Brunnstrom Flashcards
What are associated reactions
involuntary movts or reflexive increases in tone
auto responses of affected limb from movt that occurs from movt on unaffected side
when are associated reactions mostly present
w/ spasticity
when are associated reactions less common
when there is normal mm tone
Where do associated reactions produce movt
same direction in UE
opposite direction in LE
What are the 2 types of associated reactions
bimanualsynkinesis (mirror movt)
homolateralsynkinesis
What is bimanualsynkinesis
brain tells 1 side to do something, other side does it
what is homolatersynkinesis
produces movt on the same side
What are limb synergies
stereotypical movt patterns
what are the 2 types of synergies
flexor
extensor
components of flexor synergy
scapular elevation retraction shoulder ab and er elbow flexion forearm supination wrist and finger flexion
What is the strongest component of flexor synergy
elbow flexion
components of extensor synergy
scapular protraction horizontal ad IR elbow ext forearm pronation wrist and finger flexion
what is the strongest component of extensor synergy
adduction and pronation
What to assess
synergy sensory adls balance and transfers vision and cognition
How to assess
through ops, formal assessments, Fugl-Meyer
What are the stages of recovery
- Flaccidity
- Spasticity develops
- spasticity increases(begin voluntary movt, associated reactions)
- Decreased spasticity- (some movt occurs)
- Synergies diminish-(more voluntary movt)
- isolated movts.- (movt freely occurs, very close to normal movt)
What does not follow the brunnstrum stages
hand recovery
What is flaccidity
no movt
what happens during spasticity
synergys may occurs. flexion b/f extension
What are the 3 steps stage 4 (decreased spasticity) is broken into
IR
Arm to forward horizontal
pronation/supination w/ elbow flexed
What is the goal of brunnstrom
to progress through all stages
What does brunnstrom use
reflexes, associated reactions, cutaneous and prop simulation (focus on stages 1-3)
What to develop in brunnstrom
voluntary control
Order voluntary control develops
isometric, eccentric, concentric
reverse movts.
Interventions to facilitate trunk control
balance response
forward flexion
trunk rotation
(reach for something over counter)
Interventions to facilitate upper extremity control
Rowing
weight bear
shoulder elevation (ab,er, supination)
Interventions to develop hand function
mass grasp and release (involuntary) wrist stabilization voluntary release active grasp ad release (voluntary) e.g. holding papers, book, using key, dressing tasks, dealing cards, holding pencils
What are strengths of brunnstrom
research has shown it is just as affective as other approaches
what are limitations of this approach
limited research
what do most therapists believe
don’t believe that reflexive patterns or associated mov patterns should be facilitated during recovery
Assumptions of brunnstrom
- primitive reflexes and movt patterns promote movt.
- prop input and cutaneous stimulation facilitate movt
- once primitive movt. patterns become voluntary, facilitation using reflexes is discouraged
- correct, new movt patterns need to be practiced
- voluntary movt is enhanced by incorporating daily functional tasks
