L3 Part 1: Brunstromm’s Movement Therapy

Question 1

Definition

It is the facilitation and normalization of motor function through primitive reflexes and abnormal patterns, pathological response to facilitate movements.

Answer 1

Brunnstrom’s Movement Therapy

Question 2

The movement therapy uses these patterns in order to improve motor control through central facilitation.

Answer 2

Primitive Synergystic Patterns

Question 3

What concept does the Brunnstrom Movement Therapy rely on?

Answer 3

The damaged CNS regressed to older or less mature patterns of movements

(Limb Synergies and Primitive Reflexes)

Question 4

Identification

Synergies, primitive reflexes, and other abnormal movements are considered as (1) before (2) are attained

Answer 4

1. Normal processes of recovery
2. Normal patterns

Question 5

Overview

The pts are taught what at a particular point during their recovery phase?

Answer 5

Use and voluntarily control the motor patterns available to them

Allowing these abnormal movements is temporary.

The application of cutaneous and proprioceptive stimuli combined with central facilitation can amplify targeted synergies.

Question 6

Overview: Additional Info

Why is it better that the pt is presenting with spasticity?

Answer 6

Because the next stage from spasiticty is recovery.

Recovery will be must faster since the time duration to it is closer.

Question 7

Magnus (Associate of Sherrington)

Within the human body, this regulates our bodily functions.

Answer 7

A set of fundamental patterns

These patterns are subject to variation and alteration

Question 8

Magnus (Associate of Sherrington)

What are the basic limb synergies of hemiplegic patients throughout the evolutionary process?

Answer 8

Primitive Spinal Cord Patterns

Primitive Reflexes → Spinal Reflex → Brainstem Reflex → Cortical Reflex

Question 9

Magnus (Associate of Sherrington)

When a lesion affects a certain artery, this affectation will be present.

Answer 9

Contralateral Affectation (In half side of the body)

↑ Motions in the affected side, ↑ Presentation of Synergistic Pattern

Question 10

Groups of Motor Centers

Represent all the muscles of the body in a few movement combinations that are mostly automatic activities of the body.

Do not need volitional control

Answer 10

Lowest Motor Control

Ex. Breathing, Eye movement

Question 11

Group Motor Centers

Re-representing the muscles of the body in numerous combinations

More voluntary and less automatic

Answer 11

Middle Motor Center

Ex. Sneezing, blinking, urination, defecation

Question 12

Group Motor Centers

Re-representing the muscles of the body in the most numerous and most voluntary combinations.

Answer 12

Highest Motor Center

Ex. Walking, sitting, and standing

Question 13

Identify the Postural Reflex and Motor Development

Cortex

Answer 13

Postural Reflex: Equilibrium Reactions
Motor Development: Bipedal Function

Question 14

Identify the Postural Reflex and Motor Development

Midbrain

Answer 14

Postural Reflex: Righting Reactions
Motor Development: Quadrupedal Function

Question 15

Identify the Postural Reflex and Motor Development

Brainstem, Spinal Cord

Answer 15

Postural Reflex: Primitive Reflex
Motor Development: Apedal Function

Question 16

Overview

This theory falls under Brunnstrom’s Movement Therapy in relation to the nervous system when it is injured (CVA)

Answer 16

Hughling Jackson’s Theory

Question 17

Hughling Jackson’s Theory

When the nervous System is injured (CVA), an individual goes through what?

Answer 17

Evolution in Reverse

Movement becomes primitive, reflexive, and automatic

Question 18

Hughling Jackson’s Theory

If a pt’s middle motor is affected, what will the patient do?

Answer 18

Pt will have to rely on the lower motor center

Allows few movements and combinations

Question 19

Hughling Jackson’s Theory

This lesion occurs with severely involved patients & remain indefinitely in a stage that allows few movement combinations

Answer 19

Internal Capsule Lesion

Question 20

Hughling Jackson’s Theory

Less severely involved patients rely on which motor center?

Answer 20

Middle motor centers

Question 21

Hughling Jackson’s Theory

Changes in tone and the presence of reflexes considered as what?

Answer 21

A normal process of recovery

This is in the perspective of Brunnstrom

Question 22

Observations of Recovery following Stroke

Stereotyped, primitive movement patterns associated with the prescne of spacticity.

↑ Presence of spasticity, ↑ Synergistic patterns

Answer 22

Basic Limb Synergies

Question 23

Obsevations of Recovery following Stroke

Abnormal automatic repsonse of the involved limb to either voluntary effort or reflex stimulation and can be elicit reflexly or due to resistance.

Answer 23

Associated Reaction/Movements

Question 24

Observations of Recovery following Stroke

Why should you not give stroke pts external resistance

Answer 24

Resistance must not be given to pts with spasticity. Stroke pts are spastic and when performing Brunnstrom Technique, we want the spasticity to elicit the synergistic patterns.

