ArtsAutosBooksBusinessEducationEntertainmentFamilyFashionFoodGamesGenderHealthHolidaysHomeHubPagesPersonal FinancePetsPoliticsReligionSportsTechnologyTravel

Physical Therapy Following a Stroke- The Brunnstrom Approach

Updated on May 11, 2011

The Brunnstrom Approach

The primary goal of physical therapy following a stroke is to assist you to recover normal muscle function and maximize the independence of your life. Your normal muscle movements are produced by groups of muscles that work together as units called synergies (Shumway-Cook, 1995). After a stroke, your brain can no longer coordinate your muscle synergies and your muscles become weak, and this weakness produces abnormal movement patterns. These atypical movement patterns can develop in your arm, or your leg, or both. Therapists focus on treating abnormal muscle synergies because they prevent you from recovering function and maximizing your life after a stroke.

There are many different therapeutic approaches to treating abnormal movement patterns. Prior to the 1950s, if you have undergone physical therapy following a stroke, the therapist would have primarily used a muscle re-education approach. In a muscle re-education approach, a therapist retrains specific and isolated muscles that are weak rather than retraining muscle synergies. After the 1950s, therapists developed neurofacilitation approaches that focus on larger movement problems and overall motor control. Different types of neurofacilitation approaches include the Bobath approach, the Rood approach, proprioceptive neuromuscluar facilitation (PNF), the sensory integration technique, and the Brunnstrom approach. While other approaches focus on inhibiting abnormal synergies or moving parts of the body in opposite directions to the synergy patterns, the Brunnstrom approach encourages patients to actively use abnormal synergy patterns. Therapists have found the Brunnstrom approach to be highly clinically effective in improving voluntary movements.

The Swedish physical therapist Signe Brunnstrom developed the Brunnstrom approach in the 1960s. In the Brunnstrom approach, you move through seven stages as you regain motor control in an arm or leg after a stroke (Brunnstrom 1966, 1970).

1. Your muscles are flaccid and you have no voluntary movements in your affected extremities.

2. You begin to make small and abnormal movement patterns that are not voluntary.

3. You begin to make small movements that are voluntary but abnormal.

4. You begin to make normal movements, but most of your movements are still abnormal.

5. You begin to make normal and voluntary movements that are more complex, and your abnormal movements have diminished.

6. You begin to move your individual joints, and you can coordinate complex reaching movements.

7. Your normal movements have completely returned.

Signe Brunnstrom believed that damage to the brain after a stroke causes your central nervous system to regress to more primitive patterns of movement. Moreover, she believed that abnormal movement patterns are a normal part of recovery. The Brunnstrom approach encourages you to actively use the muscle synergies that are available at each phase of recovery to move your arms or legs, and techniques to facilitate movement are included in this approach. The central tenet of this approach is that as you regain more voluntary motor control your synergies will disappear. This approach has proved to be highly successful, and its techniques are used by many physical therapists to treat patients after a stroke.


References

Brunnstrom S. Motor testing procedures in hemiplegia: based on sequential recovery stages. Phys Ther. 1966;46:357–75.

Brunnstrom S. Movement Therapy in Hemiplegia: A Neurophysiological Approach. New York: Medical Dept., Harper & Row, 1970.

Sara Cuccurullo. Physical Medicine and Rehabilitation Board Review. New York: Demos Medical Publishing, 2004.

Shumway-Cook and Woollacott. Motor Control: Theory and Practical Application. Lippincott Williams & Wilkins, 1995

Comments

    0 of 8192 characters used
    Post Comment

    No comments yet.

    working

    This website uses cookies

    As a user in the EEA, your approval is needed on a few things. To provide a better website experience, hubpages.com uses cookies (and other similar technologies) and may collect, process, and share personal data. Please choose which areas of our service you consent to our doing so.

