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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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You’re Really on a Roll! See how Jerry is regaining movement with FitMi home therapy

My husband is getting better and better!

“My name is Monica Davis but the person who is using the FitMi is my husband, Jerry. I first came across FitMi on Facebook. I pondered it for nearly a year. In that time, he had PT, OT and Speech therapy, as well as vision therapy.

I got a little more serious about ordering the FitMi when that all ended 7 months after his stroke. I wish I hadn’t waited to order it. He enjoys it and it is quite a workout!

He loves it when he levels up and gets WOO HOOs! It is a wonderful product! His stroke has affected his left side. Quick medical attention, therapy and FitMi have helped him tremendously!”

Monica & Jerry’s FitMi review

What are these “WOO HOOs” about?

FitMi is like your own personal therapist encouraging you to accomplish the high repetition of exercise needed to improve.

When you beat your high score or unlock a new exercise, FitMi provides a little “woo hoo!” as auditory feedback. It’s oddly satisfying and helps motivate you to keep up the great work.

In Jerry’s photo below, you can see him with the FitMi pucks below his feet for one of the leg exercises:

FitMi is beloved by survivors and used in America’s top rehab clinics

Many therapists recommend using FitMi at home between outpatient therapy visits and they are amazed by how much faster patients improve when using it.

It’s no surprise why over 14,000 OTs voted for FitMi as “Best of Show” at the annual AOTA conference; and why the #1 rehabilitation hospital in America, Shirley Ryan Ability Lab, uses FitMi with their patients.

This award-winning home therapy device is the perfect way to continue recovery from home. Read more stories and reviews by clicking the button below: