Brunnstrom Stages of Stroke Recovery

Brunnstrom Stages of Stroke Recovery

Understanding the Brunnstrom stages of stroke recovery will allow you to identify where you are in your stroke recovery timeline and foresee what obstacles you’ll face (and overcome!) on the road to recovery.

In the model, you’ll see spasticity referenced quite frequently, so we’ll begin with a brief definition and then move onto the Brunnstrom stages of stroke recovery.

Spasticity Explained

Spasticity involves any of the following conditions: impaired muscle movement, muscle stiffness, muscle spasms, and limited coordination.

Spasticity is a common side effect of neurological injury caused by the new miscommunication between the central nervous system and muscles. The best treatment for spasticity is rehab exercises.

Although exercise is probably the last thing you want to do with stiff muscles, it’s the only way to retrain the brain and repair that communication between the brain and muscles.

Now let’s move on to the Brunnstrom stages of stroke recovery.

Stage 1: Flaccidity

No movement in the affected muscles

Flaccidity is a condition characterized by muscles weakness or paralysis. In the beginning of your motor recovery, you will start off with a certain degree of flaccidity in your affected muscles caused by the stroke or other neurological injury. At this point, active movement of the affected muscles isn’t possible.

Stage 2: Spasticity Is Present

Passive movement and spasticity occur

Then, a small amount of movement seeps in. During the second stage of motor recovery after stroke, a small amount of movement is recovered, usually as passive movement or response from stimuli (like TENS therapy). No voluntary movement is present.

Stage 3: Spasticity Increases

Active movement and spasticity occur

During the next stage of stroke recovery, movement continues to increase (while spasticity comes to a peak) and difficult, voluntary movements start to emerge. At this point, you’ve been diligently performing your rehab exercises and your brain is effectively relearning how to communicate with your muscles.

Stage 4: Spasticity Decreases

Significant motor control emerges

We’re halfway through the stages and things are starting to look promising. At stage 4, muscle control increases and movement starts to become easier. Some abnormal movement still occurs, but spasticity has significantly decreased.

Stage 5: Spasticity Wanes

Complex movement develops

At this stage, spasticity continues to decrease and muscle control increases. You can start to make complex movements on your own.

Stage 6: Coordination Reappears

Spasticity is no longer present

Then, spasticity disappears completely and coordination rapidly improves. Complex coordinated moves are almost fully restored and a full recovery is within sight.

Stage 7: Normal Function Returns

Full control of muscle movement is restored

This is when you do your happy dance. You’ve been consistently performing your rehab exercises and now complex movement patterns are fully restored. You can move again with normal timing, coordination, strength, and endurance.

If you want to reach the final stage, we encourage you to read our unconventional guide on how to recover from stroke and stroke paralysis treatments.

  • Tamara Pots

    These stages go hand in hand with the stages of grief by Kubler-Ross right? I’ve been stuck in stage 3 Brunnstrom for years now, because I’m so angry and frustrated. And ashamed, because I feel like an ugly invalid in stead of being sexy.

    • Betsey

      Hang in there Tamara! You are not an ugly invalid, you are beautiful and deserve to know that!

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  • Francis E Williams

    Hello Tamara Pots, and any one else reading this thread. My half body stroke affected everything, form eyes, speech, emotion, leg, arm, stomach and even eye muscles. In July 2013 I thought I was confined to a slurred speech unbalanced and infirm lifestyle for the for seeable future.

    To give myself a goal, I gave every muscle a name, when I wanted it to move I spoke it’s name. In fact I never stopped speaking for the first month, and using a voice recorder made my speech improve. (positive feedback). I also got real angry, this allowed me to encourage the bits of damaged me to want to recover. This is an excellent recovery tool! ..use it, it really really works!

    I am also a type 2 diabetic, been disabled for 50 years with a motor bike accident injuries. (3.5 yrs in plaster & crutches). I have had double pneumonia as a bonus. I suffer visual cortex damage, and have been diagnosed with MS ( I feel incorrectly). I am typing this with both hands using a high powered pair of glasses fitted with a x4 loupe to see letters.

    So, my message is very simple and from the heart, every tiny movement and every tiny improvement will lead to your recovery process. You are still you, (albeit less confident by the sound of it.) you will always be you, seek out people who you don’t see regularly (grandchilren?) they will tell you the truthy about how you are progressing.

    Me?, aged 69 in 6 days time, full of pain where I force myself to exercise, I will never give up. I suggest you look in the mirror and do the same please, otherwise your life will be harder than it needs to be. I am not religious, but I have great faith in myself. I hope you can have that too… Bill

    • Tamara Pots

      People who don’t see me regularly always see they notice I’ve made progress, but I’m 8 years post now and I’m just done with this invalid stuff. (I’m 43 by the way) I’ve found a new therapy to treat trauma: TRE (http://traumaprevention.com). Bessel van der Kolk writes in his book “The body keeps the score” that there are 3 ways to treat trauma: 1. Top down by talking. 2. Pills. 3. Bottom up by working with the body. There is no one size fits all, you have to find out what works for you. I’ve talked and read a lot the last few years and intellectually I get it, but I don’t feel it, so I hope the body work is going to help me.

  • shekhar

    Respected sir,
    Please give me suggestion for my father condition 3 years back stroke is happned in rt side now he is better but the thing is that on rt leg below knee to foot a major pain is menace so please give me a suggestion i waiting for your reply do the needful.

    • Flint

      Hi Shekhar! Have you talked to your fathers doctor or therapist? They have the answers that you need. You can also join our stroke support group on Facebook to talk to other stroke survivors and get their opinion as well: https://www.facebook.com/groups/flintstrokesupportgroup/