THE COMMON FACILITATORY AND INHIBITORY TREATMENT TECHNIQUES It is of great challenge for physical therapist to select methods most efficient for each patient's needs. Appropriate selection of the treatment methods depends upon the understanding of many aspects, such as :1) The neuro-physiological bases of each method.2) The biomechanical influencing of the treated body parts), segments), or body as a !hole on the applied method, and the mechanical effect of the inter"ention on the treated part.#) The nature of pathology and symptoms affecting the patient's acti"ity.$) The indi"idual characters of each patient. To initiate a mo"ement response !e should try to increase the neuronal acti"ity it refers as facilitation) or to decrease the capacity to initiate a mo"ement response!e should try to decrease the neuronal acti"ity it refers as inhibition) The sensory stimulation techni%ue can be used separately or grouped according to the receptors acti"ated, the nature of stimulation intensity, duration and fre%uency) need to be ad&usted and read&usted to meet the indi"idual needs of the patient.The techniques commonly used are classified according to the type of sensory receptors activated.The common facilitator techni!"e# are$1) 'ropriocepti"e stimulation techni%ues. 2) ()trocepti"e stimulation techni%ues.#) *estibular stimulation techni%ues.$) +pecial senses"ision, hearing, smell and taste ) stimulation techni%ues.,) -ulti-sensory stimulation techni%ues..) Autonomic ner"ous system stimulation techni%ues.%ro&rioce&ti'e #tim"lation techni!"e#$a( Stretch$ May be applied in three ways; quick, prolonged, and maintained stretch)Application of this techni%ue may include tapping !hich is commonly used in three forms/ on tendon, on muscle belly and !ith the use of gra"ity. It is used in preceding passi"e mo"ement. The quick stretch produce a relati"ely short li"ed contraction of the agonist muscle and short li"ed inhibition of the antagonist muscle. Prolonged and firm stretch produces inhibition of muscle responses !hich may help in reducing hypertonus, e.g. 0obath's neuro-de"elopmental techni%ue, inhibitory splinting and casting techni%ue. The maintaine* #tretch , resistance can be applied manually or mechanically or by using of gra"ity and body !eight. 1esistance facilitates muscle contraction !hich is directly proportional to the amount of resistance applied. Impro"ing 2inesthetic a!areness and increasing strength are another t!o benefits gained from resistance. +(,i+ration$May be applied in two ways; high and low frequency. The high frequency vibration is dri"en from "ibratorthat optimally operates at a fre%uency of 133 4 233 56 and at amplitude of 1 4 2 mA. This type of "ibration produce facilitation of muscle contraction through !hat is 2no!n as tonic "ibration refle). This facilitatory effect sustained for a brief time after application. Therefore it can be used for stimulatingmuscles !hose primary function is one of tonic holding. The low frequency stimulation, -,3 56 has an inhibitory effect on muscle through its acti"ation of spindle secondary endings and golgi tendon organs. C( A&&ro-imation or com&re##ion of the .oint #"rface#$facilitates posture e)tensors !hich are needed to stabili6e the body. Approimation can be applied slowly to inhibit muscle control or in !erkymanner to facilitate muscle control. The application may be manually and7or by using !eight bearing postures.8oint a!areness may be impro"ed by appro)imation !hich !ill lead toenhancing motor control.*( A firm an* mo*erate inhi+itor &re##"re on ten*on#$may result in inhibition of muscle control. It can be applied manually and7or through de"ices such as splints. 'ositioning may be used to achie"e an inhibitory pressure, e.g. %uadruped position to inhibit the %uadriceps muscle and the long fingerfle)ors of the hand.E-teroce&ti'e #tim"lation techni!"ea( To"ch$ Is one of the simple !ays of facilitation of muscle acti"ity by eliciting the phasic, protecti"e !ithdra!al refle)es. This reaction maintained for se"eral seconds after discharge. The location of the stimulus and its intensity play the important role in the magnitude of reaction. Application of the touch m can be manually using brief, light stro2e, brief s!ipe ice cube, no)ious stimulus and7or light pinching. +( Br"#hin/:As a therapeutic techni%ue presented originally by -argeret 1ood to facilitate mo"ement responses. Application can be manually or by using battery-operated brush. +2in o"erlying muscle can facilitate it and enhances static holding postural e)tensors and !ill ha"e immediate and long latency responses.c( Icin/ for a lon/ &erio*: more than 23 min3 can inhibit muscle acti"ity, postural tone locally). Application of the prolonged ice can be used clinically by four types/ ice chips, ice !raps, ice pac2 and immersion in cold !ater.*( Ne"tral 0armth:It is one of the most common !ay to inhibit postural tone and muscleacti"ity. It acts through stimulating the thermo receptors and acti"ating of parasympathetic responses. 9sually 13-23 minutes are sufficient period to produce effect. The application may be by !rapping body part !ith to!els, hot pac2s, tepid baths and air splints.e( Maintaine* to"ch: It can be used to produce a general calming effect and generali6ed inhibition. :irm manual contacts pressure3 to midline abdomen, bac2 are the common used techni%ues.f( Slo0 #tro1in/$ It Is another techni%ue used to produce a generali6ed calming effect by acti"ation of A;+. It may be applied by using a flat hand o"er the para"ertebral muscles from cer"ical to sacral regions. The generally calming effect can decrease muscle tone. #-, minutes are a sufficient period to produce effect. /( Man"al contact: Itis one of the most success techni%ue to facilitate motor control.A manual direct firm contact o"er the desired muscles is the used techni%ue.,e#ti+"lar Stim"lation Techni!"e The "estibular stimulation techni%ue is a propriocepti"e uni%ue sensory system !ith multi-sensory function. According to the type of stimulus !e can use the "estibular system to achie"e many treatment alternati"es. Total body inhibition can be achie"ed by slo! roc2ing, slo! anterior-posterior mo"ement, slo! hori6ontal mo"ement, slo! "ertical mo"ement and slo! linear mo"ement. Total body facilitation can be achie"ed by rolling patterns, a roc2ing pattern on elbo!s and e)tended elbo!s and cra!ling. Also spinning induces tonal responses and causes a strong facilitation of mo"ement through the o"erflo! of impulses to higher centers. A facilitation of postural e)tensors is another effect of "estibular stimulation if it is used by a rapid !ay anterior-posterior or angular acceleration of the head and body !hile the child in prone position. The in"erted position is commonly used no! to achie"e a total body inhibition, !hile it may be used to increase to in certain e)tensors.S&ecial Sen#e# Stim"lation techni!"e,i#"al ##tem$-ay be used to produce a decrease or an increase in firing of sensory afferent fibers andha"e an o"erall effect on