BRUNSTORM APPROACH

BY- MUNIRA INDOREWALA (INTERN)

 Grading for voluntary control
Stage Characteristics
Grade Period of flaccidity
I Neither reflex nor voluntary movements are available
Grade Basic limb synergies may appear as associated reactions
II Spasticity starts appearing. Mostly evident in strong
components
Minimal voluntary responses may be present
Initiation is in pattern. Cannot complete the range actively

Grade Synergy pattern is completely developed

III Spasticity reaches its peak
Stage Characteristics
Grade Some movement patterns appear out of synergy
IV Initiation of the movement is isolated, goes in pattern after
mid range
Spasticity begins to decline
Grade Movements appear out of synergy
V Pattern appears only during resisted movements
Spasticity declines further
Grade Isolated movements are possible
VI
Recovery stages- for shoulder and elbow
Stage Description
1 No VC. Limb is flaccid
2 Limb synergies appear. Flexor synergy appears before
extensor synergy. Spasticity develops
3 Flexor synergy- scratch behind the ear
Extensor synergy- touch between knee held together
4 A-Placing hand behind the body
B- Elevation of arm to a forward horizontal position
C- Pronation supination with elbow at 90
5 A- Arm raising at a side; Horizotal position
B- Arm raising forward and overhead
C- Pronation supination with elbow extended
6 Isolated joint movement
 Recovery stages- Hand
Stage Description
1 Flaccid
2 Little or no active finger flexion
3 Mass grasp, Hook grasp but no release. No voluntary finger
extension
4 Lateral prehension, Release by thumb movements. Semi
voluntary finger extension
5 Palmar prehension, possibly cylindrical and spherical grasp
6 Individual finger movements. Voluntary extension of
fingers, less accurate than opposite side
 Recovery stage- lower limb
Stage Description
1 Flaccid
2 Minimal voluntary movement of lower limb
3 Able to do hip knee and ankle flexion in supine and standing
4 A- Sitting- knee flexion beyond 90⁰ with sliding backward on
the floor
B- Voluntary dorsiflexion of the ankle without lifting the foot of
the floor
5 A- Standing- Isolated non weight bearing knee flexion with hip
in extension
B- standing- Isolated dorsiflexion the ankle with knee in
extension
6 A- Standing- Hip abduction
B- Sitting- Flexion of the knee, combined with inversion and
eversion
1. STAGE I and STAGE II:-
• To initiate finger flexion or mass grasp, the traction
response in which stretch of the scapular adductors
produces reflex finger flexion or an associated
reaction of resisted grasp by the unaffected hand
may be used in combination with voluntary effort.
• To initiate wrist extension, elbow is kept in
extension with the wrist supported by the therapist,
patient is asked to squeeze. Perform until wrist
extensors respond.
• Then therapist asks the patient to hold the wrist in
extension.
• Repeat the same with elbow in flexion.
1. STAGE III and Stage IV :-
• To initiate semi voluntary to mass finger
extension spasticity of the finger flexors needs to
be eliminated.
I. To release the grasp hold thumb in extension
and abduction and then rhythmically pronate
and supinate.
II. Use exteroceptive stimulus to activate
extension. Continue until flexion release.
III. Use souque’s phenomenon.
IV.Provide opportunities to the patient to reach out
for the objects by performing overhead
activities and extending the fingers .
• STAGE V and STAGE VI :-
Once extension Is achieved voluntarily then it is
proceeded to stage V where palmar prehension
(holding a pencil or brush), cylindrical and
spherical grasps are trained.
In stage VI all individual finger movements are
performed voluntarily.
THANK YOU!