Brunnstrom 2

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Describe the arm in stages 1 & 2. Aim is to elicit muscle tone using reflexes & synergy, 1. Proximal traction response used to elicit flexion synergy, 2. associated reactions, 3. Tapping over upper/middle trap, rhomboids, and biceps-flexor syn, 4. Tapping over triceps – ext syn, 5. Passive mvmts alternately through synergy patterns, 6. Quick stretch & stroking  
Describe the arm in stages 2 & 3. Aim is to achieve voluntary control of synergy patterns, arm as stabilizer, 1. Repetitious alternating performance of synergy patterns, 2. Facilitate by resistance to voluntary motions, voice commands, tapping, cutaneous stimulation, 3. Follow with voluntary repetition of synergy patterns without facilitation, 4. Separate components, 5. Rowing, WB  
Describe the arm in stages 3 & 4. 1. Adapt functional activities – sanding, finger painting, sponging off table tops, using push broom, 2. Hand to chin, hand to ear, hand to opposite shoulder, etc.  
Describe the arm in stages 4 & 5. Break away from synergies & mix components from synergies, 1. Increase complexity of mvmts, 2. Skateboard, powder board arcs, figure eights, 3. Work on speed of mvmt  
Does recovery of the hand correlate with the arm? No, it does not correlate with arm  
What is Goal 1 for recovery of the hand? Achieve mass grasp, Proximal traction response – maintain wrist in extension and command to squeeze  
What is Goal 2 for recovery of the hand? Achieve wrist fixation, Apply resistance to proximal palm while in shoulder abduction, Percussion of wrist extensors while elbow is extended and arm elevated and supported, tap proximal extensors and use command (Souques Phenomenon), Begin with wrist extension, hand closed in elbow extension, then wrist flexion, hand open with elbow flexion, Gradually decrease elbow extension with wrist staying in extension  
What is Goal 3 for recovery of the hand? Achieve active release of grasp  
What is Technique #1 for achieving active release of grasp? Rotation, Face pt, pull thumb out of palm by grasping the thenar eminence, grasping the thenar & hypothenar eminence, supination, wrist slightly flexed, Alternate pronation & supination with emphasis on supination, Pressure on thumb decreased during pronation, Cutaneous stimulation over dorsum of hand in supination  
What is Technique #2 for achieving active release of grasp? Same hand positioning as for technique #2, Therapist uses free hand for rapid stroking over proximal phalanges of affected hand, Stroke PIP & DIP joints  
What is Technique #3 for achieving active release of grasp? Finger extension exercise glove, Pull thumb out, same position as above, forearm supinated, Soques Phenomenon facilitates extension, Gradually discontinue support as pt takes over  
What is Goal 4 for recovery of the hand? When reflex extension is well established, Alternate opening and closing of hand, Hand can be placed on ulnar side and pat attempts to move thumb away from index, Stimulate abductor pollicis by tapping  

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