CVA-06 · Stroke Motor Recovery, Brunnstrom Stages, and Constraint-Induced Movement Therapy

Stroke Motor Recovery, Brunnstrom Stages, and Constraint-Induced Movement Therapy. Part of the Cerebrovascular / Stroke series of the Reflex PM&R Board Review podcast. Audio corrections: (1) In the audio: it is also pulled into inversion, which actually comes from the flexor synergy. — Correct: Ankle inversion belongs to both lower-extremity synergies. The extensor synergy is plantarflexion plus inversion; the flexor synergy is dorsiflexion plus inversion. Inversion is not borrowed from the flexor synergy. (2) In the audio: If you leave a recovering stage five patient locked in a rigid solid orthosis, they physically can't use the muscle they just worked so hard to recover. You are essentially training learned helplessness into their gait. — Correct: AFO design is chosen by examination, not by Brunnstrom stage. Weigh range of motion, tone, knee control, stance stability, swing clearance and the observed response to the device; the randomized comparison of articulated plantarflexion-stop and plantarflexion-resistance AFOs enrolled Brunnstrom stages II through VI, so there is no stage-three-solid, stage-four-hinged rule. Reassess the prescription as the limb changes, but a solid AFO does not by itself train learned helplessness. The written chapter is correct. Full correction register: https://www.reflexpmr.com/errata. The full companion chapter and a linked board-style Q-bank set for this topic are at https://www.reflexpmr.com/read/CVA-06.