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What Flexion Synergy Patterns After Stroke Mean For Recovery

Physical therapist checking patient's flexion synergy patterns after stroke

Although flexion synergy patterns after stroke can be frustrating to deal with, they are actually a sign of improvement.

Synergistic movements occur when too many muscles are activated at once. For example, if you try to move your shoulder, your elbow might contract.

To help you better understand flexion synergy patterns, this article will explain the cause of synergistic movements and how to eliminate them.

What are Synergy Patterns?

Coordinated muscle movements are a result of different muscle groups working together. Therapists call these patterns of movement synergies.

To complete a successful movement, two things must happen at once:

  • The agonist muscles (the muscles that initiate movement) must contract.
  • The antagonist muscles (the muscles that inhibit movement) must relax.

The brain is in charge of coordinating these movements. It makes sure the muscle groups do not accidentally conflict with each other.

It does this by sending inhibitory or excitatory signals to the right muscle groups.

For example, to pick up a fork, you must extend your arm first, which means your bicep muscle cannot fire while this is happening. Otherwise, your arm would just contract.

The brain, therefore, will send signals to your bicep, telling it to relax. This allows you to extend your arm with ease. 

After a stroke, however, your brain cannot send the correct signals to the muscle groups. As a result, these synergies become mixed up and strange patterns can occur.

What Flexion Synergy Patterns After Stroke Mean for Recovery

Flexion synergy patterns after stroke involve three movements:

  • External rotation of the shoulder
  • Flexion of the elbow
  • Supination of the forearm

In other words, whenever you try to move your affected arm, your shoulder will raise, your elbow will contract, and your wrist will turn until your palm faces up. This can also happen even if you don’t initiate movement.

While these movements can be irritating, they are also a sign that you are making progress in your stroke recovery.

The Brunnstrom Stages of Stroke Recovery and Flexion Synergy Patterns

Flexion synergy patterns appear in stages 2 and 3 of the Brunnstrom stages of stroke recovery.

In the first Brunnstrom stage, the muscles are in a state of flaccidity. This means that no messages from the brain can reach your muscles, leaving them effectively paralyzed.

As you enter stages 2 and 3, however, the brain has begun to re-establish a connection to the muscles, and the muscles start to finally “wake up.”  That is when synergy patterns emerge.

Flexion synergy patterns are your brain’s way of relearning how to control your muscles again. This process is slow, but it is possible to help it along.

Treating Flexion Synergy Patterns After Stroke

The best way to overcome flexion synergy patterns after stroke is through massed practice of stroke rehabilitation exercises. This helps activate neuroplasticity and rewire the brain.

The more you move your affected muscles, the more your brain can create new neural pathways that will reestablish communication with muscle groups.

Of course, this can be hard to do, especially when movements are abnormal. That’s why your best option is to work with a physical therapist to find the ideal approach.

As you continue with your exercises, you should eventually achieve normal movement and function — to get as close as possible.

Here are some examples of exercises you can do to overcome flexion synergy patterns:

1. Passive Exercises and Stretching

physical therapist assisting stroke patient through passive exercises for flexion synergy patterns after stroke

Passive range-of-motion exercises can help you maintain range of motion and regain control of your muscles. During passive exercises, the therapist moves your muscles for you.

Even though you technically aren’t moving it yourself, having someone else do the motion is enough to stimulate the brain and rekindle the neural networks that help you move. 

2. Sensory Exercises

Sensory stimulus plays a crucial role in synergistic movements. It’s what allows your muscles to know how and where to move.

For example, the proprioceptive sense helps the brain detect what position your joints are already in. This lets it choose which muscles it needs to activate in order to change positions.

After a stroke, sensation can be diminished. Sensory exercises help you restore your senses and thus improve your movement.

The following are a few helpful sensory exercises you can try at home:

  • Joint sensation. Sit blindfolded on a chair, and have a caregiver move your arm to several different positions. Try to identify where your arm is without looking.
  • Fingertip touch. While still blindfolded, have someone touch each of your fingertips separately. Your goal is to correctly name which finger they touch. Then take off the blindfold and see if you were right.

Because of your brain’s neuroplasticity, the more consistently you stimulate your senses, the faster your brain will relearn how to interpret sensation and improve synergy patterns.

3. Active Range-of-Motion Exercises

man in wheelchair practicing active stroke exercises at home

Active exercises are the best way to increase proper synergy patterns and regain voluntary movement.

Examples of active exercises include:

  • Hand to opposite knee. Sit on a chair without armrests, lean against the chair’s back, and hold head up. Move your affected hand from your lap to your opposite knee. Repeat 5 times.
  • Hand to chin. While sitting in the same position, move your hand from lap to your chin and back down. This gives you a chance to practice the full range of elbow flexion.

Again, when you first start these motions, you will probably not be able to do them correctly. That is fine, just do what you can and keep practicing.

See all active stroke rehab exercises »

Flexion Synergy Patterns After Stroke: Key points

Flexion synergy patterns cause you to move multiple parts of your arm at once. They are uncomfortable, but they are a sign of improving communication between your brain and muscles.

Fortunately, you can overcome flexion synergy patterns with consistent practice of therapeutic rehab exercises. These movements help rewire the brain and allow you to isolate the correct muscle group.

With enough practice, you can regain voluntary control of your muscles and move your arm smoothly again.

Featured Image: ©iStock/wutwhanfoto

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