Movement Therapy/ Brunnstrom Approach
(opposite of NDT approach)
- Uses primitive synergistic patterns in order to improve motor control through central facilitation.
- Based on concept that damaged CNS regressed to older or less mature patterns of movements (limb synergies and primitive reflexes); thus, synergies, primitive reflexes, and other abnormal movements are considered normal processes of recovery before normal patterns of movements are attained
- Patients are taught to use and voluntarily control the motor patterns available to them at a particular point during their recovery process (e.g., limb synergies)
- Enhances specific synergies through use of cutaneous/proprioceptive stimuli, central facilitation using Twitchell’s recovery
- Opposite to Bobath (which inhibits abnormal patterns of movement)
Process of Recovery:
- Flaccidity (immediately after the onset)
No “voluntary” movements on the affected side can be initiated
- Spasticity appears
Basic synergy patterns appear
Minimal voluntary movements may be present
- Patient gains voluntary control over synergies
Increase in spasticity
- Some movement patterns out of synergy are mastered (synergy patterns still predominate)
Decrease in spasticity
- If progress continues, more complex movement combinations are learned as the basic synergies lose their dominance over motor acts
Further decrease in spasticity
- Disappearance of spasticity
Individual joint movements become possible and coordination approaches normal
- Normal function is restored
Resources for full article “A Detailed Outline of Neurorehabilitation Technique for Post-Stroke Symptoms”:
Corbett, A. (2012). Stroke. Brain Foundation: Headache Australia. Retrieved on December 9, 2012 from http://brainfoundation.org.au/a-z-of-disorders/107-stroke#effectsofstroke
Cuccurullo S, editor. Physical Medicine and Rehabilitation Board Review. New York: Demos Medical Publishing; 2004. Stroke Rehabilitation. Available from: http://www.ncbi.nlm.nih.gov/books/NBK27209/
Dickstein, R., Hocherman, S., & Shaham, R. (1986). Stroke Rehabilitation: Three Exercise Therapy Approaches. Physical Therapy Journal, 66 (8).
Ernst, E. (1990). A review of stroke rehabilitation and physiotherapy. Stoke. Retrieved on December 10, 2012 from http://stroke.ahajournals.org/content/21/7/1081
IPNFA. (2012). What is IPNFA? Proprioceptive Neuromuscular Facilitation from facilitation to participation. Retrieved on November 25, 2012 from http://www.ipnfa.org/index.php?id=115
Kollen, B., Lennon, S., Lyons, B., Wheatley-Smith, L., Scheper, M., Buurke, J., Halfens, J., Geurts, A., & Kwakkel, G. (2009). Stroke Rehabilitation What is the Evidence? American Heart Association Journals. Retrieved on November 25, 2012 from http://stroke.ahajournals.org/content/40/4/e89
Mayo Clinic Staff. (2012). Stroke. Diseases and Conditions. Retrieved on November 25, 2012 from http://www.mayoclinic.com/health/stroke/DS00150
O’Sullivan, S. & Schmitz, T. (2007). Strategies to Improve Motor Function. Physical Rehabilitation 5th ed. Retrieved on November 25, 2012 from http://www.google.com/url?url=http://docs.thinkfree.com/tools/download.php%3Fmode%3Ddown%26dsn%3D861433&rct=j&sa=U&ei=1JLGUOuvBNTOqQHI9oGwDg&ved=0CBUQFjAA&sig2=4094qnrZ_b4KrzUbJGHsIw&q=physical+rehabilitation+5th+ed+osullivan+and+shmitz+Strategies+to+Improve+Motor+Function+chapter+13&usg=AFQjCNGi1S0r5Dc1uP6pMAu7uWtmIaAWxA