Stroke: Symptoms, Causes, Diagnosis, Risk Factors,Life Expectancy, Types, Prevention ,Treatment & More

Stages of recovery from stroke

“Brunnstrom approach” describes the sequence of events as the brain moves towards recovery after a stroke. From the absolute loss of control of a limb to regaining its functional capacity, the Brunnstrom approach grades these stages to assess the extent of recovery. This recovery is achieved via rehabilitation, which is aimed at reviving the physical, mental, social, and economic capacity of the stroke survivor. The stages of Brunnstrom’s study are discussed below along with the rehabilitation intervention effective in each.

Stage 1: flaccidity

In the first stage, the muscle is in flaccid paralysis, owing to its denervation. The brain does not recognize the muscle because of the damage to the muscle’s control center in the brain. The affected muscle hence is unable to perform any movement. Physiotherapy at this stage is aimed at reactivating the neuronal pathways from the muscle to the brain by increasing the sensory input. The unaffected hand is used to sensory stimulate the affected muscle in a technique called “passive range of motion”

Stage 2: spasticity appears

The brain still cannot send impulses down to the muscle. Owing to its immobility, the muscle develops spasticity. In this stage, the muscle becomes taught and rigid at joints and is unable to perform a movement easily. The maneuver is still to trigger sensory impulses from the affected muscle to the brain via “passive range of motion” exercise.

Stage 3: increased spasticity

The affected muscle becomes more tense and unable to move. In an attempt to voluntarily move the muscles, there may be a sudden jerky movement of more than one muscle called synergy. This is not a coordinated movement, but it results from a rapid outburst of impulse from the brain. The exercise in this stage is passive plus active assisted motion. That is, the patient tries to voluntarily activate the muscles to perform a task, and that way the impulse pathway can be reestablished to the affected muscle.

Stage 4: decreased spasticity

In this stage, the muscle tends to decrease its tone when activated. It is a step towards a controlled impulse generation. There may be synergies in this stage, but the survivor can learn to use the synergies to accomplish a task and may even minimize synergy to focus the movement of the target muscle only.

Stage 5: spasticity decreases further

The muscle becomes less and less rigid in response to an attempt to move. This is a step closer to regaining the functional power of the muscle. At this stage strengthening is used, boosting the neuronal pathways to the muscle by increased training. A little impediment to movement, such as a slight weight can be added to the muscle to relearn the effort.

Stage 6: coordination

At this stage, the muscle does not show any spasticity and can coordinate action with the other non-affected side of the body. The patient can still exercise to restore strength and functional potential of the muscles by engaging in activities that require coordination like clapping hands etc.

References

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