Brunnstrom

Brunnstrom Approach- Hemiplegia Recovery

• It focuses on synergic pattern of spastic muscles for the
recovery of stroke patients through various stages.
• Provide insight into your stroke prognosis.
• Brunnstrom framework provide insight into stroke prognosis.
• Ability to move from one stage to another is a strong
indication of recoverability.
Brunnstrom Stages of Motor Recovery in stroke
Stage 1
• Flaccid stage
• No voluntary movement can be elicited

Stage 2
• Spasticity begins to develop.
• Initiation of basic limb synergies & associated reactions.

Stage 3
• Spasticity increases.
• Gain voluntary control over limb synergies.

Stage 4
• Spasticity begins to decline
• Movements outside synergies can be performed

Stage 5
• Learns movement combination
• Synergies starts to disappear

• Spasticity disappears.
Stage 6 • Joint movement becomes possible & coordination improves
• Normal motor function is restored.
 Stage 1: Flacidity
• Stage of Flaccidity (Cerebral shock)
• Areflexia (Absent DTR)
• No muscle tone
• No Voluntary Movement can be elicited
 STAGE 2
• Spasticity begins to develop.
• Inititiation of basic limb synergies (Flexion & Extension)
• Voluntary movements may be present.
• Development of assosiated reactions
• Homolateral Limb synkinesis
• RAIMESTE’S phenomenon
 Stage 3:
• Spasticity Increases & Reaches peak
• Voluntary control over movement synergies
• Movement outside synergy is not possible
• No control over the outcome of movement
 Stage 4
• Spasticity begins to decline
• Resistance to non-synergistic movements still present
• Movement outside synergy can be performed
• Key Movements: Outside synergy
• Hand behind back (Dissociation of pec. Major from triceps)
• Supination & pronation with elbow flexed 90 and adducted
(Indicates dissociation of bicep from supinator muscle)
• Upper limb horizontal elevation with elbow extended. (Indicate
dissociation of pec major muscle from triceps)
• Lower limb movements outside synergy:
• Knee flexion beyond 90 in sitting
• Ankle dorsiflexion without leg lifting