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PT10117 Neurological Evaluation and Intervention > L3 Part 1: Brunstromm’s Movement Therapy > Flashcards

L3 Part 1: Brunstromm’s Movement Therapy Flashcards

1
Q

Definition

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

A

Brunnstrom’s Movement Therapy

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2
Q

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

A

Primitive Synergystic Patterns

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3
Q

What concept does the Brunnstrom Movement Therapy rely on?

A

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

(Limb Synergies and Primitive Reflexes)

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4
Q

Identification

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

A
  1. Normal processes of recovery
  2. Normal patterns
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5
Q

Overview

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

A

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.

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6
Q

Overview: Additional Info

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

A

Because the next stage from spasiticty is recovery.

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

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7
Q

Magnus (Associate of Sherrington)

Within the human body, this regulates our bodily functions.

A

A set of fundamental patterns

These patterns are subject to variation and alteration

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8
Q

Magnus (Associate of Sherrington)

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

A

Primitive Spinal Cord Patterns

Primitive Reflexes → Spinal Reflex → Brainstem Reflex → Cortical Reflex

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9
Q

Magnus (Associate of Sherrington)

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

A

Contralateral Affectation (In half side of the body)

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

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10
Q

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

A

Lowest Motor Control

Ex. Breathing, Eye movement

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11
Q

Group Motor Centers

Re-representing the muscles of the body in numerous combinations

More voluntary and less automatic

A

Middle Motor Center

Ex. Sneezing, blinking, urination, defecation

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12
Q

Group Motor Centers

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

A

Highest Motor Center

Ex. Walking, sitting, and standing

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13
Q

Identify the Postural Reflex and Motor Development

Cortex

A

Postural Reflex: Equilibrium Reactions
Motor Development: Bipedal Function

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14
Q

Identify the Postural Reflex and Motor Development

Midbrain

A

Postural Reflex: Righting Reactions
Motor Development: Quadrupedal Function

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15
Q

Identify the Postural Reflex and Motor Development

Brainstem, Spinal Cord

A

Postural Reflex: Primitive Reflex
Motor Development: Apedal Function

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16
Q

Overview

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

A

Hughling Jackson’s Theory

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17
Q

Hughling Jackson’s Theory

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

A

Evolution in Reverse

Movement becomes primitive, reflexive, and automatic

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18
Q

Hughling Jackson’s Theory

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

A

Pt will have to rely on the lower motor center

Allows few movements and combinations

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19
Q

Hughling Jackson’s Theory

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

A

Internal Capsule Lesion

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20
Q

Hughling Jackson’s Theory

Less severely involved patients rely on which motor center?

A

Middle motor centers

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21
Q

Hughling Jackson’s Theory

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

A

A normal process of recovery

This is in the perspective of Brunnstrom

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22
Q

Observations of Recovery following Stroke

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

↑ Presence of spasticity, ↑ Synergistic patterns

A

Basic Limb Synergies

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23
Q

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.

A

Associated Reaction/Movements

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24
Q

Observations of Recovery following Stroke

Why should you not give stroke pts external resistance

A

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

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25
Q

Observations of Recovery following Stroke

Seen during the early spastic stage as either a reflex response or as a voluntary movement (or both)

Stereotyped

A

Hemiplegic Limb Synergies

Ex. Starfish position → Frog Leg Position

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26
Q

Observations of Recovery following Stroke

Occurs in reponse to stimulus or voluntary effort or Both

A

Mass Movement Patterns

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27
Q

Synergy Patterns

UE Flexor Synergy

A
  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)
28
Q

Synergy Patterns

UE Extensor Synergy

A
  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
29
Q

Syngery Patterns

Giving resistance to normal side does what?

A

Heightens the synergy of the affected side

Thus resistance must not be given to stroke pts

30
Q

Synergy Patterns

LE Flexor Synergy

A
  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
31
Q

Synergy Patterns

LE Flexor Synergy

A
  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
32
Q

Synergy Patterns

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

A
  1. Flexor synergy
  2. Extensor Synergy

It is easier to walk with an extensor synergy.

