Brunnstrom Approach
The Brunnstrom Approach sets out a sequence of stages of recovery from hemiplegia after a stroke. It was developed by the Swedish physical therapist Signe Brunnström, and emphasises the synergic pattern of movement which develops during recovery. This approach encourages development of flexor and extensor synergies during early recovery, with the intention that synergic activation of muscles will, with training, transition into voluntary activation of movements. Sequential motor recovery following stroke. The Brunnstrom Approach follows six proposed stages of sequential motor recovery after a stroke. A patient can plateau at any of these stages, but will generally follow  this sequence if he or she makes a full recovery. The variability found between patients depends on the location and severity of the lesion, and the potential for adaptation. Brunnstrom (1966, 1970) and Sawner (1992) also described the process of recovery following stroke-induced hemiplegia. The process was divided into a number of stages: The 6 stages are as follows: Assessment methods. The six component stages of the Brunnstrom Approach have influenced the development of a variety of standardized assessment methods used by physiotherapists and occupational therapists to evaluate and track the progress of persons recovering from stroke. The Fugl  Meyer Assessment of Physical Performance (FMA) is an example of one widely used scale. The FMA consists of five sub-scales that relate to various aspects of a patient's upper and lower extremity, and the sub-scales are as follows: Each component of the FMA may be evaluated and scored individually or, a total possible summative score for all 5 sub-scales of 226 may be used to track a patient's degree of recovery. The influence of the Brunnstrom Approach on the development of the FMA is most evident within the Motor sub-scale for both the upper  and lower extremity where there is a strong emphasis on the evaluation of muscle synergies.