BRUNNSTROM'S APPROACH Flashcards
Limb synergies, stages of recovery after hemiplegia
Brunnstrom
This approach emphasizes synergy patterns as part of the recovery from hemiplegia with a sequential progression from synergies into voluntary movement control.
Brunnstrom’s Approach
Brunnstrom
What is the Brunnstrom approach based on?
- 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:
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:
“evolution in reverse”
Brunnstrom
the two main contributions of the Brunnstrom approach were:
- Basic limb synergies: stereotyped mov’t patterns lacking individual joint isolation
- Stages of recovery: sequence of events occurring following a stroke
Brunnstrom
Upper extremity flexion synergy:
- Scapula retraction, elevation, adduction
- Shoulder flexion, abduction, and external rotation
- Elbow flexion
- Forearm supination
- Wrist flexion
- Finger flexion
Brunnstrom
Upper extremity extension synergy:
- Scapula depression and abduction
- Shoulder extension adduction and internal rotation
- Elbow extension
- Forearm pronation
- Wrist flexion
- Finger flexion
Brunnstrom
Lower extremity flexion synergy:
- Hip flexion, abduction and external rotation.
- Knee flexion
- Ankle dorsiflexion and inversion
Brunnstrom
Lower extremity extension synergy:
- Hip extension, adduction, internal rotation
- Knee extension
- Ankle plantar flexion and inversion
Brunnstrom
stages of recovery after a stroke:
- Flaccid stage: no voluntary mvmt, limb feels heavy and little or no resistance is felt.
- No volitional mvmt, spasticity developing
- Highest point of spasticity, no isolation of movement.
- One joint isolation only, decreased spasticity
- Two joint isolation possible, spasticity continues to decrease.
- Spasticity is absent, 3 joint isolation is possible.
- Restoration of normal motor function is complete including timing, sequence, and coordination
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
Stage 1
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
stage 2
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
Stage 3
Brunnstrom
spasticity starts to decrease, and movement may begin to deviate from basic limb synergy. ONE JOINT isolation only:
stage 4
Brunnstrom
TWO JOINT isolation is possible, spasticity continues to decrease
stage 5
Brunnstrom
THREE JOINT isolation possible, spasticity is absent
stage 6