BRUNNSTROM  MOVEMENT  THERAPY

Basics and Principles

 

Brunnstrom, a physical therapist, was particularly concerned with the problems of patients with hemiplegia. The basic premises of this approach are: In normal persons, spinal cord and brain stem reflexes become modified during development and their components rearranged into purposeful movement by the influence of higher centers. Since reflexes represent normal stages of development, they can be used when the CNS has reverted to an earlier developmental stage as in hemiplegia.

Also, she believed that no reasonable training method should be left untried. Moreover, the sub-cortical motion synergy, which can be elicited on a reflex basis, may serve as a wedge by which the limited willed movement may be learned.

Brunnstorm’s movement therapy is an example of augmented maturation treatment because it facilitates the recovery of abilities from first level or developed capacities and organic substrates.

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Assumptions that underlie the brunnstrom movement therapy approach are as follows:

• In normal motor development, spinal cord and brainstem reflexes become modified and their components become rearranged into purposeful movement through the influence of higher centers

• Because reflexes and whole limb movement patterns are normal stages of development  and because stroke appears to result in “development in reverse”, reflexes and primitive movement patterns should be used to facilitate the recovery of voluntary movement post stroke

• Proprioceptive and exteroceptive stimuli can be used to evoke desired motion or tonal changes.

• Recovery of voluntary movement post stroke proceeds in sequence from flexor to extensor synergies and later a combine movement featuring both the patterns, lastly to discrete movements at individual joints.

• Newly produced movements must be practice in ADL’S in order to learn them.

 

Principles:

• Treatment progresses developmentally from evocation of reflex responses to willed control of voluntary movement to automatic functional motor behavior

• When no motion exists, movement is facilitated using reflexes, associated reactions, proprioceptive facilitation, and/or exteroceptive facilitation to develop muscle tension in preparation for voluntary movement.

• The responses of the patient from such facilitation combine with the patient's voluntary effort to produces semivoluntary movement.

• Proprioceptive and exteroceptive stimuli assist in eliciting the synergies.

• When voluntary effort appears:

  1. The patient is asked to hold (isometric) the contraction.

  2. If successful, he is asked for an eccentric (controlled lengthening) contraction.

  3. Finally, a concentric (shortening) contraction.

  4. Reversal of the movement between the agonist and antagonist.

• Even when only partial movement is possible stress reversal of movement in each treatment session.

• Facilitation is reduced or dropped out as quickly as the patient shows voluntary control (primitive reflexes & associated reactions).

• Place emphasis on willed movement to overcome the linkages between parts of synergies.

• Goal- directed correct movement is repeated and practiced in the form of ADL.