Brunnstrom Evalution

目的 :

1: To evaluate the neurological

recovery of patient after stroke

2. To design treatment program

according to the stage of recovery

Brunnstrom Evalution

Stroke 之後 , patient 在 recovery 時 , 發生的次序

Stage I : Flaccid, no movement

Stage II:Spasticity 開始出現 , 自主動作要 誘發才能出現 . Associated movement

Stage III:Synergy stage. Spasticity 最強 上肢以 Flexor spasticity 為主 下肢以 extensor spasticity 為主

Brunnstrom Evalution

Stage IV: Some isolated movement,

Spasticity 下降Stage V: Synergy pattern 下降 Spasticity 更弱StageVI: Movement coordination near

normal.

Spasticity minimal

Motor stage assessment

Proximal part

I: Presynergy stage:

Flaccid

II:Spasticity:

Associated movement

Motor stage assessment

III:Synergy stage:

1. Extension components:(use key to

grading)

a: Shoulder Protract, Add, Int. Rot

b:Elbow extension

c:Forearm pronation

Motor stage assessment

2. Flexor components

a: Shoulder girdle elev.

b: Shoulder girdle retract.

c: Shoulder joint hyperext.

d: Shoulder abd.

e: Shoulder joint ext. rot

f: Elbow Flexion

g: Forearm supination

Motor stage assessment

IV:Movements deviating from basic synergies

1.Hand to sacrum

2.Raise arm forwd. To horiz.

3.Pronation (Elbow flexed)

4.Supination (Elboe Flexed)

Motor stage assessment

V.Relative independence of basic synergies

1.Raise armto side - horz.

2.Supination (Elbow Extened)

3.Forward reach from horiz.

4.raise arm over head

VI. Nearly normal coordinated movement

Motor stage assessment

Hand

I: Flaccid

II: Spasticity : Active finger flexion (+/-)

III: 1. Mass grasp

2. Hook grasp without release

3. Reflex finger extension (+/-)

Motor stage assessment

IV: 1. Lateral prehension with release by

thumb movement

2.Semivoluntary finger extension (small

range)

V: 1.Palmar prehension

2.Cylindrical / Spherical grasp with

limited function

Motor stage assessment

3.Voluntary mass finger extension

(variable range)

VI: 1. Control of all prehension type

movement with skill

2.Voluntary finger extension (full range )

3.Individual finger movement , less

accurate

Motor stage assessment

Lower limb

I: Flaccid

II: Minimal voluntary movement of the lower

limb

III:Hip-knee-ankle flexion in sitting and

standing

Motor stage assessment

IV: 1. Sitting

Knee flexion beyond 90 degree with

the foot sliding backward on the floor

2. Voluntary dorsiflexion of the ankle

without lifting the foot off the floor

Motor stage assessment

IV: 1. Standing

Isolated non-weight-bearing knee flexion ,

hip extended or nearly extened

2. Standing

Isolated dorsiflexion of the ankle , knee

extended, heel forward in a position of a

short step

Motor stage assessment

VI: Standing ( hip abduction) beyond range

obtained from elevation of the pelvis

Sitting

Reciprocal action of the inner and outer

hamstring muscles, resulting in inward

and outward rotation of the leg at the

knee, combined with inversion and

eversion of the ankle

Key muscle

Muscle gradation Description

5 (normal)

4 (good)

3 (fair)

2 (poor)

1 (trace)

0 (abscent)

Key muscle

C5 Elbow flexors

C6 Wrist extensors

C7 Elbow extensors

C8 Finger flexors (distal phalanx of

middle finger)

T1 Finger abductors (little finger)

Key muscle

L2 Hip flexors

L3 Knee extensors

L4 Ankle dorsiflexors

L5 Long toe extensors

S1 Ankle plantar flexors