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The Brunnstrom Stages of Stroke Recovery: Understanding the Process

brunnstrom stages of stroke recovery

Because every stroke is different, every stroke recovery time frame will be different too. This can be frustrating when you’re trying to get an idea of your stroke recovery process.

Fortunately, there’s a tool that can provide a general picture of what your stroke recovery process will look like. It’s called the Brunnstrom Stages of Stroke Recovery, and it’s one of the best ways to measure how far you are on your stroke recovery journey.

The Brunnstrom stages (also called the Brunnstrom Approach) are used by many physical and occupational therapists to assess how well their patients are recovering. It’s also used to teach stroke patients what actions they should take to aid their rehabilitation.

That’s why, to help you along with your recovery, we’re breaking down the seven stages of the Brunnstrom approach and showing you exactly what you need to do at each stage to maximize your recovery.

What Are the Brunnstrom Stages of Stroke Recovery?

The seven Brunnstrom stages were developed in the 1960s by Swedish physical therapist Signe Brunnstrom as a framework to understand how muscle control can be restored after stroke.

What makes the Brunnstrom approach so unique is how it views spasticity 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!

Stage 1: Flaccidity

therapists helping stroke survivor out of wheelchair during stage 1 of brunnstrom stages of stroke recovery

The first stage of the Brunnstrom approach is the period immediately after a stroke when the connection between the muscles and brain are so damaged that flaccid paralysis (flaccidity) sets in.

This means that the stroke survivor cannot initiate any muscle movements on their affected side.

If the flaccidity lasts too long, the muscles will begin to atrophy.

How to recover during stage 1

The best thing you can do during this stage is to start passive range-of-motion exercises. This is where somebody else does the movement for you.

Even though you aren’t “doing it yourself,” this type of exercise is still useful for activating neuroplasticity, which will help your brain repair its connection to your muscles.

Passive exercises also help minimize spasticity, which is discussed in the next stage. Proper positioning of the flaccid limbs is also very important, so have a therapist in the hospital educate you about this.

Stage 2: Spasticity Appears

In the second stage of stroke recovery, the brain and muscles are starting to reconnect, and this means that the muscles are getting stimulated again.

The problem is the connection is still weak, and your brain is not able to coordinate movement and tell your body which muscle should contract and which should relax. As a result, they may stay contracted, which is what we call spasticity.

How to recover during stage 2

Continue with passive exercises with gentle stretching at the end of the range of motion to maintain flexibility. You’ll also want to start initiating active range-of-motion exercises on your affected side at this point, if possible.

Even if you can only move a small amount, it’s important to keep activating movement as that’s the best way to help your brain recover.

Stage 3: Spasticity Increases

therapist stretches patient to overcome stage 3 brunnstrom stages of stroke recovery

At this stage, spasticity will reach its peak and it can cause discomfort and even pain.

It might seem as though recovery is not improving but only worsening when you reach this stage, but do not give up!

In fact, the increased spasticity should actually be seen as a good thing, because it means the neural connections between your brain and muscles are improving.

You are over the hump in recovery and with hard work and the right tools, it only gets better from here!

How to recover during stage 3

doctor with botox syringe

You should continue the therapy treatments from stages 1 and 2, focusing on active and passive range of motion exercises.

If your doctor approves, you may be able to receive Botox injections to relieve your spasticity, especially if it is causing you a lot of pain. Just make sure you continue with your therapy exercises after your injection!

Botox only treats the symptoms of spasticity, not the cause, which as you now know is a result of poor communication between your muscles and brain.

The best way to improve this connection is to continue activating neuroplasticity through your exercises, and that’s why you should never give them up.

Splinting/bracing can also be helpful for spasticity, so speak with your therapists about this.

Stage 4: Spasticity Decreases

stroke patient doing stretches at home with wheelchair off to the side

Once you reach the fourth stage of stroke recovery, your spasticity should begin to decline and you’ll start to regain control of your muscles, mostly in your extremities.

At first you will have a hard time moving normally, because your movements may be out of sync, but as you continue to work on it this should improve.

How to recover during stage 4

Now that you are starting to regain control, you should focus on strengthening and improving your muscle control with more intensive active stroke exercises.

You may still need a therapist’s help guiding your movement at first, but eventually you should notice your coordination improving.

Rehabilitation tools like Flint Rehab’s FitMi might offer a great way to keep up with daily physical therapy at home.

You should also continue with your stretching, in order to preserve flexibility.

Stage 5: Complex Movement Returns

woman doing yoga pose after overcoming post-stroke spasticity

At this stage, you should be able to make more controlled and deliberate movements, such as combing your hair and picking up a fork on your own!

Spasticity may still be present but it will be mild and not affect your abilities as much.

How to recover during stage 5

At this point, the goal of therapies may revolve more around fine tuning your skills and increasing your independence with daily tasks.

Perhaps you begin to rehabilitate your fine motor skills or work on improving foot drop.

More specific rehab tools, like Flint Rehab’s MusicGlove, can help with the fine tuning process.

Stage 6: Spasticity Disappears

Once you reach stage six, spasticity disappears entirely and motor control is almost fully restored.

You are also able to move individual joints and your movement is much more coordinated!

When a person reaches the sixth stage of stroke recovery, this usually means that a full recovery is just around the corner…

Stage 7: Normal Function Returns

man celebrating recovery from stroke

At the final stage, all your therapy stretches and exercises have finally paid off. You have regained full function in the areas affected by the stroke.

Now you can move your hand, feet, legs and arms in a controlled and voluntary manner and you can coordinate complex muscle movement easily.

Now all you need to do is go and celebrate! You’ve earned it.

Finding Hope in the Brunnstrom Stages of Stroke Recovery

Those are the seven stages of stroke recovery according to Brunnstrom. However it is important to remember that not every individual will move through all of the stages since every stroke recovery process is different.

Fortunately, functional gains are possible for a lifetime with an appropriate, consistent rehabilitation program.

Even if you seem stuck at a certain stage for some time, this does not mean you will never make more progress.

The brain is an amazing organ and it has the ability to rewire and repair itself even years after an injury! You’ll never know how much you can recover unless you try, so never give up.

We wish you good luck on the road to recovery.

Keep It Going: Download Our Stroke Recovery Ebook for Free

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Get our free stroke recovery ebook by signing up below! It contains 15 tips every stroke survivor and caregiver must know.

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Get Inspired with This Stroke Survivor Story

5 stars

Mom gets better every day!

“When my 84-year-old Mom had a stoke on May 2, the right side of her body was rendered useless. In the past six months, she has been blessed with a supportive medical team, therapy team, and family team that has worked together to gain remarkable results.

While she still struggles with her right side, she can walk (with assistance) and is beginning to get her right arm and hand more functional. We invested in the FitMi + MusicGlove + Tablet bundle for her at the beginning of August.

She lights up when we bring it out and enjoys using it for about 20 to 30 minutes at a time. While she still doesn’t have enough strength to perform some of the exercises, she rocks the ones she can do!

Thanks for creating such powerful tools to help those of us caring for stroke patients. What you do really matters!”

David M. Holt’s review of FitMi home therapy

More Ways to Recover with Flint Rehab:

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More Ways to Recover with Flint Rehab:

Step 1: Download Free Rehab Exercises

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Step 2: Discover Award-Winning Neurorehab Tools

Step 3: See What Other Survivors Are Saying