BRUNNSTROM APPROACH

Question 1

Proponent of Brunnstrom Approach

Answer 1

Signe Brunnstrom

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a first systematic approach to treatment of motor dysfunction cerebrovascular stroke

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“movement therapy”

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Premise

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“evolution in reverse”

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Intrinsic – Stretch & Resistance

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Proprioceptive

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Extrinsic – Vibration, Heat, Cold.

Answer 5

Exteroceptive

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Movements on the affected side in response to voluntary forceful movements in other parts of the body.

Answer 6

Associated Reactions

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Triggered by effortful voluntary movement.

Answer 7

Associated Reactions

Question 8

Mostly, associated reaction for upper extremity would elicit same direction
of movement and opposite direction would be elicited in the lower extremity.

Answer 8

Associated Reactions

Question 9

Elicited by application of distally moving deep pressure over certain areas of palmar surface of the hand and digits

Answer 9

Grasp Reflex

Question 10

Voluntary motion on the unaffected extremity will evoke a similar motion to the affected extremity.

Answer 10

Mirror/Imitation Synkineses

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Active/Passive elevation of hemiplegic upper extremity above horizontal evokes reflexive finger extension of that extremity.

Answer 11

Souques’ Finger Phenomenon

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Similar motion occurs in the limb on the same side of the body.

Answer 12

Homolateral Limb Synkineses

Question 13

Resistance applied to abduction/adduction of non – affected lower extremity evokes a similar reaction in the affected extremity.

Answer 13

Raimiste’s Phenomenon

Question 14

May occur reflexively or as early stages of voluntary control when spasticity is present.

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Basic Limb Synergies

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They act as a bound unit in a primitive and stereotypical manner.

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Basic Limb Synergies

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No isolated movements are present.

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Basic Limb Synergies

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Scapular Adduction and Elevation

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Flexor Synergy

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Shoulder Abduction & External Rotation

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Flexor Synergy

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Elbow Flexion

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Flexor Synergy

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Forearm Supination

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Flexor Synergy

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Wrist Flexion

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Flexor Synergy

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Finger Flexion

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Flexor Synergy

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Hip Flexion, Abduction & External Rotation

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Flexor Synergy

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Knee Flexion

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Flexor Synergy

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Ankle Dorsiflexion & Inversion

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Flexor Synergy

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Toe Extension

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Flexor Synergy

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Shoulder Adduction & Internal Rotation

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Extension Synergy

Question 27

Scapular Abduction & Depression

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Extension Synergy

Question 28

Elbow Extension

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Extension Synergy

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Forearm Pronation

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Extension Synergy

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Wrist Flexion/Extension

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Extension Synergy

Question 31

Hip Adduction, Extension & Internal Rotation

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Extension Synergy

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Finger Flexion/Extension

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Extension Synergy

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Knee Extension

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Extension Synergy

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Ankle Plantarflexion & Inversion

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Extension Synergy

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Toe Flexion

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Extension Synergy

Question 36

Represents that most hypertonic components of both synergy patterns.

Answer 36

Resting Posture

Question 37

Shoulder Adduction, Elbow Flexion, Forearm Pronation, Wrist and Finger Flexion

Answer 37

Resting Posture

Question 38

Typical posture of a post – stroke patient.

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Resting Posture

Question 39

Spontaneous motor recovery follows an ontogenetic process, usually proximodistal

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Motor Recovery Process

Question 40

Arm function would usually have

Answer 40

rapid progress

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Hand function would usually be

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slow or non – progressive

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Stage 1: Flaccidity

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No Function

Question 42

Stage 2: Spasticity develops

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Associated Reactions

Question 43

Stage 2: Spasticity develops

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Emergence of Gross Grasp

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Stage 3: Spasticity Peaks

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Gross Grasp; No Release

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Stage 3: Spasticity Peaks

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Voluntary Synergistic Patterns

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Stage 4: Limb synergies

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Minimal Voluntary Movement Patterns deviating from Synergies

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Stage 4: Limb synergies

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Gross Grasp; Minimal Finger Movements; Some Thumb Movements

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Stage 5: Decline of Spasticity

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Synergies are no longer dominant; Increase in voluntary movement patterns

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Stage 5: Decline of Spasticity

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Increase of prehension patterns

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Stage 6: Improvement of willed movements

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Isolated join movements

Question 50

Stage 6: Improvement of willed movements

Answer 50

All types of prehension and full range of voluntary extensions