Can be given when they are in the later stages of recovery / ↑ strength

Question 25

# Observations of Recovery following Stroke Seen during the early spastic stage as either a reflex response or as a voluntary movement (or both) | Stereotyped

Answer 25

Hemiplegic Limb Synergies | Ex. Starfish position → Frog Leg Position

Question 26

# Observations of Recovery following Stroke Occurs in reponse to stimulus or voluntary effort or Both

Answer 26

Mass Movement Patterns

Question 27

# Synergy Patterns UE Flexor Synergy

Answer 27

1. Retratction/elevation of shoulder girdle 2. External rotation of shoulder 3. Abduction of shoulder in 90º 4. Flexion of the elbow to an acute angle 5. Full-range supination the forearm Stimulus to Reflex Response: Resist Elbow Flexion Response to Voluntary Movement: Rot of head to (N)

Question 28

# Synergy Patterns UE Extensor Synergy

Answer 28

1. Fixation of the shoulder girdle in a protracted position 2. Internal rotation of shoulder 3. Adduction of the arm in front of the body 4. Extension of the elbow (complete range) 5. Full-range prontation of the forearm Stimulus to Reflex Response: Resist to push on the N Response to Voluntary Movement: Rot of head to affected

Question 29

# Syngery Patterns Giving resistance to normal side does what?

Answer 29

Heightens the synergy of the affected side | Thus resistance must not be given to stroke pts

Question 30

# Synergy Patterns LE Flexor Synergy

Answer 30

1. Flexion of the hip 2. Abduction and external rotation of hip 3. Flexion of knee to about 90º 4. DF and inversion of ankle 5. DF of toes Stimulus to Reflex Response: Resist PF on N Response to Voluntary Movement:Rot of head to N

Question 31

# Synergy Patterns LE Flexor Synergy

Answer 31

1. Extension of hip 2. Adduction and internal rotation of hip 3. Extension of knee 4. PF and inversion of ankle 5. PF of toes Stimulus to Reflex Response: Resist DF on N Response to Voluntary Movement: Rot of head to affected side

Question 32

# Synergy Patterns (1) is more common in UE while (2) is more common in LE.

Answer 32

1. Flexor synergy 2. Extensor Synergy | It is easier to walk with an extensor synergy.

Question 33

What are the key muscles not usually involed in either synergy?

Answer 33

FLATS Fingers, Latissimus Dorsi, Ankle Evertors, Teres Major, Serratus Anterior | Hard to treat d/t these muscles are the ones used in the typical ADLs

Question 34

# Combination of the Strongest Synergies Responsible for the strongest component of extension synergy | (Adduction IR or Adduction Flexion)

Answer 34

Pectoralis Major

Question 35

# Combination of the Strongest Synergies Next storngest component of extensor synergy. | In long-stnading hemiplegic condition

Answer 35

FA Pronation

Question 36

# Combination of the Strongest Synergies This is a stronger component to the elbow extension because they are antigravity muscles, and more tension

Answer 36

Elbow Flexor

Question 37

# Combination of the Strongest Synergies What reinforces the extensor synergy and appease in early spastic period of recovery?

Answer 37

Weight-bearing

Question 38

# Associated Reactions The response of one extremity to stimulus will elicit the same responses in its ipsilateral extremity | Ex. Flexion of one limb evokes or facilitate flexion on the LE

Answer 38

Homolateral Limb Synkinesis | Can be reinforces by neck reflexes

Question 39

# Associated Reactions Resisted abduction or adduction of the normal limb evokes a similar reaction in the affected limb. | Para makalaban yung isa, yung isa lalaban din

Answer 39

Ramiste's Phenomena (Resistance to (n) Side) | Applicable to Stroke Pts

Question 40

# Associated Reactions Synergies d/t stimulus where the affected side suddenly creates movement

Answer 40

Associated Reactions Evoked by Yawning, Snzeeing, & Coughing

Question 41

# Associated Reactions Reaction evoked when yawning

Answer 41

Reaches forward and hand open up

Question 42

# Associated Reactions Reaction evoked when sneezing & coughing

Answer 42

Evoke sudden muscle contraction for a short duration

Question 43

# Additudinal or Postural Responses The head rotation to the left causes extension of left arm and leg and flexion of the right arm and leg | And Vice Versa

Answer 43

Asymmetric Tonic Neck Reflex (ATNR)

Question 44

# Additudinal or Postural Responses Flexion of the neck results in flexion of the arms and extension of the legs. Extension of the neck results to extension of the arms and flexion of the legs.

