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neuro eval test 1 > Brunnstrom Approach > Flashcards

Brunnstrom Approach Flashcards

1
Q

what are the principles of Brunnstrom tx?

A
  1. developmental progression
  2. facilitation of reflexes + associated reactions
  3. voluntary effort
  4. constant reversal of movement
  5. gradual reduction of input
  6. practice
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2
Q

what is used to overcome synergy patterns?

A

willed movement

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3
Q

what are the strong/weak components of the UE flexor synergy?

A

strong: elbow flex
weak: abduction/ext rotation

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4
Q

what are the strong/weak components of the UE extensor synergy?

A

strong: adduction/int rotation
weak: elbow extenion

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5
Q

what are strong/weak components of the LE flexor synergy?

A

strong: hip flex, abduction, ext rot, knee flex
weak: hip abduction, extension, ext rotation

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6
Q

what are strong/weak components of the LE extensor synergy?

A

strong: hip adduction, knee extension, plantar flexion/inversion
weak: hip extension/int rotation

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7
Q

what are the typical components of the LE?

A 
hip flexion(slight)
hip adduction
knee extension *
plantar flexion
inversion
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8
Q

what are the 4 rules of recovery?

A
  1. No stage is omitted
  2. Recovery may arrest at any time
  3. Synergies + associated reactions may be observed after recovery
  4. Developmental concepts observed during the recovery process
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9
Q

how does control return?

A

High level responses replace low level responses
Proximal control before distal control
Gross before fine movement

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10
Q

what are the 6 stages after stroke?

A
  1. flaccidity
  2. synergy patterns, spasticity, minimal active movement
  3. Spasticity (lots), voluntary synergy patterns (incomplete range)
  4. Less synergy patterns, decrease spasticity
  5. increase volitional, decrease synergy, decrease spasticity
  6. spasticity eliminated, isolated muscle fx
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11
Q

what occurs during (flaccidity) stage 1?

A

short duration
absent deep tendon reflexes
no tone
no associated reactions

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12
Q

what occurs during (synergy pattern) stage 2?

A 
Elbow flexion comes 1st 
Increased tension at knee
Slow return of reflexes
Slow return of flexor patterns using associated reactions
Minimal voluntary movement
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13
Q

what motion appears first?

A

elbow flexion

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14
Q

what occurs during (spasticity) stage 3?

A

Able to move in abnormal synergy without full range

Where secondary impairments can occur

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15
Q

what occurs during (decreased spasticity) stage 4?

A

Pt can do components of flexor/extensor synergy

begin isolated movement

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16
Q

what occurs during (volitional) stage 5?

A

More equipped to move out of synergy voluntarily

Normalizing tone

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17
Q

what occurs during (isolated muscle) stage 6?

A

Residual speed, timing of movement and dexterity

no more spasticity

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18
Q

what is required for a pt to be assigned to a stage?

A

pt must perform ALL the movements of the stage

arm, leg, hand, wrist can be at different stages

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19
Q

what are the stages of hand recovery?

A
  1. Flaccidity
  2. Little or no active movement
  3. Mass grasp, hook, no voluntary finger extension, reflex extension
  4. Lateral pinch; some finger extension
  5. Awkward grasp/pinch, Palmer pinch, some cylindrical and spherical grasp; voluntary extension
  6. All prehension skill improve; voluntary extension; isolated finger mov lacks accuracy
20
Q

what are the order of wrist/finger recovery?

A

Wrist flexion with finger flexion
Wrist flexion with finger extension
Wrist extension with finger flexion (grasp)
Wrist extension with finger extension

21
Q

what is the limitation of working with the wrist and finger stages of recovery?

A

increases stretch
can cause soft tissue shortening
Doesn’t involve extension of wrist which is IMPORTANT

22
Q

how do you use tonic reflexes to cause associated reactions?

A

raise head to increase extension of back
elicited by proprioceptors in lumbar spine
Disassociate pelvis and shoulder using rotation of trunk

23
Q

what is ATNR used for?

A

to include hemiparetic side

24
Q

what associated reaction is used for flaccid pts?

A

Applying resistance to strong side to elicit changes in muscle tone on weaker side

25
Q

what does Resistance to shoulder elevation on strong side elicit?

A

increased tension in elevators in weak side muscle tone

26
Q

what does Resistance to horizontal adduction elicit?

A

Bring arm in with resistance will get increased tension

Other adductors increases tension

27
Q

what does Homolateral limb synkinesis elicit?

A

Flex LE Associated reactions create flexor response in UE

Flex UE associated reactions create flexor response in LE

28
Q

what does Ramistes Phenomena elicit?

A

Relates to adduction or abduction
Used to increase muscle tone in flaccid LE
Elicit tension toward abduction on weaker side

29
Q

what does UE resistance to the sound side elicit?

A

resist flexion: elicit flexion of weaker side
resist extension: elicit extension of weaker side
Increase in synergy

30
Q

what does . LE resistance to the sound side elicit?

A

crossed effects
resist flexion of strong side: elicit extension in weak side
resist extension of strong side: elicit flexion of weak side

31
Q

how do you elicit true grasp?

A 
pressure to palmar surface
proximal to distal
Tendency for flexion and adduction of fingers
deep moving pressure
Radial surface
32
Q

how do you elicit instinctive grasp?

A

placement of stationary object in hand
Fingers close around object
Flexion and adduction of fingers
Unable to open hand or release

33
Q

how do you elicit Instinctive Avoiding Reaction for extension?

A 
Arm placed forward with elbow extended
Deep moving pressure
Extension and abduction of fingers
Palmar surface
Close to touching object-moment of hesistancy
34
Q

how do you elicit souques finger phenomena?

A

Placement of UE with elbow extended
Stretching fingers by bringing hand forward
Gradual release and opening of hand (not full extension

35
Q

what is souques finger phenomena good for?

A

PROM

36
Q

why cant quick stretch always be used?

A

increases tone response

37
Q

what tactile input is used to facilitate muscles?

A

Percussion, rubbing (over muscle belly), tapping (unique to Brunnstrom)

38
Q

what is the development of muscle control?

A

isometric
concentric
eccentric

39
Q

what techniques are used in stage 1 + 2 of tx?

A 
bed positioning
guided trunk movement
balance
bilateral rowing
waist squeezing
PROM + active assisted
40
Q

what are the stages of tx?

A

stage 1 + 2: elicit muscle tone + reflexive movement
stage 2 + 3: Voluntary Control in Fxnl Activities
stage 4: Voluntary Control that Combines Movement
stage 5: isolated movement
stage 6: coordinated movement

41
Q

what are the skills developed in stage 2 +3 of tx?

A 
Extension Synergy of the UE
wean away from reflex
weight bearing
use synergy patterns
peak of spasticity
42
Q

what are the skills developed stage 3 tx?

A

balance of flexor and extensor synergy

43
Q

what are the skills developed for stage 4 of tx?

A

Arm behind the back, shoulder abduction
reaching
Pronation and supination/elbow at 90 degrees of flexion

44
Q

what are the skills developed for stage 5 of tx?

A

90 degrees shld. flexion, elbow extended with shoulder abducted
Imitation synkinesis
lateral reaching
Pronation/supination with elbow extended

45
Q

what is imitation synkinesis?

A

use strong side as guide to encourage movement of weak side

46
Q

what are the skills developed in stage 6 of tx?

A

speed and timing

neuro eval test 1 (1 decks)

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