    For more information on managing or withdrawing consents and how we handle data, visit our Privacy Policy at: https://hubpages.com/privacy-policy#gdpr

    Show Details
    Necessary
    HubPages Device IDThis is used to identify particular browsers or devices when the access the service, and is used for security reasons.
    LoginThis is necessary to sign in to the HubPages Service.
    Google RecaptchaThis is used to prevent bots and spam. (Privacy Policy)
    AkismetThis is used to detect comment spam. (Privacy Policy)
    HubPages Google AnalyticsThis is used to provide data on traffic to our website, all personally identifyable data is anonymized. (Privacy Policy)
    HubPages Traffic PixelThis is used to collect data on traffic to articles and other pages on our site. Unless you are signed in to a HubPages account, all personally identifiable information is anonymized.
    Amazon Web ServicesThis is a cloud services platform that we used to host our service. (Privacy Policy)
    CloudflareThis is a cloud CDN service that we use to efficiently deliver files required for our service to operate such as javascript, cascading style sheets, images, and videos. (Privacy Policy)
    Google Hosted LibrariesJavascript software libraries such as jQuery are loaded at endpoints on the googleapis.com or gstatic.com domains, for performance and efficiency reasons. (Privacy Policy)
    Features
    Google Custom SearchThis is feature allows you to search the site. (Privacy Policy)
    Google MapsSome articles have Google Maps embedded in them. (Privacy Policy)
    Google ChartsThis is used to display charts and graphs on articles and the author center. (Privacy Policy)
    Google AdSense Host APIThis service allows you to sign up for or associate a Google AdSense account with HubPages, so that you can earn money from ads on your articles. No data is shared unless you engage with this feature. (Privacy Policy)
    Google YouTubeSome articles have YouTube videos embedded in them. (Privacy Policy)
    VimeoSome articles have Vimeo videos embedded in them. (Privacy Policy)
    PaypalThis is used for a registered author who enrolls in the HubPages Earnings program and requests to be paid via PayPal. No data is shared with Paypal unless you engage with this feature. (Privacy Policy)
    Facebook LoginYou can use this to streamline signing up for, or signing in to your Hubpages account. No data is shared with Facebook unless you engage with this feature. (Privacy Policy)
    MavenThis supports the Maven widget and search functionality. (Privacy Policy)
    Marketing
    Google AdSenseThis is an ad network. (Privacy Policy)
    Google DoubleClickGoogle provides ad serving technology and runs an ad network. (Privacy Policy)
    Index ExchangeThis is an ad network. (Privacy Policy)
    SovrnThis is an ad network. (Privacy Policy)
    Facebook AdsThis is an ad network. (Privacy Policy)
    Amazon Unified Ad MarketplaceThis is an ad network. (Privacy Policy)
    AppNexusThis is an ad network. (Privacy Policy)
    OpenxThis is an ad network. (Privacy Policy)
    Rubicon ProjectThis is an ad network. (Privacy Policy)
    TripleLiftThis is an ad network. (Privacy Policy)
    Say MediaWe partner with Say Media to deliver ad campaigns on our sites. (Privacy Policy)
    Remarketing PixelsWe may use remarketing pixels from advertising networks such as Google AdWords, Bing Ads, and Facebook in order to advertise the HubPages Service to people that have visited our sites.
    Conversion Tracking PixelsWe may use conversion tracking pixels from advertising networks such as Google AdWords, Bing Ads, and Facebook in order to identify when an advertisement has successfully resulted in the desired action, such as signing up for the HubPages Service or publishing an article on the HubPages Service.
    Statistics
    Author Google AnalyticsThis is used to provide traffic data and reports to the authors of articles on the HubPages Service. (Privacy Policy)
    ComscoreComScore is a media measurement and analytics company providing marketing data and analytics to enterprises, media and advertising agencies, and publishers. Non-consent will result in ComScore only processing obfuscated personal data. (Privacy Policy)
    Amazon Tracking PixelSome articles display amazon products as part of the Amazon Affiliate program, this pixel provides traffic statistics for those products (Privacy Policy)