In a D2 flexion proprioceptive neuromuscular facilitation pattern, a patient becomes confused during the activity. Which verbal instruction BEST helps the patient complete the pattern?

• A. Open your hand and push down and away from your body
• B. Open your hand and pull up and away from your body
• C. Close your hand and pull up and across your body
• D. Close your hand and pull down and across your body

Answer: (B)

D2 flexion is a diagonal pattern where the arm moves from a starting position of extension/adduction/internal rotation toward flexion/abduction/external rotation, with the forearm supinating and the hand ending in an open position. The best verbal cue directly guides both the direction and the hand shape: “Open your hand and pull up and away from your body.” Opening the hand prompts the needed hand position (hand in an open state rather than clenched) and pulling up and away directs the arm into the up-and-out, flexed/abducted/external-rotated trajectory characteristic of D2 flexion. This combination helps the patient establish the correct neuromuscular pattern even when attention or comprehension is limited. Other cues that describe different directions (toward the body or across the midline) or that imply a closed hand would not align with the proper pattern timing and end position, making completion more challenging.