BRUNNSTROM'S APPROACH Flashcards

Limb synergies, stages of recovery after hemiplegia

1
Q

Brunnstrom

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

A

Brunnstrom’s Approach

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2
Q

Brunnstrom

What is the Brunnstrom approach based on?

A
  • 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:
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3
Q

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:

A

“evolution in reverse”

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4
Q

Brunnstrom

the two main contributions of the Brunnstrom approach were:

A
  • Basic limb synergies: stereotyped mov’t patterns lacking individual joint isolation
  • Stages of recovery: sequence of events occurring following a stroke
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5
Q

Brunnstrom

Upper extremity flexion synergy:

A
  • Scapula retraction, elevation, adduction
  • Shoulder flexion, abduction, and external rotation
  • Elbow flexion
  • Forearm supination
  • Wrist flexion
  • Finger flexion
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6
Q

Brunnstrom

Upper extremity extension synergy:

A
  • Scapula depression and abduction
  • Shoulder extension adduction and internal rotation
  • Elbow extension
  • Forearm pronation
  • Wrist flexion
  • Finger flexion
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7
Q

Brunnstrom

Lower extremity flexion synergy:

A
  • Hip flexion, abduction and external rotation.
  • Knee flexion
  • Ankle dorsiflexion and inversion
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8
Q

Brunnstrom

Lower extremity extension synergy:

A
  • Hip extension, adduction, internal rotation
  • Knee extension
  • Ankle plantar flexion and inversion
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9
Q

Brunnstrom

stages of recovery after a stroke:

A
  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
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10
Q

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

A

Stage 1

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11
Q

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

A

stage 2

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12
Q

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

A

Stage 3

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13
Q

Brunnstrom

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

A

stage 4

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14
Q

Brunnstrom

TWO JOINT isolation is possible, spasticity continues to decrease

A

stage 5

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15
Q

Brunnstrom

THREE JOINT isolation possible, spasticity is absent

A

stage 6

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16
Q

Brunnstrom

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

A

stage 7

17
Q

Brunnstrom

Brunnstrom’s treatment principles regarding stages of recovery

A
  • 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
18
Q

Brunnstrom

Brunnstrom’s Summary

A
19
Q

Brunnstrom

Fugl Meyer Assessment of Motor Recovery

(FMA)

A

Evaluates and measures recovery in post-stroke hemiplegic patients

20
Q

Brunnstrom

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

A

Souque’s phenomena

21
Q

Brunnstrom

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

A

stage 2

22
Q

Brunnstrom

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

A
23
Q

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

A

stage 4

24
Q

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.

A

stage 5

25
Q

Brunnstrom

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

A
  • Placing the hand behind the body
  • alternative pronation- supination with the elbow at 90° flexion
  • elevation of the arm to a forward horizontal position
26
Q

Brunnstrom

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

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