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The seven stages after a stroke




The period after a stroke is very important for a patient. The symptoms of the brain injury show within 6-8 months. Spasticity of the upper and lower limb is the most usual symptom of a patient after a stroke. In this article, you can learn about the stages after a stroke and how this situation can affect your life.


Stage 1 - Muscle weakness

In the early stage of paralysis, the patient can not do movements on the affected side of the body due to muscle weakness. If this status will continue for a long time without physiotherapy, the motionless muscles become much weaker.




Stage 2 - Spasticity

The second stage in the recovery of stroke consists of the reconstruction of the limbs, as some muscles are activated or deactivated and other muscles in the same system begin to respond. The muscles begin to make small, spastic and abnormal movements during this stage. While these movements are mostly involuntary, they can be a promising sign as the patient recovers. Minimal voluntary movements may or may not occur in the second stage. Muscle synergies arise from the muscles that coordinate movements to perform different tasks. These synergies allow for common patterns of movement that involve either combined or reciprocal muscle activation. Because muscles are interconnected, an activated muscle can lead to partial or complete responses to other muscles. These synergies can restrict the patient's muscles to certain movements, preventing them from completing the voluntary movements they want to make. However, as neurological cell growth and recurrence occur after a stroke, some new connections can form in weakened muscle tissue. Limb synergies determine the patient's reactions to cell recurrence during stage 2 recovery. The first, the flexion synergy, involves the external rotation of the shoulder, the flexion of the elbow, and the rotation of the forearm. The second, the synergy of the extension, involves the internal rotation of the shoulder with the extension of the elbow and the advancement of the forearm. These synergies can produce one or both of the following postures, which indicate different levels of brain injury after a stroke. Unused limbs still need stimulation to maintain or form connections with neurons. Although the nerves and ligaments that initially controlled the affected limbs may have been damaged to prevent voluntary movements, it could still be possible to restore the movement to later stages of recovery.



Stage 3: Increased spasticity

Muscle spasticity increases during the third stage of stroke recovery, reaching a maximum. Spasticity is a feeling of unusually stiff, tight, or tense muscles. It is caused by damage from a stroke to nerve pathways within the brain or spinal cord that control muscle movement. Lack of ability to restrict the motor neurons of the brain causes the muscles to shrink (shorten). Spasticity causes an abnormal increase in muscle stiffness and tone that can impede movement, speech or cause discomfort and pain. During stage 3, minimal voluntary movements are expected. The increase in involuntary movement is not due to an inability to initiate movement, but to an inability to control (the patient cannot control it (yet). The appearance of coordination between muscles facilitates voluntary movements that become stronger with occupational and physical therapy Muscles with severe spasticity, such as those in postage 3 of stroke recovery, are likely to be more limited in their ability to exercise and may need help to do so. Patients and caregivers should be educated about the importance of maintaining a range of motion and daily exercise.




Stage 4: Reduced spasticity

During the fourth stage, spastic muscle movement begins to decrease. Patients will regain control mainly in the extremities and will have a limited ability to move normally. The movements may not be synchronized with the muscle synergies, but this will improve rapidly throughout this stage. The focus during this stage is to strengthen and improve muscle control. At this stage, the patient can begin to perform normal, controlled movements on a limited basis. Therapists use Active Assisted Range of Motion (AAROM) exercises when a stroke patient has some ability to move but still needs help to perform the exercises or complete the movement. A therapist can help guide the movement with their own body (holding the limb, for example) or using other exercise equipment to support the patient.




Stage 5: Complex movement combinations

In stage 5, the spasticity continues to decrease and the synergy patterns in the muscles also become more coordinated, allowing the voluntary movements to become more complex. Abnormal movements begin to decrease significantly during stage 5. The patient can make more controlled and deliberate movements in the extremities that have been affected by the stroke. It can also perform individual movements of the joints. All voluntary movements involve the brain, which sends the motor commands that control movement. These signals begin with a thought and must also include a response to sensory stimuli. The sensory stimuli that elicit voluntary responses are found in many parts of the brain. Voluntary movements are deliberate and targeted. They are learning movements that improve with repetition or practice and require less attention. Some examples include rubbing the hair, swinging a bat, driving a car, swimming, and using utensils.



Stage 6: Spasticity disappears

In the sixth stage, spasticity in muscle movement disappears completely. The patient can move individual muscles, and synergy patterns become much more coordinated. Motor control is almost completely restored, and the patient can coordinate complex movements at the affected extremities. Unusual or spastic movements have stopped.




Step 7: Return to normal operation

The final stage of Brunnstrom's approach is when there is a complete recovery of function in the areas affected by the stroke in a controlled and voluntary manner.





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