Answer 44

Symmetric Tonic Neck Relfex (STNR)

Question 45

# Additudinal or Postural Responses Elicited by changes in position of the upper part of the body in respect to the pelvis Rotation of the anterior part of the chest to the R facilitates flexion of the R upper lumb and ext of the R lower limb | (If strong, they make the voluntary movement difficult)

Answer 45

Tonic Lumbar Reflex

Question 46

# Additudinal or Postural Responses The prone lying position facilitates flexion and the supine position facilitates extension | Can also be taught as inhibition of extensor tone in the prone position

Answer 46

Tonic Labyrinthine Reflex (TBR)

Question 47

# Treatment and Recovery Stages What are the principals of the Brunnstrom Treatment?

Answer 47

1. Facilitate pts progress throughout the recovery stages 2. Use of postural and attitudinal reflexes to inc to dec muscle tone 3. Stimulation of the skin over the muscles Resistance facilitates contraction

Question 48

# Treatment and Recovery Stages What are the goals of the Brunnstrom Treatment?

Answer 48

1. Emphasize the synergistic pattern fo movement that develops during recovery from hemiplegia 2. Encoureages development of flexor and extensor synergies during early recovery, hoping that synergic activation of muscles would, with training, transition into voluntary activation of movements.

Question 49

# Stages of Recovery (Brunnstrom) No "volunary" movement on the affected side can be initiated

Answer 49

Initial Flaccidity

Question 50

# Stages of Recovery (Brunnstrom) Basic synergy patterns appear with minimal voluntary movements may be present

Answer 50

Recovery beings (Spasticity Appears)

Question 51

# Stages of Recovery (Brunnstrom) Increases Spasticity

Answer 51

Pt regains voluntary control | Patient gains voluntary control over synergies

Question 52

# Stages of Recovery (Brunnstrom) Decrease in Spasticity

Answer 52

Spasticity Declines | Some movement pattern out of synergy are masters but still predominate

Question 53

# Stages of Recovery (Brunnstrom) If progress continues, more complex movement combinations are learned as the basic synergies lose their dominance over motor acts

Answer 53

Recovery Continues

Question 54

# Stages of Recovery (Brunnstrom) Individual joint movements become possible and coordination approaches normal

Answer 54

Spasticity Disappears

Question 55

# Stages of Recovery (Brunnstrom) Last stage or absence of synergy patterns

Answer 55

Normal function is restored | Pt will not be discharged but improve gait, coordination, and balance

Question 56

# Hand Reactions What are the restoration stages of Hand Reaction?

Answer 56

1. Tendon reflex hyperactively return 2. Spasticity develops, resistance to passive motion is felt 3. Voluntary finger flexion occurs if facilitated by proprioceptive stimuli 4. "Proprioceptive response" can be elicited 5. Control of hand movement without prorioceptive stimuli begins 6. As spasticity declines grasp is greatly reinforced by tactile stimuli at the palm of the hand 7. As spasticity decreases further, true grasp can be elicited

Question 57

# Hand Reactions This is a streatch of the flexor muscles of one of the joints of the upper limb. Any joint evokes or facilitates contreaction of the flexor muscles of tall the other joints so that a total shortening of the limb may occur.

Answer 57

Proprioceptive or Proximal Traction Response | Expect a rebound or resistance

Question 58

# Hand Reactions This is elicited by a distally moving deep pressure over certain areas of the palmar surface of the hands and digits. Pt who elicits this could progress to full recovery

Answer 58

True Grasp Reflex

Question 59

# Hand Reactions Where is the response of the True Grasp Reflex obtained?

Answer 59

Over the MCP and IP joints of all 5 digits

Question 60

# Hand Reactions Once this reflex is elicited, the person is unable to release the object in the hand without an object in hand. The grip is tightened if there is an attempt in withdrawal of the object.

Answer 60

Instinctive Grasp Reaction

Question 61

# Hand Reactions What are the stimulus and response of the IGR

Answer 61

Stimulus: Stationary Contact over the palmar of the hand Response: Closure of the hand

Question 62

# Hand Reactions Location of IGR and IAR Lesions

Answer 62

IGR: Frontal Lobe IAR: Parietal Lobe

Question 63

# Hand Reactions Called the "Lover's Extension Phenomena" where it can be elicited when there is stroking ovet the palmar surface resulting to an exaggerated response.

Answer 63

Instinctive Avoiding Reaction

Question 64

# Hand Reactions What is the stimulus and response of IAR?

Answer 64

Stimulus: Arm in forward and upward or sideways direction Response: Thumb and finger hyperextension

Question 65

# Hand Reactions What phenomenon is the IAR similar to and what is its stimulus and response?

Answer 65

Souque's Phenomenon Stimulus: Elevation of the affected arm Response: Fist open, fingers extended