The Brunnstrom Stages of Stroke Recovery

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A stroke is a life-threatening condition that occurs when the blood supply to part of the brain is blocked, or there is bleeding in the brain. Without oxygen and nutrients, parts of the brain become damaged or die. A  stroke can cause a host of complications affecting a person’s mobility, coordination, cognition, speech, and more.

Almost 800,000 people suffer a stroke every year in the United States. Recovery varies from person to person depending on the severity of the stroke, age, what part of the brain is impacted, and other factors. Generally, healthcare professionals use Brunnstrom stages to measure stroke recovery.

Understanding these stages can help survivors and their loved ones know what to expect in the days and weeks after a stroke.

What are Brunnstrom Stages?

The Brunnstrom stages, also known as the Brunnstrom approach, are well-known stroke recovery tools developed by Swedish physical therapist Signe Brunnstrom in the 1960s. 

According to an article by NIH, the World Health Organization (WHO) estimates that stroke events are likely to increase by 30% between 2000 and 2025. Following a stroke, survivors often experience hemiplegia or a loss of muscle control on one side of the body. Therefore, motor (movement) recovery is one of the most important goals for stroke patients. While working with stroke patients experiencing hemiplegia, Brunnstrom observed the sequence of extremity movement recovery in a standardized pattern. She developed a framework that includes seven commonly seen steps in motor recovery after a stroke. Brunnstrom's approach allows patients and their doctors to check the progress of movement recovery.

Widely use the Brunnstrom approach to assess motor recovery in stroke survivors. While many begin the recovery journey at stage 1 and progress sequentially through the 7 stages, recovery is different for everyone. It can start at any stage, depending on the severity of the stroke. 

Brunnstrom Stages of Stroke Recovery

The Brunnstrom Stages only refer to motor recovery and do not address recovery in speech, vision, cognition, and other areas affected by a stroke. These stages help assess the patient’s post-stroke recovery and guide treatment based on the patient’s current stage.

  • Stage 1: Flaccidity 
  • Stage 2: Spasticity Appears
  • Stage 3: Increased Spasticity 
  • Stage 4: Decreased Spasticity 
  • Stage 5: Complex Movement Combinations 
  • Stage 6: Spasticity Disappears, and Coordination Reappears
  • Stage 7: Normal Functions Returns 

Stage 1: Flaccidity 

During this stage, the muscles on the affected side will be weak, limp, and floppy, and the patients will be unable to move their muscles. A prolonged lack of movement can result in a significant loss of muscle mass and strength. Therefore, the patient needs ample physical therapy, including passive range of motion exercises.


Passive range of motion means the patient is using the unaffected arm to assist with movement or being assisted by someone else. These exercises enable the brain to restore its neural connections to the affected areas, known as neuroplasticity. Neuroplasticity is the brain’s ability to reorganize and form new neuron connections.

Stage 2: Spasticity Appears

Spasticity is when the brain is beginning to rebuild connections with the affected muscles. While this is a good sign, the connection is incomplete at this stage, and muscles may get stuck in contracted positions. The patient may not be able to complete the movement. 


While spasticity can be uncomfortable and limit the range of motion, it is actually a sign of recovery from a stroke. Consistently performing the exercises will activate neuroplasticity and promote recovery. Active-assisted range of motion, a combination of active and passive range of motion exercises, is a good way to promote further healing of muscle and nerve functions in the affected areas.

Stage 3: Increased Spasticity 

At this stage, spasticity peaks, and muscle stiffness may become even more severe. Again, this increased spasticity is a good thing as the brain is further rebuilding connections with the impacted muscles.


To treat spasticity and reduce the risk of muscle contractures, the patient needs to practice active and passive exercises emphasizing active movement. Your doctor may administer Botox injections to relieve spasticity temporarily. Other helpful interventions may include mirror therapy or using a splint or a brace. An occupational therapist may also recommend assistive devices to keep the patient engaged in functional activities during this stage.

Stage 4: Decreased Spasticity 

During this stage, spasticity begins to decrease. Brain signals are stronger, and the ability to move muscles voluntarily returns. This is a remarkable milestone in stroke recovery.


At this stage, therapy involves a range of motion, strengthening, and stretching exercises to help with recovering muscle and motor control. With assistance, the patient is asked to focus on retraining functional movement patterns, like dressing and bathing.

Stage 5: Complex Movement Combinations 

There is a further reduction in spasticity at this stage. The patient may make more voluntary movements and, more importantly, begin to coordinate complex movement combinations. At this stage, the stroke survivor may comb hair, grasp objects, and hold utensils without difficulty. 


Strength training is key at this stage. Increasing repetitions and resistance during strength training is important. The patient will be encouraged to continue using the affected side as much as possible, most likely without a therapist or caregiver assistance. Now that gross motor skills have improved, the patient can focus on retraining fine motor skills.

Stage 6: Spasticity Disappears, and Coordination Reappears

During this stage of stroke recovery, spasticity disappears completely, and motor control is almost fully restored. With infrequent spastic movements, there is a significant improvement in coordination for complex movement patterns.


