Libro de las técnicas de brunstrom, Transcripciones de Anatomía

¡Descarga Libro de las técnicas de brunstrom y más Transcripciones en PDF de Anatomía solo en Docsity!

BRUNNSTROM’S

APPROACH

Presented By: Himani Kaushik

Objectives:

➢ Discuss the concepts and principles underlying the Brunnstrom’s approach

➢ Brunnstrom recovery stages

➢ Treatment principles & techniques

Introduction:

Reflex Theory

Movement is controlled by stimulus response. Reflexes are the basis for movement: reflexes are combined into actions that create behavior.

Hierarchical Theory

Characterized by a top-down structure, in which higher centers are always in charge of lower centers.

Cont’d:

● When the CNS is injured, as in cerebrovascular accident, an individual goes through an “evolution in reverse”.

Movement becomes primitive, reflexive and automatic.

● Changes in tone and the presence of reflexes considered as a normal process of recovery.

Basic Limb Synergies:

● Normal synergistic movements are purposeful movements with maximum precision and minimum waste of energy.

● Basic limb synergy (BLS) do not permit different combination of muscles.

● BLS are considered as primitive, automatic and reflexive due to loss of inhibitory control from higher centers.

Cont’d:

● Mass movement patterns in response to stimulus or voluntary effort both

Gross flexor movement (Flexor Synergy)

Gross extensor movement (Extensor Synergy)

Combination of the strongest component of the synergies (Mixed Synergy)

● Appear during the early spastic period of recovery

Upper Limb Mixed Synergy: Scapula retraction Shoulder add.+IR Elbow flexion Forearm pronation Wrist & fingers flexion

Lower Limb Mixed Synergy: Pelvis post tilt hip add.+IR Knee extension Ankle & toes plantarflexion

Rubrospinal tract Vestibulospinal tract

Cont’d:

● Homolateral Limb Synkinesis: the response of one extremity to stimulus will elicit the same reaction in it’s ipsilateral extremity.

● Raimiste’s Phenomenon: resisted abduction or adduction of the sound limb evokes a similar reaction in the affected limb.

● Associated reactions are also evoked by Yawning, Sneezing and Coughing.

Postural Reactions:

● Asymmetric Tonic Neck Reflex (ATNR): Head rotation to the left causes extension of left arm and leg and flexion of right arm and leg; head rotation to the right causes extension of right arm and leg and flexion of left arm and leg.

● Symmetric Tonic Neck Reflex (STNR): Flexion of the neck results in flexion of the arms and extension of the legs; extension of the neck results in extension of the arms and flexion of the legs.

Brunnstrom Recovery Stages:

● Brunnstrom stereotyped sequence of events takes place during recovery.

● Initially classified into six stages later on modified into seven recovery stages.

● Depending on the severity of the insult and the degree of the sensory motor involvement,

recovery may get arrested at any stage in the process.

● Stages cannot be skipped.

● In some cases, specially when insult is minor, the recovery may proceed rapidly with no

distinct observable stages.

● Believes that the stages of recovery resemble the normal infantile motor development.

BRUNNSTROM BOBATH

V\S

Tendon Reflex

Spasticity

Voluntary finger flexion on proprioceptive stimulus Proprioceptive traction response

Control of hand movements

Grasp

reinforcement

True grasp reflex

Brunnstrom Recovery Stages for

Lower limb:

Flaccidity

Minimal voluntary movements of the lower limb

Hip - Knee - Ankle flexion in sitting and standing

Sitting knee flexion beyond 90 degrees with foot sliding backward on the floor, voluntary ankle dorsiflexion without lifting foot from the ground Standing^ isolated^ knee^ flexion beyond with hip extension, isolated ankle dorsiflexion with knee extension, heel forward in a Standing hip abduction with pelvis position of short step elevation, knee inner and outer rotation, combined with ankle inversion and eversion