Stages of Synergy Pattern
- Stage 1- flaccid 7-10 days, no movement
- Stage 2- spasticity begins to develop
- Stage 3- increase spasticity, voluntarily initiates within synergy
- spasticity begins to decline; some ability to initiate movement outside of synergy
- Stage 5- synergies lose dominance
- Stage 6- all isolated movement
UE flexion synergy
- Shoulder flexion, abduction, internal rotation
- Elbow flexion
- Forearm pronation
- Wrist flexion
- Finger flexion
UE extension synergy
- Shoulder extension, adduction, external rotation
- Elbow extension
- Forearm supination
- Wrist extension
- Finger extension
LE flexion synergy
- Hip flexion, abduction, externally rotated
- Knee flexion
- Ankle dorsiflexion
- Toes dorsiflexion
LE extension synergy
- Hip extension, adduction, internal rotation
- Knee extension
- Ankle plantarflexion
- Toes plantarflexion
Motor recovery
Motor recovery is expected first proximally
Fugl-Meyer score
A cumulative numerical score system for assessment of development of motor function and balance in s/p CVA patients.
Marie-Foix maneuver
- Stretch the finger and wrist extensors–> facilitates contraction of the flexors and pronators of the elbow and the flexors, abductors, and internal rotators of the shoulder
- Stretch the toe dorsiflexors–> initiates a flexor response of the ankle, knee, and hip
A patient 2 weeks s/p a left MCA stroke who has tone in the hip flexors will probably be at least household ambulatory.
TRUE
There is no way to determine if there is a brachial plexus lesion in a hemiparetic arm
FALSE– look at the patterns of return
Specific gait training should NOT wait until the hemiparetic LE is no longer dominated by an extension synergy.
start early
Exercise programs with a neurophysiologic focus?
- Brunnstrom
- Rood
- PNF
- NDT
- Bobath
Brunnstrom stages of motor recovery in the stroke patient
Stage 1 Stage 2 Stage 3 Stage 4 Stage 5 Stage 6
After a stroke motor function is expected first in the
proximal muscles
