Stroke Rehabilitation Brunnstrom stages

Stroke rehabilitation based on the Brunnstrom Approach (Brunnstrom Stages of Recovery) is a therapeutic framework that leverages synergistic movement patterns (abnormal synergies) post-stroke to facilitate motor recovery. The approach acknowledges that recovery progresses through predictable stages, and therapy is tailored to each stage to maximize functional improvement.

Brunnstrom’s 7 Stages of Stroke Recovery

Brunnstrom classified motor recovery into seven stages, reflecting the transition from flaccidity to voluntary control:

  1. Stage 1: Flaccidity

    • No voluntary movement.

    • Muscles are limp (flaccid paralysis).

    • Rehab Focus: Passive ROM exercises, positioning, sensory stimulation.

  2. Stage 2: Spasticity Appears & Basic Limb Synergies Emerge

    • Spasticity (muscle tightness) begins.

    • Minimal voluntary movement in synergy patterns (flexor/extensor).

    • Rehab Focus: Use synergy patterns to initiate movement (e.g., facilitating flexion in the arm).

  3. Stage 3: Increased Spasticity & Synergy Dominance

    • Spasticity peaks.

    • Voluntary movement only in obligatory synergies (mass movement patterns).

    • Rehab Focus: Strengthen within synergies, encourage movement outside synergies.

  4. Stage 4: Decreasing Spasticity & Some Synergy Breaking

    • Spasticity declines.

    • Some voluntary control outside synergies (e.g., partial finger movement).

    • Rehab Focus: Train isolated movements, improve coordination.

  5. Stage 5: Further Synergy Breakdown & More Complex Movement

    • Spasticity further decreases.

    • Voluntary movements improve with less synergy dependence.

    • Rehab Focus: Refine movement, increase speed/coordination.

  6. Stage 6: Spasticity Disappears & Near-Normal Coordination

    • Minimal spasticity.

    • Isolated joint movements with good control.

    • Rehab Focus: Fine motor skills, endurance, advanced activities.

  7. Stage 7: Normal Motor Function

    • Full recovery of voluntary movement.

    • No spasticity or synergy interference.

    • Rehab Focus: Maintain function, prevent compensatory habits.

Key Principles of Brunnstrom Rehabilitation

  • Use synergies early (Stages 2-3) to initiate movement.

  • Progressively break synergies (Stages 4-5) for isolated control.

  • Encourage voluntary control (Stages 6-7) for refined movement.

  • Combine with other techniques (e.g., PNF, task-specific training).

Clinical Application

Brunnstrom’s approach is complementary to other therapies like Bobath (NDT) or constraint-induced movement therapy (CIMT), depending on the patient’s recovery stage.

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