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Brunnstrom Approach for Hemiplegia

This document summarizes Brunnstrom's stages of recovery for hemiplegia and associated reactions and reflexes seen in the hemiplegic limb. It outlines 6 stages of recovery from flaccidity to independent joint movement and coordination. It also describes common reflexes like flexor and extensor synergies as well as associated reactions like Raiste's phenomenon where movement on the normal side results in opposite movement on the affected side. Guidelines are provided for exercising the hemiplegic arm, focusing on proper handling and range of motion exercises in the scapular plane.

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Nicole Andrea Garcia
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264 views2 pages

Brunnstrom Approach for Hemiplegia

This document summarizes Brunnstrom's stages of recovery for hemiplegia and associated reactions and reflexes seen in the hemiplegic limb. It outlines 6 stages of recovery from flaccidity to independent joint movement and coordination. It also describes common reflexes like flexor and extensor synergies as well as associated reactions like Raiste's phenomenon where movement on the normal side results in opposite movement on the affected side. Guidelines are provided for exercising the hemiplegic arm, focusing on proper handling and range of motion exercises in the scapular plane.

Uploaded by

Nicole Andrea Garcia
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOCX, PDF, TXT or read online on Scribd

BRUNNSTROM – UMN DISORDERS/hemiplegic limb

A. Limb Synergies
o Flexor (dominant on ue) and Extensor (dominant on le) Synergies

B. Associated Reactions – involuntary muscle contraction of affected side due to forceful movement of
the other parts of the body; Hemiplegic arm is rested at arm. The movement she stands up, the arm
flexes
B.1. HOMOLATERAL LIMB SYNKINESIS - flexion of upper ex at hemiplegic side is equal to
flexion of the lower ex at hemiplegic side; Extension of ue at hemiplegic side is equal to flexion
of le at hemiplegic side
B.2. RAIMESTE’S PHENOMENON – proponent: dr. raimeste; Hip abduction or adduction at
normal side will result to abduction or adduction of affected side; Used to gain movement
during flaccid phase
- All resisted movements on normal side of UE will result to same movement on affected side
UE
- All resisted movements on normal side of LE will result to opposite movement on affected side
LE, except for hip abduction/adduction
- Factors:
Level of Spasticity – greater spasticity = greater response
Amount of Resistance – greater resistance = greater response
B.3. SOUQUE’S PHENOMENON – arm elevation will result to finger extension
B.4. IMITATION SYNKINESIS – normal side copies the movement of abnormal side + resistance
B.5. MARIE-FOIX (BECHTEREV’S) – passive toe flexion of affected side is equal to ankle
dorsiflexion, knee flexion, hip flexion
B.6. HUNTINGTON’S PHENOMENON – yawning, coughing, sneezing is equal to increases
spasticity of affected side

C. POSTURAL REFLEXES
1. TNR (TONIC NECK REFLEX)
a. ATNR (fencers position)
i. stimulus: neck rotation
ii. response: extension of face side and flexion of skull side
iii. present at birth to 4-6 months (if after 4-6 months, meron pa rin ito kay meron ka
problems)
b. STNR
i. stimulus: neck flexion
ii. response: flexion of UE | extension of UE
extension of LE | flexion of LE
iii. present at 4-6 months and integrates at 8-12 months
2. TLR (TONIC LABYRINTHINE REFLEX)
i. stimulus: neck extension
ii. response: extension of LE and UE and back
iii. present from birth to 4-6 months
Cortex
|
Midbrain
|
Medulla

+ Reflexes initiate movement


+ cortex gains control over midbrain and medulla
+ UMN disorder damages cortex
+ medulla controls reflexes pag bata pa

BRUNNSTROM’S STAGES OF RECOVERY


1. Flaccidity/ No movement
2. Spasticity begins to develop
3. Peak of spasticity (semi-voluntary)
4. Movement combination, spasticity declines
To test UE:
o hand behind back
o pronation-supination, elbow flexed 90 degrees
o horizontal elevation with elbow extension
To test LE:
o knee flexion > 90 degrees
o dorsiflexion of ankle in sitting without lifting feet off the ground
5. More difficult movement combination
To test UE:
o abduction 90 degrees with elbow extension
o abduction 90 degrees with pronation-supination
o horizontal elevation 90 degrees
To test LE:
o knee flexion in standing
o ankle dorsiflexion in step standing
6. Independent joint movement, coordination
7. Normal

EXERCISING THE HEMIPLEGIC ARM


 Key points
o Adequate handling
o No shoulder movement beyond 90 degrees in acute phase (possibly in stage 2 or flaccid)
o Maintain scapulo-humeral rhythm
o Avoid vigorous passive movements
o Utilize scaption plane during ROM exercises (SH ABD & ER)
o Indirect methods of mobilization if (+) severe pain (to facilitate flexion of shoulders, bend the
body forward while sitting para mag move forward ang shoulders)
- Areflexive zones, flexor and extensor synergies

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