BRUNNSTROM'S APPROACH

Question 1

Brunnstrom

This approach emphasizes synergy patterns as part of the recovery from hemiplegia with a sequential progression from synergies into voluntary movement control.

Answer 1

Brunnstrom’s Approach

Question 2

Brunnstrom

What is the Brunnstrom approach based on?

Answer 2

• on the reflex hierarchical model of motor control
• ❗️ It was developed based on Brunnstrom’s understanding of sensorimotor mechanisms & neurophysiology and what she observed in her patient’s with hemiplegia:

Question 3

Brunnstrom

In the theory of the hierarchy of the nervous system, evolution is the passage from most simple to most complex, most automatic to most voluntary. Motor recovery after hemiplegia constitutes a reversal of the disintegration of motor function, this is sometimes referred as:

Answer 3

“evolution in reverse”

Question 4

Brunnstrom

the two main contributions of the Brunnstrom approach were:

Answer 4

• Basic limb synergies: stereotyped mov’t patterns lacking individual joint isolation
• Stages of recovery: sequence of events occurring following a stroke

Question 5

Brunnstrom

Upper extremity flexion synergy:

Answer 5

• Scapula retraction, elevation, adduction
• Shoulder flexion, abduction, and external rotation
• Elbow flexion
• Forearm supination
• Wrist flexion
• Finger flexion

Question 6

Brunnstrom

Upper extremity extension synergy:

Answer 6

• Scapula depression and abduction
• Shoulder extension adduction and internal rotation
• Elbow extension
• Forearm pronation
• Wrist flexion
• Finger flexion

Question 7

Brunnstrom

Lower extremity flexion synergy:

Answer 7

• Hip flexion, abduction and external rotation.
• Knee flexion
• Ankle dorsiflexion and inversion

Question 8

Brunnstrom

Lower extremity extension synergy:

Answer 8

• Hip extension, adduction, internal rotation
• Knee extension
• Ankle plantar flexion and inversion

Question 9

Brunnstrom

stages of recovery after a stroke:

Answer 9

1. Flaccid stage: no voluntary mvmt, limb feels heavy and little or no resistance is felt.
2. No volitional mvmt, spasticity developing
3. Highest point of spasticity, no isolation of movement.
4. One joint isolation only, decreased spasticity
5. Two joint isolation possible, spasticity continues to decrease.
6. Spasticity is absent, 3 joint isolation is possible.
7. Restoration of normal motor function is complete including timing, sequence, and coordination

Question 10

Brunnstrom

No voluntary or reflexive movement can be elicited in either involved limb, and when moved passively the limbs feel heavy and little to no resistance is felt

Answer 10

Stage 1

Question 11

Brunnstrom

NO volitional movement present. Some components of the basic limb synergies may be noted BUT ONLY reflexively, on an attempt to move, or as associated reaction

Answer 11

stage 2

Question 12

Brunnstrom

Spasticity is at the highest point (may be severe), Basic limb synergies noted on
command for active movement. NO isolation of movement is present. Some patients stay in this stage long and others never progress

Answer 12

Stage 3

Question 13

Brunnstrom

spasticity starts to decrease,  and movement may begin to deviate from basic limb synergy. ONE JOINT isolation only:

Answer 13

stage 4

Question 14

Brunnstrom

TWO JOINT isolation is possible, spasticity continues to decrease

Answer 14

stage 5

Question 15

Brunnstrom

THREE JOINT isolation possible, spasticity is absent

Answer 15

stage 6

Question 16

Brunnstrom

at this stage, Restoration of normal motor function is complete including timing, sequence, and coordination

Answer 16

stage 7

Question 17

Brunnstrom

Brunnstrom’s treatment principles regarding stages of recovery

Answer 17

• DO NOT PERFECT A SYNERGY! Once initial control is achieved, out of synergy combinations are facilitated
• Use of resistance to elicit associated reactions
• Use of associated reactions & primitive reflexes to influence background ‘stiffness’ (resting tone): ATNR, STNR, TLR, homolateral limb synkinesis, Raimste’s
• Use sensory input through tapping, stroking & quick stretching to facilitate muscle contraction
• Use of reciprocal inhibition to voluntarily deviate from synergy

Question 18

Brunnstrom

Brunnstrom’s Summary

Answer 18

Question 19

Brunnstrom

Fugl Meyer Assessment of Motor Recovery

(FMA)

Answer 19

Evaluates and measures recovery in post-stroke hemiplegic patients

Question 20

Brunnstrom

Elevation of the affected arm above the horizontal evokes an extension and abduction response of the fingers.

Answer 20

Souque’s phenomena

Question 21

Brunnstrom

Basic limb synergy develops, no voluntary movement, can be done as spasticity appears but is not marked.

Answer 21

stage 2

Question 22

Brunnstrom

: Basic limb synergy develops voluntarily and is marked, spasticity is marked. (This is the stage of maximal spasticity).

Question 23

Brunnstrom

Spasticity begins to decrease, four movement combinations deviate from basic limb synergies and become available, which are: Placing the hand behind the body, alternative pronation- supination with the elbow at 90° flexion and elevation of the arm to a forward horizontal position

Answer 23

stage 4

Question 24

Brunnstrom

There is relative independence of the basic limb synergies. Spasticity is wanning, and movements can be performed as arm raising to a side horizontal position, alternative pronation- supination with the elbow extended and bringing hand over the head.

Answer 24

stage 5

Question 25

Brunnstrom

which movements can a patient perform in Brunnstrom’s stage 4 of recovery?

Answer 25

• Placing the hand behind the body
• alternative pronation- supination with the elbow at 90° flexion
• elevation of the arm to a forward horizontal position

Question 26

Brunnstrom

which movements can a patient perform in Brunnstrom’s stage 5 of recovery?

Answer 26

• raising arm to a side horizontal position,
• alternative pronation- supination with the elbow extended
• bringing hand over the head.