The Brunnstrom Approach sets out a sequence of stages of recovery from hemiplegia after a stroke. It was developed by the Swedish

physical therapist Physical therapy (PT), also known as physiotherapy, is one of the allied health professions. It is provided by physical therapists who promote, maintain, or restore health through physical examination, diagnosis, management, prognosis, patien ...

Signe Brunnström, and emphasises the

synergic Synergy is an interaction or cooperation giving rise to a whole that is greater than the simple sum of its parts. The term ''synergy'' comes from the Attic Greek word συνεργία ' from ', , meaning "working together". History In Christian ...

pattern of movement which develops during recovery. This approach encourages development of

flexor A flexor is a muscle that flexes a joint. In anatomy, flexion (from the Latin verb ''flectere'', to bend) is a joint movement that decreases the angle between the bones that converge at the joint. For example, one’s elbow joint flexes when one ...

and

extensor In anatomy, extension is a movement of a joint that increases the angle between two bones or body surfaces at a joint. Extension usually results in straightening of the bones or body surfaces involved. For example, extension is produced by extendin ...

synergies during early recovery, with the intention that

activation of muscles will, with training, transition into voluntary activation of movements.

Sequential motor recovery following stroke

The Brunnstrom Approach follows six proposed stages of sequential motor recovery after a stroke. A patient can plateau at any of these stages, but will generally follow this sequence if he or she makes a full recovery.O'Sullivan, S.B. (2007). ''Stroke: Motor Function''. In S. B. O’Sullivan, & T. J. Schmitz (Eds.)
''Physical Rehabilitation''
(pp. 719). Philadelphia: F.A. Davis Company. The variability found between patients depends on the location and severity of the

lesion A lesion is any damage or abnormal change in the tissue of an organism, usually caused by disease or trauma. ''Lesion'' is derived from the Latin "injury". Lesions may occur in plants as well as animals. Types There is no designated classif ...

, and the potential for adaptation. 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: # Flaccidity (immediately after the onset) #No "voluntary" movements on the affected side can be initiated #

Spasticity Spasticity () is a feature of altered skeletal muscle performance with a combination of paralysis, increased tendon reflex activity, and hypertonia. It is also colloquially referred to as an unusual "tightness", stiffness, or "pull" of muscles ...

appears #Basic synergy patterns appear #Minimal voluntary movements may be present #Patient gains voluntary control over synergies #Increase in spasticity #Some movement patterns out of synergy are mastered (synergy patterns still predominate) #Decrease in spasticity #If progress continues, more complex movement combinations are learned as the basic synergies lose their dominance over motor acts #Further decrease in spasticity #Disappearance of spasticity #Individual joint movements become possible and coordination approaches normal #Normal function is restored The 6 stages are as follows:

Assessment methods

The six component stages of the Brunnstrom Approach have influenced the development of a variety of standardized assessment methods used by

physiotherapist Physical therapy (PT), also known as physiotherapy, is one of the allied health professions. It is provided by physical therapists who promote, maintain, or restore health through physical examination, diagnosis, management, prognosis, patien ...

s and

occupational therapist Occupational therapists (OTs) are health care professionals specializing in occupational therapy and occupational science. OTs and occupational therapy assistants (OTAs) use scientific bases and a holistic perspective to promote a person's abi ...

s to evaluate and track the progress of persons recovering from stroke. The Fugl Meyer Assessment of Physical Performance (FMA) is an example of one widely used scale. The FMA consists of five sub-scales that relate to various aspects of a patient's upper and lower extremity, and the sub-scales are as follows: #Motor #Balance #Sensation #Joint Range of Motion #Pain 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. 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.

References

{{Reflist Physical therapy