Brunnstrom's approach

Which characteristic best describes Brunnstrom Stage 2 for the upper limb?

• Flaccidity with no voluntary movement

• Minimal voluntary movement and emerging spasticity

• Voluntary movement within synergy patterns

• Isolated voluntary movement outside of synergy

Answer explanation

Brunnstrom Stage 2 is characterized by minimal voluntary movement and the onset of spasticity, indicating a transition from flaccidity to more active muscle tone.

Which characteristic best describes Brunnstrom Stage 3 for the lower limb?

• Voluntary movement confined to synergy patterns

• Isolated voluntary movement outside of synergy

• Minimal voluntary movement with spasticity emerging

• Isolated voluntary movement become more coordinated

Answer explanation

Brunnstrom Stage 3 for the lower limb is characterized by voluntary movements that are limited to synergy patterns. This means that the patient can initiate and control voluntary movements, but these movements are constrained by the synergy pattern.

What are associated reactions in the context of stroke rehabilitation?

• Reflexive responses caused by pain or discomfort

• Unintentional movements in the affected limb triggered by voluntary movements in other parts of the body

• Voluntary movements outside of synergy patterns

• Involuntary muscle spasms caused by fatigue

Answer explanation

Associated reactions refer to unintentional movements in the affected limb that occur when a person voluntarily moves other parts of the body. This phenomenon is common in stroke patients as the stroke often impairs the brain's ability to coordinate movement in a purposeful and isolated manner.

Which of the following activities is most likely to elicit an associated elbow flexion in the affected limb?

• Resisting shoulder adduction of the unaffected arm

• Resisting shoulder extension of the unaffected arm

• Resisting flexion of the unaffected elbow

• Resisting extension of the unaffected elbow

Answer explanation

The central nervous system has interconnected pathways that can lead to "overflow" of neural activity. When actively resisting flexion on the unaffected side, the brain receives strong proprioceptive signals about the movement, which can then trigger a similar movement pattern on the affected side due to the interconnected neural pathways.

How can the therapist use the Asymmetrical tonic neck reflex (ATNR) to stimulate elbow flexion on the affected side?

• Turn the patient's head toward the affected side

• Turn the patient's head toward the unaffected side

• Flex the neck forward

• Extend the neck backward

Answer explanation

Turning the patient's head toward the unaffected side promotes flexion of UL+LL on the affected side and extension of UL+LL on the unaffected side.

Neck flexion/extension refers to Symmetric tonic neck reflexes(STNR).

What is the primary treatment goal for the lower limb in Stage 3?

• Strengthen synergy patterns for stability

• Facilitate isolated movements outside synergy

• Reduce voluntary movements to manage spasticity

• Focus solely on passive exercises to prevent contractures

Answer explanation

In Stage 3, the focus is on facilitating isolated movements outside synergy to improve functional mobility and reduce compensatory patterns.