Two methods for stroke Rehabilitation

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   Our user asked: "When it comes to methods to help patients rehabilitate after a stroke, what do the Brunnstrom Method and the Proprioceptive Neuromuscular Facilitation Method (PNF) have in common with each other? I am a student and I have seen some articles that seem to almost use the two terms interchangeably but I don't see what the two methods have in common with each other. Can you help?"

Ask a PT Response: "Brunnstrom and PNF are both forms of movement facilitation for stroke rehab, and they share the same goal of normalizing tone in hypotonic and flaccid patients. But they are slightly different in their delivery.  

With the Brunnstrom approach, patients are taught to use and control motor patterns during recovery; often are primitive syngergistic patterns of movement (via central facilitation).  This approach will be used immediately upon first day of stroke rehab for best early recovery.    

With PNF, patients use spiral and diagonal movement components to facilitate functional activities/movements (via peripheral facilitation).  Uses resistance to indirectly facilitate movement; resistance to strong components in order to facilitate the weaker components of movement.  More commonly introduced in the later stages of recovery.

Now the Bobath (or neurodevelopmental technique-NDT) differs significantly from Brunnstrom and PNF by using reflex inhibition to increase tone, which is all done without resistance.

For more information on the different techniques, check out the below article:
This article “Stroke Rehabilitation.”  Physical Medicine and Rehabilitation Board Review.
Cuccurullo S, editor.  New York: Demos Medical Publishing; 2004.
http://www.ncbi.nlm.nih.gov/books/NBK27209/ 

How the article defines PNF and Brunnstrom approaches: 
Proprioceptive (or peripheral) Neuromuscular Facilitation (PNF) (Knott and Voss, 1968)
· Uses spiral and diagonal components of movement rather than the traditional movements in cardinal planes of motion with the goal of facilitating movement patterns that will have more functional relevance than the traditional technique of strengthening individual group muscles 
· Theory of spiral and diagonal movement patterns arose from observation that the body will use muscle groups synergistically related (e.g., extensors vs. flexors) when performing a maximal physical activity
· Stimulation of nerve/muscle/sensory receptors to evoke responses through manual stimuli to increase ease of movement-promotion function
· It uses resistance during the spiral and diagonal movement patterns with the goal of facilitating "irradiation" of impulses to other parts of the body associated with the primary movement (through increased membrane potentials of surrounding alpha motoneurons, rendering them more excitable to additional stimuli and thus affecting the weaker components of a given part)
· Mass-movement patterns keep Beevor's axiom: Brain knows nothing of individual muscle action but only movement
Brunstrom approach/Movement therapy (Brunnstrom, 1970)
· Uses primitive synergistic patterns in training in attempting to improve motor control through central facilitation 
· Based on concept that damaged CNS regressed to phylogenetically older patterns of movements (limb synergies and primitive reflexes); thus, synergies, primitive reflexes, and other abnormal movements are considered normal processes of recovery before normal patterns of movements are attained
· Patients are taught to use and voluntarily control the motor patterns available to them at a particular point during their recovery process (e.g., limb synergies)
· Enhances specific synergies through use of cutaneous/proprioceptive stimuli, central facilitation using Twitchell's recovery
· Opposite to Bobath (which inhibits abnormal patterns of movement)"

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Ask a PT Members Profile Send Private Message Find Members Posts Add to Buddy List Senior Member Joined: Jul 07 2008 Status: Offline Points: 954	Post Options Post Reply Quote Ask a PT Report Post Thanks(0) Quote Reply Topic: Two methods for stroke Rehabilitation Posted: Nov 27 2011 at 9:55pm
	Our user asked: "When it comes to methods to help patients rehabilitate after a stroke, what do the Brunnstrom Method and the Proprioceptive Neuromuscular Facilitation Method (PNF) have in common with each other? I am a student and I have seen some articles that seem to almost use the two terms interchangeably but I don't see what the two methods have in common with each other. Can you help?" Ask a PT Response: "Brunnstrom and PNF are both forms of movement facilitation for stroke rehab, and they share the same goal of normalizing tone in hypotonic and flaccid patients. But they are slightly different in their delivery. With the Brunnstrom approach, patients are taught to use and control motor patterns during recovery; often are primitive syngergistic patterns of movement (via central facilitation). This approach will be used immediately upon first day of stroke rehab for best early recovery. With PNF, patients use spiral and diagonal movement components to facilitate functional activities/movements (via peripheral facilitation). Uses resistance to indirectly facilitate movement; resistance to strong components in order to facilitate the weaker components of movement. More commonly introduced in the later stages of recovery. Now the Bobath (or neurodevelopmental technique-NDT) differs significantly from Brunnstrom and PNF by using reflex inhibition to increase tone, which is all done without resistance. For more information on the different techniques, check out the below article: This article “Stroke Rehabilitation.” Physical Medicine and Rehabilitation Board Review. Cuccurullo S, editor. New York: Demos Medical Publishing; 2004. http://www.ncbi.nlm.nih.gov/books/NBK27209/ How the article defines PNF and Brunnstrom approaches: Proprioceptive (or peripheral) Neuromuscular Facilitation (PNF) (Knott and Voss, 1968) · Uses spiral and diagonal components of movement rather than the traditional movements in cardinal planes of motion with the goal of facilitating movement patterns that will have more functional relevance than the traditional technique of strengthening individual group muscles · Theory of spiral and diagonal movement patterns arose from observation that the body will use muscle groups synergistically related (e.g., extensors vs. flexors) when performing a maximal physical activity · Stimulation of nerve/muscle/sensory receptors to evoke responses through manual stimuli to increase ease of movement-promotion function · It uses resistance during the spiral and diagonal movement patterns with the goal of facilitating "irradiation" of impulses to other parts of the body associated with the primary movement (through increased membrane potentials of surrounding alpha motoneurons, rendering them more excitable to additional stimuli and thus affecting the weaker components of a given part) · Mass-movement patterns keep Beevor's axiom: Brain knows nothing of individual muscle action but only movement Brunstrom approach/Movement therapy (Brunnstrom, 1970) · Uses primitive synergistic patterns in training in attempting to improve motor control through central facilitation · Based on concept that damaged CNS regressed to phylogenetically older patterns of movements (limb synergies and primitive reflexes); thus, synergies, primitive reflexes, and other abnormal movements are considered normal processes of recovery before normal patterns of movements are attained · Patients are taught to use and voluntarily control the motor patterns available to them at a particular point during their recovery process (e.g., limb synergies) · Enhances specific synergies through use of cutaneous/proprioceptive stimuli, central facilitation using Twitchell's recovery · Opposite to Bobath (which inhibits abnormal patterns of movement)"

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Bryana Butlar Members Profile Send Private Message Find Members Posts Add to Buddy List Newbie Joined: Dec 13 2011 Location: Los Angeles Status: Offline Points: 7	Post Options Post Reply Quote Bryana Butlar Report Post Thanks(0) Quote Reply Posted: Dec 23 2011 at 4:16am
	The post¬graduate courses in most of the colleges includes PNF Method for its spread to therapists worldwide. These therapists learn the method and then share their knowledge with colleagues in their respective countries. This promotes the clinical use of PNF everywhere.
	Success is never final. Failure is never fatal. Courage is what counts. – Sir Winston Churchill

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