Brunnstrom stages of recovery
Brunnstrom stages / DTR Scales
DTR / UE PNF
Incomplete lesions
Differential Dx
100

Spasticity appears: Muscles begin to show basic movements, sometimes abnormally. For example, muscles may tighten involuntarily in response to a stimulus, such as a prod with a finger.

Stage 2

100

Decreased spasticity: Involuntary muscle movement starts to decline.

Stage 4

100

4+

A tap elicits a repeating reflex (clonus) which is always abnormal

100

- results from compression and damage to anterior part of spinal cord or ASA

- MOI is usually cervical flexion

- loss of motor, pain and temp below lesion

Anterior cord syndrome

100

- autoimmune disease resulting in neuromuscular junction pathology, associated w/ diabetes, RA, lupus

S&S include: 

- extreme fatiguability and skeletal muscle weakness that can fluctuate within minutes or over an extended period

- ocular muscles usually affected first, can experience ptosis and diplopia

Myasthenia Gravis

200

Complex movement combinations: Increased complex voluntary movements.

Stage 5

200

Normal function returns: Full motor function returns

Stage 7

200

D1 Extension

Starting position: Flexion, adduction, external rotation

Ending position: Extension, abduction, internal rotation

200

- results from compression and damage to central portion of spinal cord

- MOI is usually cervical hyperextension

- UE damaged more than LE, more motor deficits than sensory

Central cord syndrome

200

- demyelination of sheaths that surround nerves in brain and spinal cord

- highest incidence in patients 20-35 years old

S&S include:

- visual problems, paresthesia, clumsiness, balance dysfunction, weakness, fatigue 

- consists of periods of exacerbations and remissions

Multiple sclerosis

300

Flaccidity: The muscles on the affected side of the body are limp and unable to move.

Stage 1

300

3+

A very brisk response, which may or may not be normal

300

D1 Flexion

Starting position: Extension, abduction, internal rotation

Ending position: Flexion, adduction, external rotation

300

- usually caused by a stab wound which produces hemisection of spinal cord

- ipsilateral paralysis and loss of vibratory and proprioception 

- loss of pain and temp on contralateral side

Brown-sequard's syndrome

300

- deterioration and irreversible damage within cerebral cortex and subcortical areas of brain

- risk increases w/ age and higher incidence in women

S&S include:

- difficulty w/ new learning, loss of orientation, word finding difficulties, depression, impaired self-care

- end-stage includes incontinence, functional dependence, inability to speak



Alzheimer's disease

400

Spasticity disappears: Coordination returns.

Stage 6

400

1+ 

A slight but definite response, which may or may not be normal

400

D2 Extension

Starting position: flexion, abduction, external rotation

Ending position: extension, adduction, internal rotation


400

- injury below L1 

- peripheral nerve injury

- flaccidity, areflexia, impairment of bowel and bladder function

- full recovery not typical due to distance needed for axonal regeneration

Cauda Equina

400

- produces UMN and LMN impairments; loss of anterior horn cells and motor cranial nerve nuclei in lower brainstem produces weakness and muscle atrophy, demyelination of corticospinal and corticobulbar tracts produce UMN symptoms

- higher incidence in men 40-70 years old

S&S include:

- asymmetric muscle weakness, cramping, atrophy within hands, weakness spreads distal -> proximal

- spasticity, clonus, (+) babinski, fatigue, oral motor impairment and eventual respiratory paralysis

ALS

500

Increased spasticity: Involuntary movement increases due to improved neural connections between the brain and muscles.

Stage 3

500

2+

A brisk response, which is normal
500

D2 flexion

Starting position: Extension, adduction, internal rotation

Ending position: Flexion, abduction, external rotation

500

- caused by compression of PSA

- loss of proprioception, two-point discrimination and stereognosis

- motor function preserved

Posterior cord syndrome

500

- demyelination of peripheral nerves' myelin sheaths resulting in axonal degeneration

- young adults and adults 50-80

- autoimmune response to respiratory infection; viral infections, Epstein-barr syndrome, cytomegalovirus

S&S include:

- motor, symmetrical weakness distal -> proximal, sensory impairment and possible respiratory paralysis

- peaks within 2-4 weeks, absence of DTR, inability to speak/swallow

GBS or acute polyneuropathy