Brunnstrom Evalution

目的 : 1: To evaluate the neurological recovery of patient after stroke 2. To design treatment program according to the stage of recovery

Brunnstrom Evalution

Stroke 之後 , patient 在 recovery 時 , 發生的次序Stage I : Flaccid, no movementStage II:Spasticity 開始出現 , 自主動作要 誘發才能出現 . Associated movementStage III:Synergy stage. Spasticity 最強 上肢以 Flexor spasticity 為主 下肢以 extensor spasticity 為主

Brunnstrom Evalution

Stage IV: Some isolated movement, Spasticity 下降Stage V: Synergy pattern 下降 Spasticity 更弱StageVI: Movement coordination near normal. Spasticity minimal

Motor stage assessment

Proximal part

I: Presynergy stage: FlaccidII:Spasticity: Associated movement

Motor stage assessment

III:Synergy stage: 1. Extension components:(use key to grading) a: Shoulder Protract, Add, Int. Rot b:Elbow extension c:Forearm pronation

Motor stage assessment

2. Flexor components a: Shoulder girdle elev. b: Shoulder girdle retract. c: Shoulder joint hyperext. d: Shoulder abd. e: Shoulder joint ext. rot f: Elbow Flexion g: Forearm supination

Motor stage assessment

IV:Movements deviating from basic synergies 1.Hand to sacrum 2.Raise arm forwd. To horiz. 3.Pronation (Elbow flexed) 4.Supination (Elboe Flexed)

Motor stage assessment

V.Relative independence of basic synergies 1.Raise armto side - horz. 2.Supination (Elbow Extened) 3.Forward reach from horiz. 4.raise arm over headVI. Nearly normal coordinated movement

Motor stage assessment

Hand

I: FlaccidII: Spasticity : Active finger flexion (+/-)III: 1. Mass grasp 2. Hook grasp without release 3. Reflex finger extension (+/-)

Motor stage assessment

IV: 1. Lateral prehension with release by thumb movement 2.Semivoluntary finger extension (small range)V: 1.Palmar prehension 2.Cylindrical / Spherical grasp with limited function

Motor stage assessment

3.Voluntary mass finger extension (variable range) VI: 1. Control of all prehension type movement with skill 2.Voluntary finger extension (full range ) 3.Individual finger movement , less accurate

Motor stage assessment

Lower limb

I: FlaccidII: Minimal voluntary movement of the lower limbIII:Hip-knee-ankle flexion in sitting and standing

Motor stage assessment

IV: 1. Sitting Knee flexion beyond 90 degree with the foot sliding backward on the floor 2. Voluntary dorsiflexion of the ankle without lifting the foot off the floor

Motor stage assessment

IV: 1. Standing Isolated non-weight-bearing knee flexion , hip extended or nearly extened 2. Standing Isolated dorsiflexion of the ankle , knee extended, heel forward in a position of a short step

Motor stage assessment

VI: Standing ( hip abduction) beyond range obtained from elevation of the pelvis Sitting Reciprocal action of the inner and outer hamstring muscles, resulting in inward and outward rotation of the leg at the knee, combined with inversion and eversion of the ankle

Key muscle

Muscle gradation Description 5 (normal) 4 (good) 3 (fair) 2 (poor) 1 (trace) 0 (abscent)

Key muscle

C5 Elbow flexorsC6 Wrist extensorsC7 Elbow extensorsC8 Finger flexors (distal phalanx of middle finger)T1 Finger abductors (little finger)

Key muscle

L2 Hip flexorsL3 Knee extensorsL4 Ankle dorsiflexorsL5 Long toe extensorsS1 Ankle plantar flexors