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Flashcards in Brunnstrom Deck (14):

Associated reaction:

Involuntary movements or patterned, reflexive increases in muscle tone and limb position on the hemiplegic side that occur in stressful situations. They are commonly seen when movement is resisted, when the patient exerts effort, or when the patient fears loss of balance.



Supposition that something is true; foundation of a theory


Extensor synergy:

For the UE: scapular protraction, shoulder horizontal adduction and internal rotation, elbow extension, and forearm pronation. For the LE, hip extension, adduction, and internal rotation, knee extension, plantar flexion, and inversion of the ankle, and plantar flexion of the toes.



State of readying neurons to depolarize and propagate an impulse or to make contraction of a muscle or a reflex response more likely.


Facilitation techniques:

manual treatment techniques and hand placements used to increase muscle tone and to produce movement responses.


Flexor synergy:

for the UE, scapular elevation and retraction, shoulder abduction and external rotation, elbow flexion, and forearm supination. For the LE, hip flexion, abduction, and external rotation; knee flexion; ankle dorsiflexion and inversion; and dorsiflexion of the toes.



Repetition with the intent to improve



Patterned movements of the entire affected limb in response to a stimulus or to voluntary effort.

State of excess tone and hyperactive response to stretch. If moderately to severely spastic, the limb feels tight and is difficult to move into position.


Stage 1

Flaccidity; no voluntary movement or stretch reflexes


Stage 2

Arm Beginning spasticity; limb synergies begin to appear as associated reactions, flexion develops before extension

Hand -Gross grasp beginning; minimal finger flexion possible

Leg- Spasticity develops; minimal voluntary movements


Stage 3

Arm- Spasticity increasing; beginning voluntary movement, but only in synergy.

Hand- Gross grasp; hook grasp possible; no release; no voluntary finger extension

Leg- Spasticity peaks; flexion & extension synergy present; hip-knee –ankle flexion in sitting and standing


Stage 4

Arm- Spasticity decreasing; some movements deviating from synergy :( hand behind back, arm to forward horizontal position, pronation & supination with the elbow flexed to 90).

Hand Gross grasp present; lateral prehension developing with release by thumb; small amount of finger extension

Leg- Knee flexion past 90 degrees in sitting, with foot sliding backward on floor; dorsiflexion with heel on floor and knee flexed to 90


Stage 5

Arm Independence from basic synergies: Arm to side horizontal position, arm forward and overhead, pronation & supination with elbow fully extended. Spasticity waning.

Hand- Palmar prehension, spherical and cylindrical grasp(awkward) Voluntary mass finger extension(variable ROM)

Leg- Knee flexion with hip extended in standing; ankle dorsiflexion with hip and knee extended


Stage 6

Arm Spasticity minimal Isolated mvmts freely performed with near coordination.

Hand- All types of prehension, voluntary finger extension full (ROM), Individual finger mvmts

Leg- Hip abd. in sitting or standing; reciprocal internal & external rotation of hip with inversion&eversion of ankle in sitting