The Stages Of Stroke Recovery

BRUNNSTROM STAGES

The Brunnstrom Approach was developed in the 1960’s by Signe Brunnstrom, an occupational and physical therapist from Sweden. With seven stages, the Brunnstrom Approach breaks down how motor control can be restored throughout the body after suffering a stroke.

Normally, muscle movements are the result of different muscle groups working together. Researchers have termed this collaboration between muscles as “synergies”. The brain has the delicate task of coordinating these movements, many of which become severely affected after a stroke.

After the stroke has occurred, your muscles become weak due to the lack of coordination between the brain and body. This causes the muscle synergies to move in abnormal patterns. Most treatments offered to stroke patients will focus on trying to inhibit atypical muscle synergies and movements. The Brunnstrom Approach, on the other hand, teaches patients how to use the abnormal synergy patterns to their advantage.

This approach has become a popular choice among both occupational and physical therapists as well as patients since its inception. It can be effective in clinical settings and can dramatically improve voluntary muscle movements after suffering a stroke.

The Seven Stages Of Stroke Recovery

Stage 1 

Flaccidity

The first stage in Brunnstrom’s Approach is flaccidity in muscles. During this stage, the patient has no voluntary muscle movements in the areas affected by the stroke. Typically, a patient will lose motor function in their legs, arms, feet, or hands.

Stage 2

Spasticity Appears

The second stage in stroke recovery is when the patient begins to regain a small amount of motor function, but muscle movements are usually not voluntary. Muscles begin to make small, spastic, and abnormal movements during this stage.

While these movements are mostly involuntary, they can be a promising sign during your recovery. There are also no discernible synergy patterns within the muscles, which is what causes the involuntary movements. Minimal voluntary movements might or might not be present in stage two.

Stage 3

Increased Spasticity

Spasticity in muscles increases during stage three, reaching its peak. Synergy patterns also start to emerge, and minimal voluntary movements should be expected. However, your movements will be small and abnormal.

The increase in voluntary movement is due to being able to initiate movement in the muscle, but not control it (yet). The appearance of synergy patterns and coordination between muscles facilitate the voluntary movements which become stronger with occupational and physical therapy.

Stage 4

Decreased Spasticity

During stage four, spastic muscle movement begins to decline. You will also begin to regain a significant amount of motor control in the affected extremities. Furthermore, you will start making normal, controlled movements on a limited basis.

Synergy patterns within the muscles become stronger during this stage. However, many movements are out of sync with muscle synergies and abnormal movements should still be expected.

Stage 5

Complex Movement Combinations

Spasticity continues to decline in stage five. Synergy patterns within the muscles also become more coordinated, and your voluntary movements begin to become more complex.

Abnormal movements also start to decline dramatically during this stage, but some may still be present. You will be able to make controlled and deliberate movements in the limbs that have been affected by the stroke. Isolated joint movements might also be possible.

Stage 6

Spasticity Dissapears

At stage six, spasticity in muscle movement disappears completely. You are able to move individual joints, and synergy patterns become much more coordinated. Motor control is almost fully restored, and you can coordinate complex reaching movements in the affected extremities. Abnormal or spastic movements have ceased, and a full recovery is on the horizon.

Stage 7

Normal Function Returns

The last stage in Brunnstrom’s Approach is when you regain full function in the areas affected by the stroke. You are now able to move your arms, legs, hands, and feet in a controlled and voluntary manner.

Since you have full control over your muscle movements, synergy patterns have also returned to normal. Reaching stage seven is the ultimate goal for therapists and patients alike.