I have spoken to a few survivors who seem quite upset that they have developed muscle spasticity. In a sense I can understand as I remembered the anxiety I felt when my arm muscles started feeling stiff and achy. In fact it still gives me anxiety and I end up being so worried of my fingers curling up that it keeps me awake.
I then was made aware of the Brunnstrom Stages Of Stroke Recovery and realised the stiffness was part of recovery and that as long as I keep working on stretching and moving my limbs, the stiffness will eventually go sway.
The Brunnstrom stages is one of the most well-known stroke recovery stages which is also known as the Brunnstrom approach. The Brunnstrom stages was developed by physical therapist Signe Brunnstrom in the 1960’s. When a stroke occurs, typically it affects one side of the body. The Brunnstrom approach describes the sequence of motor development and reorganization of the brain after stroke.
Of course every stroke is different and therefore every stroke recovery timeline is also different. This means that the Brunnstrom approach is more of a guide than an exact recipe. It is still good to know to help us understand our recovery and to plan our recovery routine. The Brunnstrom approach is unique, however, because of how it views spasticity (muscle stiffness) and involuntary muscle movement. Instead of seeing these as symptoms to fight, the Brunnstrom approach views them as part of the recovery process and utilizes them to aid recovery.
It is important to understand that not everybody starts at Stage 1. Depending on the severity of our stroke, our starting point may be at a later stage. For me, however, it took a more conventional route.
Flaccidity involves paralysis and “loose, floppy” muscles, which occur on the survivor’s affected side. Rehabilitation should focus on passive exercise during this stage. This means using our unaffected side to aid movement on our affected side.
Stage 2: Spasticity Appears
Spasticity involves muscle stiffness after stroke, and it’s actually a sign of recovery because it’s an improvement from flaccidity where the muscles have no tone at all. To treat spasticity, continue practicing passive exercises on a consistent basis to keep neuroplasticity stimulated. Even if you can only move a small amount, it’s important to keep putting in the repetition and consistency necessary to activate neuroplasticity and promote recovery.
Stage 3: Increased Spasticity
When spasticity increases, it can be discouraging but it also signifies continued recovery. Pursue a mix of active and passive exercise to help address spasticity. Splinting, gloves, etc., can also be helpful for spasticity, so speak with your therapists about this.
Stage 4: Spasticity Decreases
With enough hard work, spasticity begins to decrease and more coordinated movement emerges. This is when we want to focus on isolating movements and strengthening those connections in the brain to certain muscles with active range of motion exercises.
Stage 5: Complex Movement Returns
After movement returns to the arms and legs, it begins to improve in the hands and feet. Muscle control tends to recover from from proximal (nearest to the torso) to distal (farthest from torso). Now it’s time to add resistance to movement. Add small weights or use a household item like a half-full water bottle to your exercises. Incorporate theraband or theraputty to your daily routine.
Stage 6: Spasticity Disappears
Once spasticity disappears entirely and motor control is almost fully restored. You are also able to move individual joints without any synergistic movement. Once spasticity is gone, survivors can focus on both strength and coordination exercises.
Stage 7: Normal Function Restored
The last phase of the Brunnstrom stages of stroke recovery involves a full recovery of muscle function. Not all survivors will reach stage seven, but many can with enough hard work and dedication. At this stage of the Brunnstrom approach, you can voluntarily move your body with strength and coordination just as you did before your stroke.
You can get some home sxercise guides here or follow the #post stroke sxercise videos hashtag on this website for exercise videos that are posted every weekend.
According to the Brunnstrom stages, I may be anywhere from Stage 2 to Stage 5 of recovery, depending on where I look. There’s definitely some stiffness in the upper arms that makes movement difficult but not much stiffness in the legs. And interestingly I am beginning to see movement return to my hands and fingers even though it’s not a full range of movement yet.
The Brunnstrom stages help me to view my recovery as a process rather than a singular event. When symptoms appear to worsen after a stroke, it can cause survivors to lose motivation and, as a result, stop pursuing recovery. However, sometimes what seems like a step backwards is actually a sign of progress. This is why it’s helpful to understand how spasticity progresses throughout recovery via the Brunnstrom approach. I personally look forward to my admission to the Tun Razak Rehabilitation Centre so that I can subject myself to a more rigorous and supervised rehabilitation routine.
As much as we’d like to see a clear cut answer to how long it will take to recover from stroke, every person is different. Some may see more rapid progress in days, weeks, or months after stroke. It might take years for others. Some people may some may spend more time than they would like to on a stage.
We do know that recovery has no end date. Some stroke patients and stroke survivors(stroke victims) might not have an occupational therapist or rehabilitation program to follow. Each day is a new opportunity to look at where we’re at and take action to get to where we want to be. The Brunnstrom approach gives us a roadmap.
With enough time and hard work, we just might see ourselves progressing through the Brunnstrom stages of stroke recovery, and that is worth celebrating.
