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Sunday, April 3, 2011

Brunnstrom's Stages of Stroke & Other Things the Doctors Don't Tell You

I recently picked up a book called Stronger After Stroke by Peter Levine. The author is a researcher in the field of "neuromotor recovery" and I am amazed at the stuff in this book that was never explained to me by any of the doctors that treated Bob. One of those things is Brunnstrom's Six Stages of stroke recovery and just to know this and know that every stroke survivor goes through these stages is so enlightening that I thought I'd share it with you. I mean, this something everyone should know! Here they are:

Stage 1: Immediately after a stroke. The whole "bad" side of the body is limp. Everything including torso, face, mouth and tongue, arm and leg are limp.

Stage 2: Spasticity (muscle tightness) creeps in. This is a good thing! (I was under the impression it was bad, at least that's how the doctors acted...) Spasticity means that "messages" are getting through to the affected side from the nervous system. Involuntary movements are seen in this stage (one doctor in the ICU told me that Bob's involuntary movements were "posturing" and it meant he was close to death!!!!)

Stage 3: Spasticity gets stronger, even severe, however, the patient begins to control his movements. Movements in this stage are "synergistic movements" meaning that if the person attempts to move his foot, the whole leg moves with it.

Stage 4: Spasticity begins to decline. Movements outside of synergy begin to appear.

Stage 5: Spasticity continues to decline. Synergy continues to decline. Patient is moving better.

Stage 6: Individual joint movements become possible and coordination approaches normal. Total recovery is possible in this stage.

Well, how about them apples? It's so good to know what Bob is going through is "normal". Now I see, his right leg is in Stage 4, though his right arm is still at Stage 2. The book also goes on to say that movements begin at "the top" (example: at the shoulder and move down the arm) and that typically the leg improves before the arm and the hand is always the last thing to improve. Well! Why didn't anyone tell me this stuff? And it's not for the lack of me asking questions. Believe me, I've been peppering everyone with questions and the only answers I'm getting are "everyone is different" or "it's going to take a long time" or (one doctor) "he'll never walk again, don't get your hopes up".

Just knowing about these stages has brought me a tremendous amount of relief: the knowing that Bob's recovery process is "normal". That every stroke survivor goes through these exact stages, in order. (Of course, not everyone makes it all the way to Stage 6, that's where hard work and prayer come in to play.)  I think this is something everyone should know and I wish I had known it five months ago. I hope by sharing it here, it might help someone someday.

12 comments:

Anonymous said...

Tried to leave coment yesterday, but didn't work Aunt Neta

Anonymous said...

Hi Diane, Just wanted to let you know I have been reading your blog. Didn't know you had one, till Tammy told me.She got the address from your Mom & Dad.
Can't even begin to think of everything you guys have been through.You are a very strong person & to think of where Bob would be without you.
So glad you keep posting on here. Sure it helps, just to vent. Will stay in touch.
The only way I could get this to send , is to hit Anonymous.If there is a better way,let me know. Love Ed & Neta

Diane said...

Hi Aunt Neta (and Uncle Ed)! So nice to hear from you. Try clicking on Name/Url (you don't need a Url for it, you can leave that line blank and just fill in your first name). Feel free to leave lots of comments! I love them!

Jenn said...

Most excellent - finding the book you did! I can hear the sigh of relief (as much as that is possible) in your writing. : )
Keep on keepin' on!
Love!

Helen LaCrosse said...

Hi Diane. Sounds like a very helpful book. I hope it gives you hope regarding Bob's recovery. Your writing is so descriptive I almost feel like I am right there. Keep the faith.

Nikki said...

I'm glad you found something that gives you hope- everyone needs something like that, especially when you're in a dark place.

oc1dean said...

You've found one of the basic truths about stroke recovery, doctors know nothing, if they did they wouldn't spout, 'All strokes are different, all stroke recoveries are different' And while spasticity may be normal, it definitely is one of the main items slowing down my recovery.
Glad you joined the stroke blogging world, we need more light from the survivor/caregiver side.

barbpolan said...

Hello,I had a stroke 18 months ago and have improved tremendously since the one-year mark, when supposedly I would have recovered everything I would ever get back. I absolutely agree with Dean, whom I've corresponded with since near the very beginning of recovery. "Every stroke is different and every recovery is different" is a euphemism for "I don't know the answer to your question."

Be careful of believing Peter's "Once an AFO, always an AFO" declaration. After reading that, I wrote him an aggressive e-mail about the topic because I have every intention of going without the brace AND without the cane. He backed off immediately and said it IS possible, but takes a lot of hard work. I told him that I can do that - I do hard work 24/7, as Dean says about recovery.

AMY/AMYANDERNIE@YAHOO.COM said...

CAN YOU TELL ME HOW BOB'S SPASTICITY IS NOW? I HAD A BRAIN INJURY JAN, 2011 AND HAVE SPASTICITY ON MY LEFT SIDE. IT SEEMS TO BE GETTING BETTER BUT I AM STILL AFRAID THAT I WON'T RECOVER. I'VE BEEN LOOKING ON THE INTERNET THIS WHOLE TIME AND CAN'T FIND ANY STORIES OF PEOPLE RECOVERING.

garydotgray said...

Hi,

Thanks for creating your blog and posting this post. I have also been reading Peter's book and I have found it to be one of the best on the subject of stroke.

Peter can be a bit aggressive as he was with his comment on StrokeNation's use of a pulley system to recover arm movement on "My Life After Stroke's page.

Dean mde several excellent points and I like his blog as well.

smiles, :)

Jennifer Saake said...

Very helpful!
jenni
http://strokeofgrace.blogspot.com

Anonymous said...

Every stroke patient is capable of recovering. All it takes is prayers, hard work and proper management. I'm starting my final year in B.Physiotherapy next month and when I graduate I look forward to helping people avoid stroke in the first place and recovering from it if it has happened. Brunnstrom and Bobath's stages of neurological recovery are unknown to many doctors unfortunately. My best wishes to Bob and the family.
Fatima Mukhtar, Nigeria,Kano