Brunnstrom tx approach - 2 Flashcards
associated reactions include
UE
LE
homolateral limb synkinesis
ramiste phenomenom
raimiste like phenomen
souques phenomen
rowing patterns
marie foix reflex
UE associated reactions
flexion typically leads to flexion
extension typically leads to extension
LE associated reactions
flexion of the unaffected LE may result in extension of the affected LE
extension of the unaffected LE may result in flexion of the affected LE
homolateral limb synkinesis
movement of the unaffected UE/LE promotes movement of the other extremity of affected side in same direction at the same time
both UE or LE move into flexion or extension direction
when is homolateral limb synkinesis common
spastic hemiplegia
raimiste’s phenomenon
ABD of ADD or the unaffected LE results in the same motion of the affected LE
this is with the knee straight and bent
ramiste-like phenomenon –> ABD & ADD
of the unaffected UE results in the same motion of the affected UE
souques pehnomenon
reflex finger extension when the affected arm is passively stretched past 90 degrees of flexion
rowing patterns
capitalizing on B/L symmetrical activity
another form of an associated reaction
as pt to pull back with non-involved arm –> rowing pattern
hope to see involved arm move as wel
can use thumb grip or shake hands with pt
marie-foix reflex
not a postural reflex
movement into PF and inversion causes a reflex DF at the ankle and hip flexion at the hip
how many stages does brunnstrom have
7
recovery from CVA
no stage is revisited
no stage is skipped
pt can plateau at any stage
UE and LE may be in different stages
no set amount of time you will spend in each stage
brunnstrom stage 1
flaccid involved limb
no voluntary movement
when does brunnstrom stage 1 present
immediately following acute episode of CVA/neurologic event
as recovery begins –> brunnstrom stage 2
minimal movement present/minimal associated reactions
how is movement available –> brunnstrom stage 2
present in synergy
what is starting to develop –> brunnstrom stage 2
spasticity
dominant muscle groups are already in synergy
brunnstrom stage 3
voluntary control if movement synergy
movement –> brunnstrom stage 3
may not be able to go through the full available motion w/in synergy
brunnstrom stage 3 has
peak spasticity
often severe
what does the pt begin having –> brunnstrom stage 4
basic movements outside of synergy
basic movements outside of synergy –> brunnstrom stage 4
very difficult at first
pt can place hand behind their body
elevate arm to forward horizontal position
pronation/supination available w/ elbow flexed to 90
what is happening w/ spasticity –> brunnstrom stage 4
slowly starting to decline
still obvious
spasticty –> brunnstrom stage 5
continued decreasing spasticity
what is now possible –> brunnstrom stage 5
difficult movements out of synergy are possible
what does brunnstrom stage 5 include
decreased dominance of synergy patterns
decreased dominance of synergy patterns –> brunnstrom stage 5
can raise arm to side w/ elbow straight
arm can now be raised (flexed) and possible overhead
pronation/supination w/ elbow extended is now possible
what is occurring in brunnstrom stage 6
individual isolated movements
approaching –> brunnstrom stage 6
normal
what may a well trained eye see –> brunnstrom stage 6
awkwardness w/ movement d/t basic limb strategies
not obvious
spasticity –> brunnstrom stage 6
none w/ passive movements of the limb
brunnstrom stage 7
normal motor fxn
normal motor fxn –> brunnstrom stage 7
pt can resume all former fxn at optimal level
how many people progress through stages of motor recovry
no clear data
what do we do if a pt seems to have difficulty w/ activity in a certain stage
make easier
ultimate goal
progress pt through stages of recovery
what should we facilitate
normal fxn as we can
how do we separate stages
1-3
4-6
7
stages 1-3
pt synergy and spasticity is increasing
stages 4-6
pt synergy and spasticity is decreasing
stage 7
pt is “normal” and can now work on other things
trunk technique
arm cradling
what is arm cradling
unaffected extremity supports the affected extremity
trunk movements
flexion
oblique flexion
lateral movements
rotation
rotation w/ alternate head movements
