NEUROPHYSIOLOGICAL APPROACHES IN NEURO REHABILITATION:

NEUROPHYSIOLOGICAL APPROACHES IN NEURO
REHABILITATION:

knowledge of understanding the physiology that helps CNS function.

adaptation and reorganization of CNS function.

lead to noninvolved part of the brain functionally compensating for the
affected area of the brain.
-education Approach (1920s)


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7
0
s
)

Sensorimotor Approach (Rood, 1940s)

Movement Therapy Approach
(Brunnstrom, 1950s) Approach (Bobath,
1960-70s)
Approach (Knot and Voss, 1960-70s)


Jenn Ayers1920 -
1989)

, -Oriented Approach
(1990s)




BRUNNSTORMS APPROACH IN HEMIPLEGIA:
CONTENTS:

• HISTORY
• THEORY
• AIM
• BASIC LIMB SYNERGIES
• ATTITUDINAL AND POSTURAL REFLEX
• ASSOCIATED REACTIONS
• RECOVERY STAGES
• PRINCIPLES OF TREATMENT
• ASSESSMENT
• TREATMENT HISTORY :
• Developed by signe Brunnstrom

, a Swedish physical therapist from Sweden
THEORY:

This approach is based on the hierarchical theory of motor control
which states that higher centers control over lower centers. But when
higher centers get damaged then this

inhibitory control from the higher center is lost which leads to

,exaggeration of the movement. In normal individuals, these occur as a
smooth, rhythmic movement. Because there is a presence of control
from higher center on lower center
AIM:

• Emphasize on the development of synergy in spastic group of
muscle. This synergy helps in developing a voluntary movement.
• Associated reactions – movement of sound extremity causes
movement of affected extremity E.g.: flexion of normal upper
extremity causes movement of flexion of affected limb
BASIC LIMB SYNERGIES:

Mass movement patterns in response to stimulus or voluntary
effort or both.
• Gross flexor movement (flexor synergy)
• Gross extensor movement (extensor synergy)

• Combination of strongest components of synergies (mixed
synergies)
These synergies appear during early spastic period of recovery.
AIM: development of synergy pattern in spastic muscle and once it
developed then break the synergy.
• Flexor synergy of upper limb
• Retraction and/or elevation of the shoulder girdle
• External rotation of the shoulder
• Abduction of the shoulder to 90 degrees
• Flexion of the elbow to an acute angle
• Full-range supination of the forearm
The dominant component of flexor synergy is elbow flexion.The
movement pattern is typically initiated by

, either elbow flexion or shoulder girdle elevation.
• Extensor synergy of upper limb
• Fixation of shoulder girdle in a protracted position
• Internal rotation of the shoulder
• Adduction of the arm in front of the body
• Extension of elbow, complete range
• Full range pronation of the forearm
Shoulder adduction and internal rotation dominate the
movements within extensor synergy.
• Flexor synergy of lower limb
• Flexion of the hip
• Abduction and external rotation of the hip
• Flexion of the knee to about 90 degrees

• Dorsiflexion and inversion of the ankle
• Dorsiflexion of toes

Flexor synergy is typically the weaker of the two lower extremity
synergies and is dominated by hip flexion.
• Extensor synergy of lower limb
• Extension of the hip
• Adduction and internal rotation of the hip
• Extension of the knee
• Plantar flexion and inversion of the ankle
• Plantar flexion of the toes
Extensor synergy typically dominates in the lower extremity with
considerable hip adduction, knee extension and ankle plantar flexion
appearing. The strongest component is knee extension.


ATTITUDINAL AND POSTURAL REFLEX: