Brunnstrom Approach

Treatment for Hemiplegia
Jackson - hypothesized - reflexes are present in early development and present again after damage to the CNS. Therefore these reflexes are considered normal and precede purposeful movement.
1. Brunnstrom believed the damaged CNS reverts back to these old patterns of movement.
  1. limb synergy patterns
    1. can occur in flexion and extension
      1. LE Flexor Synergy: hip flexion & abd & external rotation, knee flexion, ankle dorsiflexion & inversion, toe extension
        LE Extensor Synergy: hip add & extension & internal rotation, knee extension, ankle plantar flexion and inversion, toe flexion
    2. Muscles in pattern are linked, cannot be isolated. If one muscle in the flexor pattern is stimulated, they all activcate.
      1. Flexor: scap add & elevation, shoulder abd & external rotation, elbow flexion, forearm supination, wrist & finger flexion
      2. Extensor: scap abd & depression, shoulder add & internal rotation, elbow extension, forearm pronation, wrist & finger flexion or extension.
  2. primitive reflexes
    1. TNR's
    2. tonic lumbar reflex
    3. TLR
    4. Reappear and normal deep tendon reflexes become exaggerated.
  3. TREATMENT & METHODS
    1. GOAL: Pt. progress through the stages
      1. Changes in head & body position can elicit early motor patterns (reflexes).
        Stimulating the skin can elicit a synergy. Rubbing the skin or tapping of the biceps can elicit a flexor synergy
        A stretch of a muscle can cause a contraction and inhibit its antagonist. Providing resistance also facilitates contraction.
    2. Use of mirrors and videos provide visual feedack.
      1. Bed Positioning: place pt. in the position opposite of the pattern they exhibit.
        Bed Mobility: log roll towards affected side.
        Trunk Movement & Balance: pt's. tend to lean to affected side. Therapist disturbs the pts. balance to elicit balance response. (SAFELY)
        as pt. progresses have them attempt positions that displace their center of gravity (ie: bending over, trunk rotation.)
    3. Shoulder ROM: achieve/maintain pain-free ROM at the glenohumeral jt. Pendulum exercises.
    4. Shoulder Subluxation: slings, used to help hold shoulder in place, but do NOT increase muscle strength.
    5. Upper LImb Training: goal is for pt. to achieve voluntary control of the synergy patterns. Achieved by REPETITION, assist of the therapist, tapping, verbal cues and stimulation applied to skin (vibration).
    6. Hand Training: 1st goal - Achieve a gross grasp.
    7. UPPER LIMB trainings to promote the progression from stage 3 to 4
      1. 1. Hand to chin
        2. Hand to ear on the same side & opposite side
        3. Hand to opposite elbow
        4. Hand to opposite shoulder
        5. Hand to forehead
        6. Hand to top of head
        7. Hand to back of head
        8. Stroking movements from top to back of head & from dorsal side of forearm to shoulder on unaffected side.

Nächster

Brunnstrom Approach

Beschreibung

Zusammenfassung der Ressource

ähnlicher Inhalt

	Erstellt von Pam Burns vor fast 11 Jahre