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Recovery begins with developing spasticity, increased reflexes and synergic movement patterns termed obligatory synergies. These obligatory synergies may manifest with the inclusion of all or only part of the synergic movement pattern and they occur as a result of reactions to stimuli or minimal
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Spasticity continues to decline, and there is a greater ability for the patient to move freely from the synergy pattern. Here the patient is also able to demonstrate isolated joint movements, and more complex movement combinations.
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The influence of the
Brunnstrom Approach on the development of the FMA is most evident within the Motor sub-scale for both the upper and lower extremity where there is a strong emphasis on the evaluation of muscle synergies.
198:. A patient can plateau at any of these stages, but will generally follow this sequence if he or she makes a full recovery. The variability found between patients depends on the location and severity of the
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Spasticity and the influence of synergy begins to decline and the patient is able to move with less restrictions. The ease of these movements progresses from difficult to easy within this stage.
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Each component of the FMA may be evaluated and scored individually or, a total possible summative score for all 5 sub-scales of 226 may be used to track a patient's degree of recovery.
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Spasticity becomes more pronounced and obligatory synergies become strong. The patient gains voluntary control through the synergy pattern, but may have a limited range within it.
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Brunnstrom (1966, 1970) and Sawner (1992) also described the process of recovery following stroke-induced hemiplegia. The process was divided into a number of stages:
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Fugl-Meyer, AR; Jääskö, L; Leyman, I; Olsson, S; Steglind, S (1975). "The post-stroke hemiplegic patient. 1. a method for evaluation of physical performance".
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The six component stages of the
Brunnstrom Approach have influenced the development of a variety of standardized assessment methods used by
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If progress continues, more complex movement combinations are learned as the basic synergies lose their dominance over motor acts
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Immediately following a stroke there is a period of flaccidity whereby no movement of the limbs on the affected side occurs.
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activation of muscles will, with training, transition into voluntary activation of movements.
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Spasticity is no longer apparent, allowing near-normal to normal movement and coordination.
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pattern of movement which develops during recovery. This approach encourages development of
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The
Brunnstrom Approach follows six proposed stages of sequential motor recovery after a
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Some movement patterns out of synergy are mastered (synergy patterns still predominate)
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Individual joint movements become possible and coordination approaches normal
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to evaluate and track the progress of persons recovering from stroke. The
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Wade, Derick T; Wood, Victorine A; Hewer, Richard
Langton (1985).
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No "voluntary" movements on the affected side can be initiated
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Movement
Therapy in Hemiplegia: A Neurophysiological Approach
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synergies during early recovery, with the intention that
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Journal of
Neurology, Neurosurgery & Psychiatry
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49:. Unsourced material may be challenged and removed.
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16:Approach to recover from hemiplegia after a stroke
497:Scandinavian Journal of Rehabilitation Medicine
155:sets out a sequence of stages of recovery from
230:Patient gains voluntary control over synergies
422:(pp. 719). Philadelphia: F.A. Davis Company.
338:Fugl Meyer Assessment of Physical Performance
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441:"Recovery after stroke--the first 3 months"
396:Movement Therapy in Hemiplegia Brunnstrom.
227:Minimal voluntary movements may be present
190:Sequential motor recovery following stroke
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109:Learn how and when to remove this message
394:. New York, New York: Harper & Row.
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245:Further decrease in spasticity
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258:The 6 stages are as follows:
224:Basic synergy patterns appear
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254:Normal function is restored
248:Disappearance of spasticity
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412:O'Sullivan, S.B. (2007).
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419:Physical Rehabilitation
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414:Stroke: Motor Function
386:Brunnstrom, S (1970).
239:Decrease in spasticity
233:Increase in spasticity
353:Joint Range of Motion
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451:(1): 7–13.
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368:References
219:Spasticity
210:Flaccidity
157:hemiplegia
69:newspapers
350:Sensation
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184:synergic
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159:after a
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