There are six Brunnstrom stages that describe the process of movement recovery after stroke. Here's what each stage means for your arm and what you can do for home exercise to maximize function.

Understanding the Brunnstrom Stages of Stroke Recovery

What are the Brunnstrom Stages of Stroke Recovery?
The brunnstrom stages is one of the most well-known stroke recovery stages which
is also known as the Brunnstrom approach. The Brunnstrom stages was developed by
physical therapist Signe Brunnstrom in the 1960’s. When a stroke occurs,
typically it affects one side of the body. The Brunnstrom approach describes the
sequence of motor development and reorganization of the brain after stroke. So
you can check the status of your stroke recovery through the Brunnstrom stages.

You can think of it as a built in organizational system. Our brain automatically
recruits lower functioning reflexes, just to get any movement. Then it begins to
sort out what is useful and what connections we need to build at a higher level.

It's also a way to know what movement actions to take advantage of during your
post stroke rehabilitation.


Table of contents

 * Stage 1: Flaccidity
 * Stage 2: Spasticity Appears
 * Stage 3: Increased Spasticity
 * Stage 4: Decreased Spasticity
 * Stage 5: Spasticity Continues to Decrease
 * Stage 6: Spasticity Disappears and Coordination Reappears
 * How long will it take to recover from stroke?




What to do for Stroke Rehabilitation or stroke recovery in each stage


Stage 1: Flaccidity
During this stage the muscles on your affected side aren't able to move and they
might feel limp and floppy.

What can I do during this stage?
Passive range of motion [https://www.youtube.com/watch?v=7G97Fu3GuVU] is one of
the most important exercises you can do in this stage. Passive simply means that
you are using your other arm to assist with movement or someone else is moving
your arm for you.

The main reason to complete these exercises is that it increases sensory input
to the brain. Right now, there aren’t any signals being sent from the brain to
the muscle to activate it, but you can send signals from the skin and muscles
about touch and movement to the brain and remind your brain that your affected
side is awake and ready to learn again!

Stage 2: Spasticity Appears
In this stage, muscles may begin to tighten reflexively and have difficulty
relaxing. This is called spasticity
[https://www.neofect.com/us/blog/spasticity-and-stroke]. This movement is
usually involuntary and in response to an outside stimulus, such as a poke. The
brain is still having a difficult time sending any signals to the muscles for
voluntary movement.

What can I do in this stage?
Passive range of motion continues to be key in this stage. With spasticity
[http://www.neofect.com/us/blog/how-to-improve-spasticity-spinal-cord-injury/],
even passive movement can be challenging. When we don’t move a joint, the
tendons start to stiffen and can make movement even more difficult in the
future. Think of it as the hinge of a door that can get rusty and hard to open
over time if it’s not taken care of. Oil your joints with movement either
passive or active-assisted range of motion.

Active-assisted range of motion [https://www.youtube.com/watch?v=-hise8ZUIAk] is
a combination of passive and active range of motion. You might be able to
activate your shoulder muscles to lift your arm up, but not all the way. For
active assisted range of motion, you want to activate the muscle as much as you
can and then use your unaffected hand to move the joint through the full range
of motion.



Stage 3: Increased Spasticity
During this stage, certain muscles might tighten more and can be more difficult
to relax. Multiple muscles might fire together when we try to move our affected
side. This is called a muscle synergy and we can use our synergies to complete
an activity if we understand it.

What can I do in this stage?
In addition to keeping up with your passive or active-assistive range of motion
exercises, it’s important to understand your synergies so you can use them
purposefully. The more we can send signals from the brain to the muscle the
stronger those signals become, and the best way to increase the amount of
signals is to incorporate your exercises into the things you already do during
the day.

There are two typical synergy patterns in this stage: the flexor synergy and the
extensor synergy. A flexor synergy at the arm would have the shoulder rotating
outward, at the same time the elbow flexes and forearm rotates out. Think about
the movement that happens when you try to touch the ear on the same side of your
body.

An extensor synergy is opposite: the shoulder rotates inward, the elbow
straightens, and the forearm rotates downward. Think about the movement that
would happen if the back of your hand touched the inside of your opposite knee.

If we know that these are the muscles that want to fire together, we can use it
to help function. For instance, you might be working on feeding yourself, but
struggling to reach your mouth. If you think about moving your shoulder does it
help move your elbow and get closer to your mouth? Little shifts in thinking can
help you be more successful, which will help encourage you to keep going!

