It is the term used to describe externally applied proprioceptive and tactile stimulus that produces reflex respiratory movt. Responses and that appears to alter rate and depth of breathing




1-For a unconscious patients-As it is not possible to place them in optimum position for postural drainage.

-Inadequate ventilation due to shallower monotonus resp. is a major factor in development of atelectasis

-Inadequate ventilations- retension of secretion

Deranged mech. ventilation or resp. function is another complication of lack of muscle tone and instability of chest wall.

-Stiff chest as a result of lack of costal muscle.


2-As a relaxation procedure to conscious patient like CVA and GBS.


Application of PNF result:


1-Visible deeper inspiration

2-larger expansion of ribs

3-Increased epigastric excursion

4-Change in R.R.

5-Involuntary coughing

6-Changes in breath sounds

7-Return of mech.chest wall stability

8-Less necesscity for suctioning

9-More normal resp.pattern

10-Increase in level of consciousness

11-Retension of new pattern by sucessive repetition.


Responses most pronounced in deeply unconscious.



1-Perioral pressure

2-Intercostal stretch

3-Vertebral pressure

4-Co contraction of abdomen

5-Anterior –stretch basal lift

6-Sustained manual pressure


Perioral pressure:

Procedure-Stimulation is provided by applying firm pressure to patient’s upper lip

-Pressure is maintained for the length of time that the therapist wishes the breath in activated pattern.

PRECAUTIONS-Keep the side of finger on lip to prevent occlusion of nasal passage and use of surgical gloves



  • The response to this stimulus is a brief period of apnea followed by increased epigastric excursions (approx-5 sec)
  • As the stimulus is maintained the epigastric excursion may increase so that movt is transmitted to upper chest and the pt. appears to be in deep breathing.
  • R.R. may become slower.

      When this is applied to unconscious patient-if the mouth is open it will close, swallowing noted and sucking movt. are evident even in the presence of oral airways


  • Movt in chewing ,sucking ,swallowing have been reported in stroking the lips in comatose pt. due to infantile rooting reflexes.
  • Studies reveal that perioral pressure to reduce spastic m/s tone .it said that perioral pressure would inhibit hypertonus and that if the pt.mouth was open the pressure will close it.
  • Some uses the stimulus as a method of relaxation.


Intercostal stretch:

  • Mech-Reflexive activation of diaphragm by intercostal afferents and its margins.
  • Procedure:This is provided by applying pressure to upper border of a rib in order to stretch the intercostal m/s in a downward direction(not inward)
  • Application of stretch should be timed with exhalation
  • Maintain till pt. achives normal breathing pattern

Can be performed unilaterally or bilaterally on any rib with exception of floating ribs or fractured

  • Observation-The response to this stimulus is a gradual increased in resp. movt. In the area under  and around the stretch.
  • PRECAUTION-Care must be exercised around the female mammary tissues.

-when performed over area of instability as in the presence of paradoxical movt. in upper rib cage over areas of decrease mobility this is an effective procedure

Vertebral pressure:

  • Pressure is applied to uppermost thoracic vertebrae results in increase epigastric excursion in the presence of a relaxed abdominal wall.

Pressure over lower thoracic vertebrae results in inspiratory movt. of apical thorax

  • Mech-Firm pressure is applied directly over the vertebrae of the upper and lower thoracic cage activities the dorsal intercostal muscles

-Pressure should be applied with an upper hand for comfort and must be firm enough to provideintrafusal stretch.

-so patient shoud be in supine  position to eliminate stabilization of patient and to observe patients relaxation.

In every intercostal space the dorsal part of external (insp) & dorsal part of inter (exp) intercostal m/s are antagonistic during quiet breathing.


Co contraction of abdomen:

  • Observation-Increase epigastric movts.

-increase tone in abdominal m/s activation of diaphragm

-decrease girth in obese

-depression of umblicus

  • Pressure is directed across the abdomen produces intrafusal stretch ,thus activating the m/s spindle side contralateral to pressure reached first.AS
  • As those m/s stretched and shortened they stretch the intrafusal fibre of opposive m/s and vice versa and cycle goes on…..

This should be done bilatrally with pressure applied alternately and maintained for some seconds on either side

Anterior stretch basal lift:

  • Procedure-Placing the hands under the ribs of the supine patients and lifting gently upwards.
  • Done uni or bilaterly
  • Observation-As the lift is sustained stretch is maintained and increasing movt. Of the ribs in a lateral and post direction can be seen and felt.
  • Increased epigastric movt. Also often becomes obvious
  • The lift to back places stretch to the spaces between some of the mid thoracic ribs.

The epigastric movt.suggest that the diaphragm is being activated by intercostals.

Dr.vikas dwivedi

One thought on “PNF OF RESPIRATION

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