Brunnstrom: Movement Therapy in Hemiplegia – Flashcards

Encourages use of synergy patterns during rehab - should be performed immediately and to develop combinations of patterns outside of synergy. Synergies are considered primitive patterns that occur at spinal cord level - * reinforcing patterns is now rarely used due to difficulty of changing these patterns

1. Associated reactions - involuntary and automatic movement of body part as result of intentional active or resisted movement in another body part 2. Homolateral synkinesis - flexion pattern of involved upper extremity facilitates flexion in lower extremity 3. Limb synergies - group of muscles that produce predictable pattern of movement in flexion/extension patterns

4. Raimiste's phenomenon - involved lower extremity with abduct/adduct with applied resistance to uninvolved lower extremity in same direction 5. Souque's phenomenon - raising of upper extremity above 100 deg. with elbow extension will produce extension and abduction of fingers 6. Stages of recovery - seven stages based on progression through abnormal tone and spasticity: these stages decribe tone, reflex activity, and volitional movment

Stage 1 - no volitional movement initiated Stage 2 - appearance of basic limb strategies: beginning of spasticity Stage 3 - Synergies are performed voluntarily: spasticity increase Stage 4 - Spasticity begins to decrease: movement patterns are not dictated by solely by limb synergies

Stage 5 - A further decrease in spasticity is noted with independence from limb synergy patterns Stage 6 - Isolated joint movements are performed with coordination Stage 7 - Normal motor function is restored

1. Evaluation of strength focuses on patterns of movement rather than straight plane motion of joint 2. Sensory examination is required to assist with treating motor deficits 3. Initially limb synergies are encouraged as necessary milestone for recovery

4. Encourage overflow to recruit active movement of weak side 5. Use repetition of task and positive reinforcement 6. Will follow stages of recovery but may have a plateau at any point so that full recovery is not achieved 7. Movement combinations that deviate from basic limb strategies should be introduced in stage 4