Brunnstrom Approach To Stroke Essay

Identification of Question and description of Disability
Cerebrovascular accident or stroke, a leading cause of death and long-term disability, occurs when blood supply to the brain is interrupted. The interruption of blood supply deprives the brain of oxygen or nutrients and causes brain cells to die. Stroke patients are predominantly older adults, but it can happen to anyone regardless of age. As a result of stroke, people lose various functional skills depending on the type of stroke. However, people can regain their functional skills because “the nervous system has a high level of neuroplasticity and individual differences in neural connections and learned behaviors play a major role in recovery” (Atchison & Dirette, 2012, p.135). One
approach that’s commonly used for post-stroke patients is the Brunnstrom approach. This approach explains the expected sequential stages of recovery and provides motor tests to help determine the stage an individual is in. The use of Brunnstrom’s stages of recovery can guide occupational therapists on the type of intervention to use in order to help regain voluntary motor skills. This paper seeks to determine the effectiveness of Brunnstrom’s stages of recovery and answer the question: does the use of Brunnstrom approach improve functional motor skills in post-stroke patients?
Analysis of the Approach
Brunnstrom approach is a reflex/hierarchical approach because it identifies sequential stages of recovery in post-stroke patients.
Primitive reflexes are typically integrated in people, however they become dominant after a stroke. Arya et al (2012) state that Brunnstrom approach “uses reflexes to develop synergistic and voluntary control of movement” (p.3). Pandian, Arya, and Davidson (2012) agree and state that “Brunnstrom movement therapy uses reflexes to develop movement behavior through sensory stimulation, in order to inhibit spasticity, and movement retraining to enhance recovery” (p.331).
Brunnstrom’s stages of recovery begin at stage 1, which is immediately after stroke with flaccidity and no voluntary movement. In stages 2 and 3, spasticity is noted and synergies are first facilitated through association reactions and then performed voluntarily. Pandian and Arya (2012) emphasize the importance of using synergies to gain more functional motor movements by explaining that "synergy is a functional linkage of muscles during voluntary motor action” (p. 543). In stages 4 and 5, spasticity begins to decline and individuals move toward independence from synergies. In the final stage, individuals are able to move their joint
independently.
Brunnstrom approach influences the development of copious assessments to help appraise an individual’s progress and one of them is the Fugl-Meyer Assessment (FMA). FMA is a stroke specific assessment that evaluates motor function, joint junction, sensation, and balance on a 3-point ordinal scale, ranging from 0 (no function) to 2 (full function). The total for each subcategory is then taken and according to Huang et al (2016), “sum scores could be an outcome indicator because any progress made on each item by a patient could be detected, which is useful for monitoring a patient’s overall change over time and determining the effects of intervention” (p.1). Thus, the use of Brunnstrom and FMA allows occupational therapists to determine what techniques to use in order to regain motor skills and keep track of progress.
Comparison of Approach Brunnstrom and the Neuro-Developmental Treatment/Bobath are two approaches used in the intervention for post-stroke patients. The Bobath approach was developed to help patients with neurological impairments to regain functional motor skills. Brunnstrom approach suggests that due to stroke, patients’ primitive reflexes are now apparent due to the malfunctioning of the higher parts of the nervous system (Lettinga, Helder, Mol, & Rispens, 1997). In contrast, Bobath approach proposes that patients’ movement patterns are pathological post-stroke. Hence, patients aren’t regressing to primitive reflexes, but instead there is damage to a developed neurosystem (Lettinga et al., 1997). The goal of therapists using the Brunnstrom approach is for the patients to learn how to use their reflexes and master their synergies so that they can perform daily tasks functionally at their own will. Patients that are rehabilitated through Brunnstrom approach are trained in a therapeutic environment that provides materials necessary for recovery and once outside of this environment, patients are unable to practice the skills learned during therapy (Lettinga et al., 1997). In contrast, therapists who use the Bobath approach are concerned about the patient’s ability to successfully complete a task as “normal” as possible and this approach allows for patients to practice outside of the clinic without the help of a therapist. Although this allows for more functional practice time, this approach requires the patient to adapt to consciously be aware of their actions as a way of life (Lettinga et al., 1997). It also requires that all members of the team, friends, and family of the patient to follow the approach so that the patient’s actions can be corrected if necessary. Brunnstrom approach does not require the therapist to incorporate the patient’s past interests into the rehabilitation. Patients can go through Brunnstrom oriented therapy without their interests in mind and be successful. Since the Bobath approach focuses on the ability to perform daily tasks at the level of pre-incident, the therapist will have to find ways to incorporate a patient’s pre-incident occupations into the therapy process. Therefore, making the knowledge of the patient’s habits and surroundings crucial to understanding what is “normal” for the patient (Lettinga et al., 1997).