The 7 Stages of Stroke Recovery

Medical emergency in which blood supply to the brain either stops or bleeds is called Stroke. The time recovered for recovery varies from person to person depending upon several conditions. Ideally the recovery starts from within 24 hours to 48 hours after the stroke has occurred.

“Stroke is likely to affect a person on different aspects. It includes speech, body part movement, coordination, cognitive abilities, swallowing, and vision, amongst other aspects” says Dr. Gurneet Singh Sawhney, one of the best Neurosurgeon in Mumbai.

The experiences post stroke could be different in case of different individuals. The recovery process can be challenging in some cases as it also depends on the emotional conditional of the sufferer. Without proper care and recovery, a patient can experience swelling after a stroke. The recovery time further depends on the severity of the injury, the extent of lesion and its location.

Experts have yet identified a pattern for the motor recovery from stroke. This article lets you know the different stages of stroke recovery. You would come to know what one should expect during the recovery period after stroke. Consult Dr. Gurneet, Spine surgeon in Mumbai for stroke treatment.

The Brunnstrom stages were observed by Signe Brunnstrom from Sweden in 1960’s. She was a occupational and physical therapist. Through her clinical research, she observed the stages in the regain of motor control. These seven stages could see a repetitive recovery pattern in stroke patients.

Muscle movements normally are result of coordination of different muscle groups. Researchers call this collaboration as “synergies”. After stroke many of these movements are severely affected. The brain has this delicate task of coordinating the movements.

After stroke the synchronization between the brain and the body gets affected. This causing the muscles to become weak. It further affects the natural movement of the muscles leading abnormal muscle movements.

The Brunnstrom approach teach the stroke survivors to cope up with the synergy patterns. It also lets you know how to use it to your advantage. This is in contrast with the normal methods that focus on inhibiting such abnormal synergy patterns.

Brunnstrom approach has gained popularity within no time since its inception. It is being widely used by both, physical and occupational therapists as well as patients. It brings a dramatic change in voluntary muscle movements after suffering a stroke. Consult Dr.Gurneet , who is one of the best Neurosurgeons for spasticity treatment in Mumbai,

The first stage in stroke recovery is the initial period of shock immediately after the stroke. This is the stage when flaccid paralysis, also called Flaccidity, sets in. It is the stage where complete lack of voluntary movement is observed.

This paralysis is caused due to failure in transmission of signals from the brain to the muscles. Irrespective whether the brain is still capable of moving the muscle or not. The damaged nerves are the biggest hindrance in transmitting the signals.

The stroke survivor fails to start any muscular movement on the affected side of their body in the initial stage of flaccid paralysis. If the muscles remain in unused state for a prolonged period it may weaken and lead to atrophy.

Hence physical therapy plays crucial role in this stage to keep the muscles in use and retain their tone. Flaccid paralysis inhibits muscles perform this important activity.

Hypotonia is the terminology used for loss of muscle tone. Weakness and numbness caused by Hypotonia many a times hampers the patient’s quality of life. Apart from physical therapy, life style modifications too are required. Besides physical therapy, protection of the affected parts from life style injuries also requires life style modifications.

Although the intensity of damage caused by stroke is high, the healthy and brain cells can make up the losses up to some extent. In reality, the patient’s body have an inbuilt mechanism to enhance the chances of entering the new stages of recovery. It can itself reduce further complications.

Retraining your brain and body soon after the stroke is beneficial even if your body is experience flaccidity and hypotonia. Consult Dr. Gurneet, Spine Surgeon in Mumbai.

Recommended flaccidity exercises:

• Variety of motion exercises
• Positioning (to prevent joint restrictions, sores, swelling and dislocation)
• Sensory re-education
• Hand over hand assist (daily routine activities like brushing)

This is the stage where few of the muscles start responding. Muscle movement may be small, spastic and involuntary. Still this is a promising sign of recovery. Slight voluntary movements may or may not be present during the second stage of recovery.