At this stage, a mix of strength and coordination exercises is established so the patient can effectively perform activities of daily living (ADLs). Most can also get back to their favorite hobbies that involve full-body motion, such as swimming, tennis, hiking, etc. 

Stage 7: Normal Functions Returns 

The final stage of stroke recovery is when the patient can perform voluntary movements without difficulty and independently perform ADLs.

This is the ultimate goal for all stroke survivors and their rehabilitation team, but not everyone will achieve this stage. Although only a small number of patients reach this advanced recovery stage, those who pursue rehabilitation consistently often see more gains than those who stop therapy after hitting a plateau.

Top Products for Stroke Recovery 

1. CanDo Theraputty Standard Exercise Putty

Squeeze, pinch, stretch, or twist therapy putty to strengthen hand muscles, reduce stiffness, and improve fine motor skills. This therapy putty is great for hand rehabilitation and general hand strengthening, and children can use it for playtime and to develop fine motor skills. Theraputty stays together without crumbling and without mess.

CanDo Theraputty Standard Exercise Putty features

  • Available in 6 color-coded firmness levels ranging from xx-soft to x-firm
  • Made from premium material that will not dry out over time
  • Available in convenient, easy-to-open plastic containers (2, 3, 4, and 6oz)
  • Latex, gluten, and casein-free

Therapy Putty Hand Exercises For Stroke Patients

Therapy putty helps stretch out and strengthen the hand and finger muscles of the stroke-affected side. The following are some hand exercises you can do with therapy putty - 

1. Finger Scissors
  • Form a ball and place it between two adjacent fingers where they meet at the palm
  • Squeeze the putty with those two fingers as if they are scissors trying to cut it
  • Try not to use the other hand while doing this
  • Repeat the process with all the fingers of the hand
2. Two-Finger Spread
  • Roll a snake and wrap it around two fingers to form a ring
  • Then, spread your fingers apart as far as you can
  • Repeat with all the fingers of the hand
3. Finger Extension
  • Roll the putty into a long strip
  • Wrap it around one finger while the finger is bent
  • Try to straighten the finger while using the putty to provide resistance
  • Continue this with other fingers

2. Norco Shoulder Pulley

Improve shoulder movement and coordination following a shoulder injury, surgery, or stroke. This shoulder pulley is ideal for home use and can be used while seated, standing, or lying down. It can be set up in minutes by positioning the web strap over the top along the hinged side of any standard door.

Norco Shoulder Pulley Features 

  • Pre-assembled and ready-to-use
  • Ergonomically designed handles
  • The webbing anchor fits snugly between the door and frame
  • An exercise booklet with step-by-step instructions and photos is included
  • Latex-free

3. Economy Dressing Stick

Designed for people with reduced range of motion, strength, and flexibility, this is an invaluable dressing aid for stroke survivors who have a reduced range of movement in their limbs. 

The dressing stick is ideal for putting on shirts, jackets, skirts, or trousers. It can even be used to pull up socks or fasten zippers. One end of the dressing stick has a small hook that helps pick up garments, while the other end has a larger hook and pusher that can be used to position clothes.

Economy Dressing Stick Features

  • Lightweight weighs less than 5oz
  • 27.5"  handle
  • Extra strong hardwood dowel
  • Plastic-coated push-pull hook and a C-pull hook
  • Latex-free

4. Aluminum Reacher With Magnetic Tip

Designed to increase independence for those with reduced hand strength, mobility, or arthritis. This reacher grabber effortlessly grabs objects from the floor, behind furniture, under beds, on high shelves, and in any hard-to-reach place without excessive bending and moving.

Aluminum Grabber Reacher Tool Features

  • Premium, heavy-duty frame
  • Extra-long
  • Slip-resistant ergonomic contoured handle
  • Comes in two lengths - 32" & 26"
  • Extra wide 3-inch jaw opening includes durable tips for a secure grip

5. Comfy Splints Resting Hand Splint

Comforts sore joints due to arthritis, sprains, and strains by immobilizing fingers, palms, and wrists. This hand splint also prevents pain and muscle contractures experienced by stroke patients. 

The Resting Hand Splint comfortably supports the hand with a firmly reinforced spine brace that is easily adaptable to the user’s hand.

Comfy Splints Resting Hand Splint Features

  • Designed with a removable finger separator
  • Made with soft, ultra-plush fabric
  • Removable, easy-to-wash cover
  • Treated with an antimicrobial barrier
  • Five soft strap closures for the ultimate fit

Learning about the Brunnstrom stages is important for stroke survivors and their loved ones to manage and optimize rehabilitation to attain the best possible quality of life.

Where to buy Stroke Recovery Products online?

At Rehab Store, we have various products and devices that aid in the rehabilitation and recovery of stroke survivors. These stroke recovery products, including daily aids, physical therapy tools, and exercise equipment, can safely and comfortably help during every stage of recovery.


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