33
Q

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

A

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

34
Q

Combination of the Strongest Synergies

Responsible for the strongest component of extension synergy

(Adduction IR or Adduction Flexion)

A

Pectoralis Major

35
Q

Combination of the Strongest Synergies

Next storngest component of extensor synergy.

In long-stnading hemiplegic condition

A

FA Pronation

36
Q

Combination of the Strongest Synergies

This is a stronger component to the elbow extension because they are antigravity muscles, and more tension

A

Elbow Flexor

37
Q

Combination of the Strongest Synergies

What reinforces the extensor synergy and appease in early spastic period of recovery?

A

Weight-bearing

38
Q

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

A

Homolateral Limb Synkinesis

Can be reinforces by neck reflexes

39
Q

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

A

Ramiste’s Phenomena (Resistance to (n) Side)

Applicable to Stroke Pts

40
Q

Associated Reactions

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

A

Associated Reactions Evoked by Yawning, Snzeeing, & Coughing

41
Q

Associated Reactions

Reaction evoked when yawning

A

Reaches forward and hand open up

42
Q

Associated Reactions

Reaction evoked when sneezing & coughing

A

Evoke sudden muscle contraction for a short duration

43
Q

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

A

Asymmetric Tonic Neck Reflex (ATNR)

44
Q

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.

A

Symmetric Tonic Neck Relfex (STNR)

45
Q

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)

A

Tonic Lumbar Reflex

46
Q

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

A

Tonic Labyrinthine Reflex (TBR)

47
Q

Treatment and Recovery Stages

What are the principals of the Brunnstrom Treatment?

A
  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
48
Q

Treatment and Recovery Stages

What are the goals of the Brunnstrom Treatment?

A
  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.
49
Q

Stages of Recovery (Brunnstrom)

No “volunary” movement on the affected side can be initiated

A

Initial Flaccidity

50
Q

Stages of Recovery (Brunnstrom)

Basic synergy patterns appear with minimal voluntary movements may be present

A

Recovery beings (Spasticity Appears)

51
Q

Stages of Recovery (Brunnstrom)

Increases Spasticity

A

Pt regains voluntary control

Patient gains voluntary control over synergies

52
Q

Stages of Recovery (Brunnstrom)

Decrease in Spasticity

A

Spasticity Declines

Some movement pattern out of synergy are masters but still predominate

53
Q

Stages of Recovery (Brunnstrom)

If progress continues, more complex movement combinations are learned as the basic synergies lose their dominance over motor acts

A

Recovery Continues

54
Q

Stages of Recovery (Brunnstrom)

Individual joint movements become possible and coordination approaches normal

A

Spasticity Disappears

55
Q

Stages of Recovery (Brunnstrom)

Last stage or absence of synergy patterns

A

Normal function is restored

Pt will not be discharged but improve gait, coordination, and balance

56
Q

Hand Reactions

What are the restoration stages of Hand Reaction?

A
  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
57
Q

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.

A

Proprioceptive or Proximal Traction Response

Expect a rebound or resistance

58
Q

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

A

True Grasp Reflex

59
Q

Hand Reactions

Where is the response of the True Grasp Reflex obtained?

A

Over the MCP and IP joints of all 5 digits

60
Q

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.

A

Instinctive Grasp Reaction

61
Q

Hand Reactions

What are the stimulus and response of the IGR

A

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

62
Q

Hand Reactions

Location of IGR and IAR Lesions

A

IGR: Frontal Lobe
IAR: Parietal Lobe

63
Q

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.

A

Instinctive Avoiding Reaction

64
Q

Hand Reactions

What is the stimulus and response of IAR?

A

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

65
Q

Hand Reactions

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

A

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

PT10117 Neurological Evaluation and Intervention (5 decks)

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