1. Brunnstrom Evalution 目的 : 1: To evaluate the neurological recovery of patient after stroke 2. To design treatment program according to the stage of recovery

2. Brunnstrom Evalution Stroke 之後, patient 在 recovery 時, 發生的次 序 Stage I : Flaccid, no movement Stage II:Spasticity 開始出現, 自主動作要 誘發才能出現. Associated movement Stage III:Synergy stage. Spasticity 最強 上肢以 Flexor spasticity 為主 下肢以 extensor spasticity 為主

3. Brunnstrom Evalution Stage IV: Some isolated movement, Spasticity 下降 Stage V: Synergy pattern 下降 Spasticity 更弱 StageVI: Movement coordination near normal. Spasticity minimal

4. Motor stage assessment Proximal part I: Presynergy stage: Flaccid II:Spasticity: Associated movement

5. Motor stage assessment III:Synergy stage: 1. Extension components:(use key to grading) a: Shoulder Protract, Add, Int. Rot b:Elbow extension c:Forearm pronation

6. Motor stage assessment 2. Flexor components a: Shoulder girdle elev. b: Shoulder girdle retract. c: Shoulder joint hyperext. d: Shoulder abd. e: Shoulder joint ext. rot f: Elbow Flexion g: Forearm supination

7. Motor stage assessment IV:Movements deviating from basic synergies 1.Hand to sacrum 2.Raise arm forwd. To horiz. 3.Pronation (Elbow flexed) 4.Supination (Elboe Flexed)

8. Motor stage assessment V.Relative independence of basic synergies 1.Raise armto side - horz. 2.Supination (Elbow Extened) 3.Forward reach from horiz. 4.raise arm over head VI. Nearly normal coordinated movement

9. Motor stage assessment Hand I: Flaccid II: Spasticity : Active finger flexion (+/-) III: 1. Mass grasp 2. Hook grasp without release 3. Reflex finger extension (+/-)

10. Motor stage assessment IV: 1. Lateral prehension with release by thumb movement 2.Semivoluntary finger extension (small range) V: 1.Palmar prehension 2.Cylindrical / Spherical grasp with limited function

11. Motor stage assessment 3.Voluntary mass finger extension (variable range) VI: 1. Control of all prehension type movement with skill 2.Voluntary finger extension (full range ) 3.Individual finger movement, less accurate

12. Motor stage assessment Lower limb I: Flaccid II: Minimal voluntary movement of the lower limb III:Hip-knee-ankle flexion in sitting and standing

13. Motor stage assessment IV: 1. Sitting Knee flexion beyond 90 degree with the foot sliding backward on the floor 2. Voluntary dorsiflexion of the ankle without lifting the foot off the floor

14. Motor stage assessment IV: 1. Standing Isolated non-weight-bearing knee flexion, hip extended or nearly extened 2. Standing Isolated dorsiflexion of the ankle, knee extended, heel forward in a position of a short step

15. Motor stage assessment VI: Standing ( hip abduction) beyond range obtained from elevation of the pelvis Sitting Reciprocal action of the inner and outer hamstring muscles, resulting in inward and outward rotation of the leg at the knee, combined with inversion and eversion of the ankle

16. Key muscle Muscle gradation Description 5 (normal) 4 (good) 3 (fair) 2 (poor) 1 (trace) 0 (abscent)

17. Key muscle C5 Elbow flexors C6 Wrist extensors C7 Elbow extensors C8 Finger flexors (distal phalanx of middle finger) T1 Finger abductors (little finger)

18. Key muscle L2 Hip flexors L3 Knee extensors L4 Ankle dorsiflexors L5 Long toe extensors S1 Ankle plantar flexors