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The Brunnstrom Stages of Stroke Recovery: What It Means for You

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 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

flaccidity is the first brunnstrom stages of stroke recovery and likely requires caregiver assistance

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.

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 stay contracted, which is what we call spasticity.

How to recover during stage 2

Continue with passive exercises 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 it only gets better from here!

How to recover during stage 3

botox treatment for spasticity

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

You can also 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.

Stage 4: Spasticity Decreases

patient stretches on floor during brunnstrom stages of stroke recovery

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 fairly quickly.

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 demonstrates flexibility during brunnstrom stage 5

At this stage, you’ll 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 physical therapy may revolve more around fine tuning.

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 the achievement of the final brunnstrom stages of stroke recovery!

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. We hope they have given you a good picture of what to expect during your own stroke recovery journey.

Before we wrap up, we just want to emphasize that even if you seem stuck on a certain stage for a long 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!

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See how Susan is recovering from post-stroke paralysis

“I had a stroke five years ago causing paralysis on my left side which remains today.

I recently began using FitMi.

At first it was difficult for me to be successful with a few of the exercises but the more I use it, the better my scores become.

I have recently had some movement in my left arm that I did not have before.

I don’t know if I can directly relate this to the use of the FitMi but I am not having occupational therapy so I conclude that it must be benefiting me.

The therapy modality motivates me to use it daily and challenges me to compete against my earlier scores.

I heartily recommend it!-Susan, stroke survivor

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