Stage 4: Decreased Spasticity
During this stage of motor recovery, the involuntary muscle tightness
(spasticity) starts to decrease. Your brain is more successful at sending
signals to specific muscles to activate. You’re still likely to use muscle
synergies, but you're able to move outside of them as well.

What can I do in this stage?
This is when we want to focus on isolating movements and strengthening those
connections in the brain to certain muscles with active range of motion
exercises [https://www.youtube.com/watch?v=XeYfdku7RA0]. Repetition is critical
for neural-reorganization. We can’t repair the damage that was done to the brain
after stroke, but we can teach a different area of the brain to do its job. We
want to do movements outside of our muscle synergies to improve how our brain
sends signals.

Stage 5: Spasticity Continues to Decrease
During this stage of motor recovery, the signals from the brain to the muscle
are even more successful and the muscle tightening of spasticity is minimal,
allowing your affected side after stroke to move more complexly.

What can I do in this stage?
Strengthening [https://www.youtube.com/watch?v=EVQcgYQyzz0] is the key
ingredient in this stage. We’ve seen a progression in the stages, but also in
the treatment. We’ve started with passive range of motion, then moved to active
assisted range of motion, then active range of motion within synergies, then
isolating muscles. Now it’s time to add resistance to movement. Add small
weights or use a household item like a half-full water bottle to your exercises.
Incorporate theraband or theraputty to your daily routine.



Stage 6: Spasticity Disappears and Coordination Reappears
During this stage of motor recovery, spasticity
[hhttp://www.neofect.com/us/blog/how-to-improve-spasticity-spinal-cord-injury/] 
disappears completely and coordination quickly begins to improve. During this
stage motor control is almost fully restored!

What can I do in this stage?
Continue strengthening the muscles that need strengthening and add coordination
exercises that incorporate both sides of the body: golfing, shuffling cards,
etc. If there’s something you used to do that you want to get back to doing,
practice it. Your brain will be motivated to practice the coordination required
for an exciting activity.

How long will it take to recover from stroke?
As much as we'd like for there to be a clear cut answer, every person is
different. Some may see more rapid progress in days, weeks, or months after
stroke. It might take years for others. Some people may some may spend more time
than they would like to on a stage.

We do know that recovery has no end date. Some stroke patients and stroke
survivors(stroke victims) might not have an occupational therapist or
rehabilitation program to follow. Each day is a new opportunity to look at where
we're at and take action to get to where we want to be. The Brunnstrom approach
gives us roadmap.



--
Has a stroke left you or your loved one struggling to regain full functionality
in your arm or hand? Introducing the Neofect Smart Rehab
[https://shop.neofect.com/], a biofeedback training device.

Repetition is the key to increase mobility. Neofect Smart Rehab
[https://shop.neofect.com/] encourages repetition in a fun, engaging way through
interactive gamified training games, challenging you to improve arm and hand
function through neuroplasticity which is the brain's ability to retrain itself
after an injury. Through repetition, you can strengthen other pathways in the
brain to improve the use of your affected side.

Call us (888) 623-8984 [tel:+18886238984] or email us at info@neofect.com to 
start your smart rehab with the Neofect today.

Stroke Recovery

It is impossible to fully reverse stroke damage, current research shows the brain is capable of relearning even years after a stroke through Neuroplasticity.

Tips for Unlocking Neuroplasticity After Stroke Part 1

Almost 800,000 people suffer from a stroke in the United States each year,
making it the primary cause of disability among adults 1
[http://www.strokecenter.org/] Strokes often cause damage to areas of the brain
resulting in loss of movement, sensation or language skills. Although it is
impossible to fully reverse the damage, current research has shown that the
brain is capable of relearning lost skills even years after a stroke through a
process called Neuroplasticity.

The word Neuroplasticity is a fancy way of saying that the brain (neuro) can
change (plasticity). After a stroke, neuroplasticity can help the brain to work
around the damaged areas in order to regenerate, re-establish, and rearrange the
neural connections related to function.

With a little work and a lot of commitment, the amazing power of Neuroplasticity
can be activated at any time, even years after a stroke. In this series of blog
posts we will look at 10 tips for unlocking the power of retraining the brain
and body and neuroplasticity after stroke
[https://blog.neofect.com/tag/neuroplasticity/]. Check out the five tips below.
Make sure to check back in for tips 6-10 in the next installment!

1. Use it or Lose it
You may have heard the expression “use it or lose it”, meaning that if we don’t
use a muscle for a long time, it can atrophy (waste away). This principle
applies to the brain as well. When a stroke affects an area of the brain
controlling one arm many people compensate by relying on the unaffected or
“good” side for most tasks. This compensatory reliance on the unaffected hand
can lead to “learned non-use” of the affected side. The longer this disuse goes
on, the harder it can be for the brain to regain control of the affected arm.

Preventing learned non use involves working to incorporate the affected side
into your life as much as possible and as often as possible.

2. Use it and Improve it
The magic of neuroplasticity
[https://blog.neofect.com/5-ways-brain-games-for-stroke-rehabilitation-increase-brain-health/] 
is that the brain can remap itself. If an area controlling movement is damaged
it is possible for a neighboring area to rewire itself to control the movement
that was lost. This remapping won’t happen spontaneously, however. You have to
use it to improve it! The brain is made up of axons that send electrical signals
to each other to communicate. Every thought and action involves communication
between axons. When we repeat a movement or thought, axons from previously
unconnected areas of the brain can link up, creating a new network. This
connection formation principle is explained best with the phrase “what fires
together, wires together”, coined by neuropsychologist Donald Hebb in the 1940s.

3. Repetition Matters
Repetitive practice of desired movement patterns helps the brain become stronger
by rewiring and reinforcing newly formed neural pathways. But how much practice
is enough? Studies in humans and animals have shown that hundreds of repetitions
are required per day to elicit change(2). This much repetition can seem
daunting, but with the help of technology such as rehab based apps and stroke
rehab devices like the Neofect Smart Glove
[https://www.neofect.com/us/smart-glove] you will be surprised how easily you
can fit repetitive movement exercise into your daily routine.



4. Intensity Matters
Anyone that has learned to play the piano can tell you that you have to practice
every day to get better. The same is true of making changes in the brain after a
stroke. No matter how many repetitions you do in one sitting it takes more than
one day of practice to change your brain. So how quickly could you see progress?
Large studies of patients who were weeks to years past their stroke have
reported long-lasting functional improvements after completing 2–12 weeks of
intensive repetitive skilled motor practice programming (3).

5. Focus Matters
Think about learning a new route to work. Initially you will need to pay close
attention and use directions to get to where you are going. After repeating the
route daily it will become habitual and you may be able to complete the drive
without too much active thought. The same is true for relearning to use your
body after a stroke. In the beginning you will need to pay close attention to
your movements and use directions given by therapists. Once you have unlocked
neuroplastic change in your brain through practice and intensity you may be able
to complete activities with much less thought.

Here at NEOFECT [https://www.neofect.com/en/], we're committed to supporting you
in your stroke rehab [https://www.neofect.com/us/smart-glove] journey. If you
have had a stroke and are looking for an effective solution for your
rehabilitation needs, please look into NEOFECT's line of Smart Rehabilitation
Solutions.

To learn more, please call (866) 534-4989 or email contactus@neofect.com.

Nudo RJ, et al. Neural substrates for the effects of rehabilitative training on
motor recovery after ischemic infarct. Science, 1996;272(5269):1971-94.

Kimberley TJ, et al. Comparison of amounts and types of practice during
rehabilitation for traumatic brain injury and stroke. J. Rehabil Res Dev. 2010;
47(9):851-62. Rehabil Res Dev. 2010; 47(9):851-62.

Dobkin, Bruce H, et al. “New evidence for therapies in stroke rehabilitation.”
Current atherosclerosis reports vol. 15,6 (2013): 331.
doi:10.1007/s11883-013-0331-y

Lo AC, Guarino et al. Robot-assisted therapy for long-term upper-limb impairment
after stroke. N Engl J Med. 2010;362(19):1772–1783. [PMC free article] [PubMed]
[Google Scholar] *

Taub E., Uswatte G., Mark V. W., Morris D. M. (2006). The learned nonuse
phenomenon: implications for rehabilitation. Eura. Medicophys. 42, 241–256
[PubMed] [Google Scholar]

Sousa et al. (2018) Interventions involving repetitive practice improve strength
after stroke: a systematic review. Journal of Physiotherapy. 64, 4. [Science
Direct]

For more information on Neuroplasticity:
Brainworks - What is Neuroplasticity
[https://brainworksneurotherapy.com/what-neuroplasticity]
ScienceDirect - Neuroplasticity
[https://www.sciencedirect.com/topics/neuroscience/neuroplasticity]
Stroke-Rehab - Neuroplasticity
[https://www.stroke-rehab.com/neuroplasticity.html]

All content provided on this blog is for informational purposes only and is not
intended to be a substitute for professional medical advice, diagnosis, or
treatment. Always seek the advice of your physician or other qualified health
provider with any questions you may have regarding a medical condition. If you
think you may have a medical emergency, call your doctor or 911 immediately.
Reliance on any information provided by the NEOFECT website is solely at your
own risk.

