BRUNNSTROM APPROACH

MU’JIZATILLAH
 PENDAHULUAN
• The Brunnstrom Approach was developed in the 1960’s
by Signe Brunnstrom, an occupational and physical
therapist from Sweden. With seven stages, the
Brunnstrom Approach breaks down how motor control
can be restored throughout the body after suffering a
stroke.
• The Brunnstrom approach is a type of physiotherapy
treatment used with patients with movement problems
following damage to the brain and spinal cord, (central
nervous system/ CNS).
 PRINSIP 1:
Dasar Neurofisiologis
• Pd KEAD. NORMAL: proses maturasi
kontrol gerak volunter berlangsung
bertahap (evolusi), dr reflek (spinal &
brainstem)  gerak semi volunter & bbrp
gerak volunter/sinergis (mid-brain)  grk
volunter (brain)
• Pd PEND. STROKE: tjd evolusi terbalik, grk
volunter hilang diganti reflek primitif 
grk stereotip dlm pola sinergis
• Pd proses PENYEMBUHAN: berjalan
melalui tahap2 tertentu (twitchell)  grk
volunter yg timbul dimulai dr pola sinergis
 PRINSIP 2:
Tahap Penyembuhan Stroke Menurut Brunstroom

• TAHAP 1: tjd segera stl serangan, tdk ada grk volunter  flaccid
• TAHAP 2: mulai timbul spastisitas & pola sinergis sbg reaksi
asosiasi / grk volunter
• TAHAP 3: spastisitas (+), pend mulai dpt melakukan
sebagaian/seluruh komponen sinergis
• TAHAP 4: spastisitas (-), pend mulai dpt melakukan grk bbrp
volunter di luar pola sinergis meski kesulitan
• TAHAP 5: spastisitas terus turun, pend dpt melakukan lbh
banyak kombinasi grk di luar pola sinergis
• TAHAP 6: spastisitas makin turun, grk individu makin baik,
koordinasi nyaris normal
 Brunnstrom Treatment
• Physiotherapists using the Brunnstrom approved aim to maximise recovery and
restore normal function as soon as possible following an injury to the CNS.
Treatment includes:Encouraging whatever movement is possible and building on
it, through; strengthening, sensory stimulation, positive reinforcement, verbal
feedback, and the use of reflexes.
• Treatments will involve tasks that are difficult but achievable. As soon as the task
is achieved new goals will be set. Patients are taught to use the voluntary
movement that is available to them to achieve goals / tasks.
• Movement will be progressed in the correct sequence. Abnormal movement
always comes first following injury and there is a normal pattern of recovery
before normal patterns of movements are obtained. The Brunnstrom approach
acknowledges that before normal movement can be restored there will be a
period of abnormal movement. It is the job of the physiotherapist to get their
patients through the stages of abnormal movement to achieve normal
movement and function.
 Prinsip Dasar Latihan
• Tahap 1-3: diberi stimulasi untuk menimbulkan reaksi
asosiasi  bila reaksi sdh timbul (dlm pola sinergis),
sgr dilakukan upaya untuk mengontrol &
memperkenalkannya
• Tahap 4-5: bila pend mampu melakukan kontrol grk
sinergis, diajarkan untuk mengontrol grk di luar pola
sinergis tsb
• Tahap 5-6: latihan ADL
 Stage 1 Flaccidity
• Though stroke does serious neurological damage, other
healthy brain cells and muscles can help make up for some of
this damage. In fact, the patient’s own body is full of tools
that reduce complications and increase their likelihood of
entering new stages of recovery. It’s never too early to start
retraining the body and brain after stroke, even if patients are
still experiencing flaccid paralysis and hypotonia.
 Stage 2 Dealing with the Appearance of
Spasticity
• Pola Sinergis muncul:
– Fleksor Lengan: retraksi/elevasi shoulder girdle, abd &
ekso rotasi humeri, fleksi elbow > 900, supinasi fore
arm;
– Fleksor Tungkai: fleksi-abd-ekso hip, fleksi knee, dorsi
fleksi ankle & kaki;
– Ekstensor Lengan: protraksi shoulder girdle, add-endo
rotasi humeri, pronasi fore arm, fleksi hand;
– Esktensor Tungkai: ekst-abd-endo hip, ekst knee, plantar
fleksi-inversi ankle, fleksi finger

Unused limbs still need stimulation to maintain or form

connections to neurons. Though the nerves and
connections that originally controlled your affected limbs
may be damaged too much to create voluntary
movements, it could still be possible to regain movement
in later stages of recovery. In order to leave this possibility
open and prevent the body’s tendency toward learned
non-use, it’s important to continue using and moving your
affected limbs and muscles as much as possible.
 Stage 3 Increased Spasticity
• Passive exercises, also known as passive range-of-motion (PROM)
exercises, should be continued during this stage to improve your
range of motion. Treatment includes how far the therapist can move
your joints in different directions, like raising your hand over your
head or bending your knee toward your chest.
• Patients and family/caregivers should be educated about the
importance of maintaining range of motion and doing daily
exercises. It is important to minimize highly stressful activities this
early in training.
 Stage 4 Decreased Spasticity
• The focus during this stage is to strengthen
and improve muscle control. Now that you are
regaining motor control and can start to make
normal, controlled movements on a limited
basis, you can start to build strength back in
your limbs and continue work on your range of
motion. Continuing to stretch out your
muscles is still important in this stage.
Therapists use
active-assisted range of motion (AA
ROM) exercises
when a stroke patient has some
ability to move but still needs help to
practice the exercises or complete
the movement.
• You can begin
active range-of-motion (AROM) exercises
once you have regained some muscle
control and can perform some exercises
without assistance. They often involve
moving a limb along its full range of
motion, like bending an elbow or rotating
a wrist. AROM exercises increase
flexibility, muscle strength, and
endurance. Range-of-motion exercises
should be practiced equally on both the
affected and unaffected sides of the body.
Stage 5 Complex Movement Combinations
• Voluntary movements are
purposeful and goal-
directed. They are learned
movements that improve
with repetition or practice
and require less attention.
Some examples include
combing hair, swinging a
bat, driving a car,
swimming, and using
eating utensils.
 Stage 6 Spasticity Disappears
• Then, spasticity disappears completely and
coordination rapidly improves. Complex
coordinated moves are almost fully restored
and a full recovery is within sight
• Lanjutkan latihan ADL
THANK YOU