Due to linkage of the muscles, activation of only one muscle may not permit the person to complete the voluntary movement that he wish to do. Hence you can observe incomplete or restricted movement in this stage of recovery. New connections with the impaired muscle tissues can be established with gradual neurological development and regrowth of cells

It is difficult to make movement due to spasticity at this stage. Still there are bright chances of recovery at a later stage. To keep this opportunity open, it is necessary to keep using and moving the affected limbs. This also prevents the tendency of the body towards learned non-use of the affected limbs. For the best spasticity treatment is Mumbai, consult  Dr. Gurneet, one of the best Nerosurgeons in India.

Recommended spasticity exercises:

• Sensory re-education
• Hand over hand assist ( daily routine activities)
• Mirror Therapy

The peak level of spasticity is seen in the third stage of recovery. Feeling of unusual stiffness, tightness or pulled muscles is experienced. This is due to the damage caused to the nerves in the nerve pathway within the brain or spinal cord which controls our muscle movements.

Muscle contraction is often observed due to the inability to restrict the brains motor neurons. It may be so severe that you might think that your condition is worsening. “Even if it may not be that comfortable, it is a sign that the brain has started rebuilding connections.” Says Dr. Gurneet, one of the best Neurosurgeons in Mumbai.

Recommended increased spasticity exercises:

• Mirror therapy
• Usage of splints and/or orthotics for prevention of contractures
• Usage of assistive devices like universal cuff

Beginning in decreased spasticity embarks the fourth stage of stroke recovery. Although suppressed and uncoordinated, increases in voluntary movements of the muscles are observed. You might experience difficulty while releasing objects. For example, you may be able to grasp a spoon but might not be able to release it.

Recommended exercises for decreased spasticity:

• Focus on motion exercises(like moving by your own) and introducing strengthening exercises
• Focus on functional movement activities with required assistance
• Practicing voluntary movements more with affected side with constraint on unaffected side movements

This is the fifth stage in stroke recovery where you will be able to do more voluntarily movements. It can be activities like lifting a spoon and loading it with food. Then taking it up to your mouth and releasing it back the spoon on to the plate. You might now be more independent with the improvised movement. It will further reduce your dependency on the therapist or the care-takers.

Recommended exercises for complex movement:

You may now work on repetitions of strengthening exercises and motion exercises and start fine motor activities. By now your gross motor activities have seen remarkable improvement. Focus more on doing functional activities yourself. Reducing help of therapists and care takers must follow.

This is the stage when spasticity almost disappears. You are now in a better position to perform more complex movements. You may now focus on practising and retaining more complex activities like cooking, watering plants, cleaning, hobbies and more.

This is final stage of recovery. The stroke survivor will now be able to perform all his day-to-day activities with the affected side. It’s done with the same ease as like with unaffected side. This is the stage where the patient is back to normalcy and is in a position to carry out his occupational activities. He is able to perform synchronized, synergistic and complex activities.

This is the ultimate goal for all the stroke survivors and their rehabilitation teams. As per Signe Brunnstrom’s writing from 1966, very small number for patients actually reaches this stage of recovery.

Stroke experience can be different for every person. The time required for recovery too can be different for every person. Even while the rehabilitation program can be different for every individual, the Brunnstrom theory summarizes the seven stages that are almost visible in all recovery patterns. The seven stages are Flaccidity, Spasticity appears, increased spasticity, p decreases spasticity, complex movement combination, disappears of spasticity and return of normal function.

While recovering from stroke you might experience frustration while you fail to seek clarifications regarding your recovery. It is very difficult even for the expert to make any guesses regarding the timelines for recovery.

Yet Brunnstrom’s stages of recovery can help your therapist to make informed guesses regarding your recovery, the most appropriate treatment for your recovery, and what should one expect next.

Although your frustration post stroke can be understood, it is important to keep patience. Focus on rehabilitation plan with a positive approach so as to expect the best outcome.