BRUNNSTROM APPROACH Flashcards
Proponent of Brunnstrom Approach
Signe Brunnstrom
a first systematic approach to treatment of motor dysfunction cerebrovascular stroke
“movement therapy”
Premise
“evolution in reverse”
Intrinsic – Stretch & Resistance
Proprioceptive
Extrinsic – Vibration, Heat, Cold.
Exteroceptive
Movements on the affected side in response to voluntary forceful movements in other parts of the body.
Associated Reactions
Triggered by effortful voluntary movement.
Associated Reactions
Mostly, associated reaction for upper extremity would elicit same direction
of movement and opposite direction would be elicited in the lower extremity.
Associated Reactions
Elicited by application of distally moving deep pressure over certain areas of palmar surface of the hand and digits
Grasp Reflex
Voluntary motion on the unaffected extremity will evoke a similar motion to the affected extremity.
Mirror/Imitation Synkineses
Active/Passive elevation of hemiplegic upper extremity above horizontal evokes reflexive finger extension of that extremity.
Souques’ Finger Phenomenon
Similar motion occurs in the limb on the same side of the body.
Homolateral Limb Synkineses
Resistance applied to abduction/adduction of non – affected lower extremity evokes a similar reaction in the affected extremity.
Raimiste’s Phenomenon
May occur reflexively or as early stages of voluntary control when spasticity is present.
Basic Limb Synergies
They act as a bound unit in a primitive and stereotypical manner.
Basic Limb Synergies
No isolated movements are present.
Basic Limb Synergies
Scapular Adduction and Elevation
Flexor Synergy
Shoulder Abduction & External Rotation
Flexor Synergy
Elbow Flexion
Flexor Synergy
Forearm Supination
Flexor Synergy
Wrist Flexion
Flexor Synergy
Finger Flexion
Flexor Synergy
Hip Flexion, Abduction & External Rotation
Flexor Synergy
Knee Flexion
Flexor Synergy
Ankle Dorsiflexion & Inversion
Flexor Synergy
Toe Extension
Flexor Synergy
Shoulder Adduction & Internal Rotation
Extension Synergy
Scapular Abduction & Depression
Extension Synergy
Elbow Extension
Extension Synergy
Forearm Pronation
Extension Synergy
Wrist Flexion/Extension
Extension Synergy
Hip Adduction, Extension & Internal Rotation
Extension Synergy
Finger Flexion/Extension
Extension Synergy
Knee Extension
Extension Synergy
Ankle Plantarflexion & Inversion
Extension Synergy
Toe Flexion
Extension Synergy
Represents that most hypertonic components of both synergy patterns.
Resting Posture
Shoulder Adduction, Elbow Flexion, Forearm Pronation, Wrist and Finger Flexion
Resting Posture
Typical posture of a post – stroke patient.
Resting Posture
Spontaneous motor recovery follows an ontogenetic process, usually proximodistal
Motor Recovery Process
Arm function would usually have
rapid progress
Hand function would usually be
slow or non – progressive
Stage 1: Flaccidity
No Function
Stage 2: Spasticity develops
Associated Reactions
Stage 2: Spasticity develops
Emergence of Gross Grasp
Stage 3: Spasticity Peaks
Gross Grasp; No Release
Stage 3: Spasticity Peaks
Voluntary Synergistic Patterns
Stage 4: Limb synergies
Minimal Voluntary Movement Patterns deviating from Synergies
Stage 4: Limb synergies
Gross Grasp; Minimal Finger Movements; Some Thumb Movements
Stage 5: Decline of Spasticity
Synergies are no longer dominant; Increase in voluntary movement patterns
Stage 5: Decline of Spasticity
Increase of prehension patterns
Stage 6: Improvement of willed movements
Isolated join movements
Stage 6: Improvement of willed movements
All types of prehension and full range of voluntary extensions