Neuroplasticity

After a stroke, organizing your day with a daily routine in a way that works for you will help you stay focused on your stroke rehabilitation and recovery.

The Importance of Setting Up a Post Stroke Routine

Having a daily routine helps us create habits to meet our goals. After a stroke,
there is a lot of information and recommendations that may feel overwhelming.
Organizing your day in a way that works for you will help you stay focused on
your post stroke rehabilitation and getting back to the things that matter most.

We'll discuss 6 things to work into your day that have been shown to assist in
your stroke recovery and rehabilitation [https://www.neofect.com/us/smart-glove]
, and show you how to begin to make them habit. Download our rehab calendar
below.

 1. Aerobic exercise
 2. Strength training
 3. Sleep
 4. Meditation
 5. Intensive Repetitions
 6. Functional Goal Training

1. AEROBIC EXERCISE
It is common for people who have had a stroke to become deconditioned. They may
have limited movement and may struggle with depression. Aerobic exercise is
important for stroke because it improves the function of the heart and lungs,
which can reduce the risk of heart disease and future strokes.

Aerobic exercise has also been shown to boost mood and improve cognition in
people post stroke, specifically information processing and motor learning
tasks.

The American Heart Association recommends people with stroke participate in
aerobic exercise 20-60 minutes, 3-5 days a week. The recommended method is
treadmill training, if able.

If you’re unable to safely use a treadmill or walk outside, there are several
other ways to get the heart pumping and increase the rate of breathing, which
are the key ingredients in aerobic exercise. A recumbent bicycle, hand bicycle,
or rowing machine are a few options. You might also try a punching bag or chair
aerobics.

2. STRENGTH TRAINING


Strength training is also an important piece of exercise to incorporate into
your daily post stroke routine. Strength training focused on high repetitions
prevents muscle atrophy, and actually improves the quality of muscle fibers and
overall functional capacity.

Guidelines for strength training are 2-3 times a week. Strength training should
take about 30 minutes. Recommendations for which muscles to train should be done
in collaboration with your physician and/or your physical or occupational
therapist. Typically, you want to address major muscle groups and complete 2-3
sets of 10-20 repetitions. You want to exercise your muscles to the point of
fatigue.

3. SLEEP
The brain requires sleep to detoxify proteins that are built up during waking
hours. It also helps solidify working memory. For people recovering from stroke
and in the process of building new neural connections, sleep is essential for
recovery.

Sleep disorders are common after stroke and should be addressed with your
physician to ensure maximum recovery, but making sleep a priority by putting it
into your schedule is one step in the right direction.

4. MEDITATION


You might be tired of hearing about the benefits of meditation, but it has been
specifically studied in people with stroke and has been shown to improve
balance, fatigue, depression, and disability. 20 minutes of daily meditation is
the recommended dosage, but if you’re new to meditation, aim for 5 minutes a day
using a meditation app and increase as you feel the benefits.

5. INTENSIVE REPETITIONS
Intensive repetitions (moving your muscles and joints over, and over, and over
again) is the best way to create neuroplasticity
[https://www.neofect.com/us/blog/why-neuroplasticity-matters-to-post-stroke-rehabilitation] 
and create new neural pathways to the muscles that were affected by the stroke.

The Neofect suite of rehabilitation tools
[https://www.neofect.com/en/about-us/rapael-suite/] help make intensive
repetitions motivating and fun. It gives you both visual and auditory feedback.

6. FUNCTIONAL GOAL TRAINING
Intensive repetition of movement is only one piece of the picture. You also need
to practice a functional goal over and over to retrain your brain how to
complete a task.

Choose one long-term goal. Write it on a sticky note and place it on the mirror.
Add it to your daily schedule and commit to practicing it everyday. Studies have
shown that quality of life increases with improvements in function over improved
motor control. One of the best ways to work on your skills is to incorporate it
into the things you already have to do during the day.

