|Treatment approach called movement therapy that is most often used in the treatment of hemiplegia ||Brunnstrom approach|
|scapular adduction and elevation, shoulder abduction and external rotation, elbow flexion, forearm supination, wrist flexion and finger flexion ||Flexor synergy of the UE |
|scapular abduction and depression, shoulder adduction and internal rotation, elbow extension, forearm pronation and wrist and finger flexion or extension ||Extensor synergy of the UE|
|hip flexion, abduction and external rotation; knee flexion; ankle dorsiflexion and inversion; and toe extension ||Flexor synergy of the LE|
|movements seen on the hemiplegia side in response to forceful movements on the normal side, can be used to elicit synergies by giving resistance to the contralateral (opposite-side) muscle group on the unaffected side ||Associated reactions |
|Progress can be facilitated by the patient’s postion and the use of ||Associated reactions|
|Excessive facilitation of associated reactions should be
|The therapist can rub skin over the muscle belly with his or her fingertips, thus producing a contraction of the muscle and eliciting the synergy pattern to which the muscle belongs ||Facilitation of a Synergy pattern|
|Synergistic movement may be reinforced by the patient’s voluntary efforts through ||Visual feedback, i.e. mirrors, videotapes, Auditory stimuli, i.e. such as loud and repetitive commands|
|Proper bed positioning begins immediately when the patient is in the ||Flaccid stage|
|Proper positioning promotes normal alignment and can decrease the influence of hypertonic muscles. This is important in the prevention of
||Contractures and deformity|
|The LE often tends to assume a position of hip external rotation and abduction and knee flexion. This position mimics ||The LE’s flexor synergy
|If the LE’s posture is characterized by extension and adduction at the hip, knee extension and ankle plantar flexion ||The extensor synergy has developed in the LE|
|If the extensor synergy dominates in the LE, the recommended bed position for patients in the supine position is ||Slight hip and knee flexion maintained by a small pillow under the knee|
|To position the affected UE, the practioner supports the arm on a pillow in a postion comfortable for the patient. Abduction of the UE should be avoided because this position can contribute to ||Shoulder subluxation|
|The patient is instructed to use the _________________to support the affected arm when moving in bed ||Unaffected hand|
|The maintenance of pain-free shoulder ROM is important in patients with hemiplegia.
Brunnstrom believed that traditional passive exercise may actually contribute to pain in these patients. Instead, the shoulder joint should be mobilized through ||Guided trunk motion without forceful stretching|
|To accomplish this motion, the patient sits erect, cradling the affected arm. The clinician supports the arm under the elbows
||while the patient leans forward.
**The more the patient leans, the greater the range of shoulder flexion that can be obtained.
|During this recovery stage, the aim of treatment is to elicit muscle tone and the synergy patterns on a reflex basis ||Brunnstrom Treatment during stages 1 and 2|
|When the patient has recovered to these stages, the treatment goal is for the patient achieve voluntary control of the synergy patterns
||Brunnstrom Treatment during stages 2 and 3|
|The treatment aim during these stages is to move away from the synergies by mixing components from both synergies to perform new and complex patterns of movement ||Brunnstrom Treatment during stages 4 and 5|
|The treatment goal during this stage is to achieve ease in performance of movement. Activities that encourage varying motions and increasing speed of performance can be introduced during this stage ||Brunnstrom Treatment during stage 6 (final recovery period)|
|Helping the patient use newly learned movement patterns for functional and purposeful activities.
Using this principle, the OTA can consider incorporating whatever movement the patient demonstrates into treatment activities.
||The focus of OT using the Brunnstrom technique|
|The extensor synergy can be used to stabilize an object on a table while the unaffected arm is performing a task ||During stage 3, when the patient can perform synergy voluntarily|
|The OTA can provide activities that encourage movements deviating from synergy, such as skateboards activities,sponging off tabletop or finger-painting ||During stage 4 |
|The number of activities that can be performed increases and more movement combinations are possible ||If the patient moves beyond stage 4|
|The involvement of the affected limbs in sweeping, dusting and washing dishes, are a few of the activities that may enlist the affected arm purposefully if ||Hand recovery is adequate|