Movement Therapy/ Brunnstrom Approach

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:

  1. Flaccidity (immediately after the onset)

No “voluntary” movements on the affected side can be initiated

  1. Spasticity appears

Basic synergy patterns appear

Minimal voluntary movements may be present

  1. Patient gains voluntary control over synergies

Increase in spasticity

  1. Some movement patterns out of synergy are mastered (synergy patterns still predominate)

Decrease in spasticity

  1. If progress continues, more complex movement combinations are learned as the basic synergies lose their dominance over motor acts

Further decrease in spasticity

  1. Disappearance of spasticity

Individual joint movements become possible and coordination approaches normal

  1. 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

Cuccurullo S, editor. Physical Medicine and Rehabilitation Board Review. New York: Demos Medical Publishing; 2004. Stroke Rehabilitation. Available from:

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

IPNFA. (2012). What is IPNFA? Proprioceptive Neuromuscular Facilitation from facilitation to participation. Retrieved on November 25, 2012 from

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

Mayo Clinic Staff. (2012). Stroke. Diseases and Conditions. Retrieved on November 25, 2012 from

O’Sullivan, S. & Schmitz, T. (2007). Strategies to Improve Motor Function. Physical Rehabilitation 5th ed. Retrieved on November 25, 2012 from

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