the Bobath concept in stroke rehabilitation: a survey within
the UK ( SHEILA LENNON, DAVID BAXTER and ANN ASHBURN, 2001 )
● EFFECTIVENESS OF BRUNNSTROM APPROACHES ON IMPROVING HAND
FUNCTION IN RIGHT HEMIPLEGIC PATIENTS - (A COMPARATIVE STUDY)
( P.P.G. COLLEGE OF PHYSIOTHERAPY )
● A Meta-Analysis of Research on Sensory Integration Treatment (Sadako Vargas,
Gregory Camilli, 1999 )