CREATING A ROUTINE
Does it all sound overwhelming? Take a deep breath and think about it one step
at a time. Create a digital or physical calendar and schedule time to complete
the above activities. You can print out a sample calendar and place it in a
plastic sheet protector. Check off your accomplishments for the week with a dry
erase marker, and wipe it clean the next week. Prioritize what’s important to
you to start with. You’ve got this!

For more support and encouragement, join our Neofect support group
[https://www.facebook.com/groups/NeofectSupportGroup/] on Facebook!



Download your blank calendar here
[https://drive.google.com/file/d/1Gqnc_x7E_UXrZVqh2TfnM-PdXUOI2slJ/view?usp=sharing]
.

To learn more about the Neofect [https://www.neofect.com/us/] line of smart
rehabilitation tools, which include support from occupational therapists to
maximize your rehabilitation, please call (866) 534-4989 or email 
contactus@neofect.com.

REFERENCES
Boyne, P., Billinger, S., MacKay-Lyons, M., Barney, B., Khoury, J., & Dunning,
K. (2017). Aerobic Exercise Prescription in Stroke Rehabilitation: A Web-Based
Survey of US Physical Therapists
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5357184/]. Journal of neurologic
physical therapy : JNPT, 41(2), 119–128. doi:10.1097/NPT.0000000000000177

Billinger, S. A., Coughenour, E., Mackay-Lyons, M. J., & Ivey, F. M. (2012). 
Reduced cardiorespiratory fitness after stroke: biological consequences and
exercise-induced adaptations
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3159380/]. Stroke research and
treatment, 2012, 959120. doi:10.1155/2012/959120

Bruno Bavaresco Gambassi, Hélio José Coelho-Junior, Paulo Adriano Schwingel, et
al., “Resistance Training and Stroke: A Critical Analysis of Different Training
Programs [https://www.hindawi.com/journals/srt/2017/4830265/],” Stroke Research
and Treatment, vol. 2017, Article ID 4830265, 11 pages, 2017.

Khot, S., Morgenstern (2019) Sleep and Stroke
[https://www.ahajournals.org/doi/10.1161/STROKEAHA.118.023553]. Stroke: 2019;
50:1612–1617 https://doi.org/10.1161/STROKEAHA.118.023553

Underwood, E (2013) Sleep: The Brain’s Housekeeper?
[https://science.sciencemag.org/content/342/6156/301] Science 18 Oct 2013: Vol.
342, Issue 6156, pp. 301. DOI: 10.1126/science.342.6156.301

Vennu, Vishal & Kachanathu, Shaji & , PriyankaBhatia & Nuhmani, Shibili. (2013). 
Efficacy of meditation with conventional physiotherapy management on sub-acute
stroke patients
[https://www.researchgate.net/publication/264554102_Efficacy_of_meditation_with_conventional_physiotherapy_management_on_sub-acute_stroke_patients]
. Scholarly Journal of Medicine. 3. 48-52.

Kelly, Kristina M; Borstad, Alexandra L; Kline, David; Gauthier, Lynne V;
National Library of Medicine.Improved quality of life following
constraint-induced movement therapy is associated with gains in arm use, but
not
motor improvement [https://www.ncbi.nlm.nih.gov/pubmed/30246613]. Topics in
stroke rehabilitation Vol. 25, Iss. 7, (October 2018): 467-474.
DOI:10.1080/10749357.2018.1481605

Additional information on Post Stroke Routines:
National Institute of Neurological Disorders and Stroke - Post Stroke
Rehabilitation Fact Sheet
[https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Post-Stroke-Rehabilitation-Fact-Sheet]
American Stroke Association - Life After Stroke
[https://www.stroke.org/en/life-after-stroke]
Healthtalk.org - Stroke Recovery
[http://www.healthtalk.org/peoples-experiences/nerves-brain/stroke/stroke-recovery-daily-activities-and-personal-care]

All content provided on this blog is for informational purposes only and is not
intended to be a substitute for professional medical advice, diagnosis, or
treatment. Always seek the advice of your physician or other qualified health
provider with any questions you may have regarding a medical condition. If you
think you may have a medical emergency, call your doctor or 911 immediately.
Reliance on any information provided by the Neofect website
[https://www.neofect.com/us/for-home] is solely at your own risk.