167492
Brunnstrom Approach
- Treatment for Hemiplegia
- Jackson - hypothesized - reflexes are
present in early development and
present again after damage to the
CNS. Therefore these reflexes are
considered normal and precede
purposeful movement.
- Brunnstrom believed the damaged
CNS reverts back to these old patterns of movement.
- limb synergy patterns
- can occur in flexion
and extension
- LE Flexor Synergy: hip flexion &
abd & external rotation, knee
flexion, ankle dorsiflexion &
inversion, toe extension
- LE Extensor Synergy: hip add &
extension & internal rotation, knee
extension, ankle plantar flexion and
inversion, toe flexion
- LE Extensor Synergy: hip add &
extension & internal rotation, knee
extension, ankle plantar flexion and
inversion, toe flexion
- LE Flexor Synergy: hip flexion &
abd & external rotation, knee
flexion, ankle dorsiflexion &
inversion, toe extension
- Muscles in pattern are linked,
cannot be isolated. If one
muscle in the flexor pattern is
stimulated, they all activcate.
- Flexor: scap add & elevation,
shoulder abd & external rotation,
elbow flexion, forearm supination,
wrist & finger flexion
- Extensor: scap abd & depression,
shoulder add & internal rotation,
elbow extension, forearm pronation,
wrist & finger flexion or extension.
- Flexor: scap add & elevation,
shoulder abd & external rotation,
elbow flexion, forearm supination,
wrist & finger flexion
- can occur in flexion
and extension
- primitive reflexes
- TNR's
- tonic lumbar reflex
- TLR
- Reappear and normal
deep tendon reflexes
become exaggerated.
- TNR's
- TREATMENT & METHODS
- GOAL: Pt. progress through the stages
- Changes in head & body
position can elicit early
motor patterns (reflexes).
- Stimulating the skin can elicit a
synergy. Rubbing the skin or tapping
of the biceps can elicit a flexor synergy
- A stretch of a muscle can cause
a contraction and inhibit its
antagonist. Providing resistance
also facilitates contraction.
- A stretch of a muscle can cause
a contraction and inhibit its
antagonist. Providing resistance
also facilitates contraction.
- Stimulating the skin can elicit a
synergy. Rubbing the skin or tapping
of the biceps can elicit a flexor synergy
- Changes in head & body
position can elicit early
motor patterns (reflexes).
- Use of mirrors and videos
provide visual feedack.
- Bed Positioning: place pt.
in the position opposite of
the pattern they exhibit.
- Bed Mobility: log roll towards affected side.
- Trunk Movement & Balance: pt's.
tend to lean to affected side.
Therapist disturbs the pts. balance
to elicit balance response.
(SAFELY)
- as pt. progresses have them attempt
positions that displace their center of
gravity (ie: bending over, trunk rotation.)
- as pt. progresses have them attempt
positions that displace their center of
gravity (ie: bending over, trunk rotation.)
- Trunk Movement & Balance: pt's.
tend to lean to affected side.
Therapist disturbs the pts. balance
to elicit balance response.
(SAFELY)
- Bed Mobility: log roll towards affected side.
- Bed Positioning: place pt.
in the position opposite of
the pattern they exhibit.
- Shoulder ROM: achieve/maintain pain-free ROM at
the glenohumeral jt. Pendulum exercises.
- Shoulder Subluxation: slings, used to help hold
shoulder in place, but do NOT increase muscle
strength.
- Upper LImb Training: goal is for pt. to achieve voluntary control
of the synergy patterns. Achieved by REPETITION, assist of
the therapist, tapping, verbal cues and stimulation applied to
skin (vibration).
- Hand Training: 1st goal - Achieve a gross grasp.
- UPPER LIMB trainings to
promote the progression
from stage 3 to 4
- 1. Hand to chin
- 2. Hand to ear on the same
side & opposite side
- 3. Hand to opposite elbow
- 4. Hand to opposite shoulder
- 5. Hand to forehead
- 6. Hand to top of head
- 7. Hand to back of head
- 8. Stroking movements from top to back of
head & from dorsal side of forearm to
shoulder on unaffected side.
- 8. Stroking movements from top to back of
head & from dorsal side of forearm to
shoulder on unaffected side.
- 7. Hand to back of head
- 6. Hand to top of head
- 5. Hand to forehead
- 4. Hand to opposite shoulder
- 3. Hand to opposite elbow
- 2. Hand to ear on the same
side & opposite side
- 1. Hand to chin
- GOAL: Pt. progress through the stages
- limb synergy patterns
- Brunnstrom believed the damaged
CNS reverts back to these old patterns of movement.
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