What are the Brunnstrom Stroke Recovery Stages?

A stroke can be a life-changing event, not just for the person who experiences it but also for their loved ones. Unfortunately, in the United States, around 795,000 people have a stroke every year.

The road to recovery may be long and challenging, filled with uncertainty and new obstacles. However, understanding the stages of stroke recovery that affect walking and other motor movement can help navigate this journey. 

Below, we’ll guide you through the Brunnstrom stages of stroke recovery — these stages describe how movement and motor function recover.

By learning about each stage, you can better understand what to expect, how to support a loved one, or what you might experience if you’re recovering from a stroke. 

Remember, every recovery journey is unique, but with patience, persistence, and the right support, many stroke survivors make remarkable progress in meeting their recovery goals and living a full life in their community.  

Your journey or that of your loved one requires strength and dedication to a rehabilitation program. This guide aims to be a supportive companion through each recovery step.

What is a Stroke?

A stroke happens when blood flow to a part of the brain is suddenly stopped or reduced. This prevents brain cells from getting the oxygen and nutrients they need, causing the cells themselves to begin dying within minutes. 

Strokes can be scary, but understanding them can help you recognize and respond quickly.

There are two main types of strokes:

1. Ischemic Stroke – This is the most common type, making up about 87% of all strokes. It happens when a blood clot blocks or narrows an artery leading to the brain. These clots often form in arteries damaged by fatty deposits.
2. Hemorrhagic Stroke – This type occurs when a blood vessel in the brain bursts, causing bleeding in or around the brain. High blood pressure and weak spots in blood vessel walls (aneurysms) are common causes.

The effects of a stroke can vary. Common symptoms include: 

• Sudden numbness or weakness, especially on one side of the body
• Confusion 
• Trouble speaking or understanding speech
• Vision problems
• Dizziness
• Loss of balance
• A severe headache with no known cause

Getting quick medical help is crucial when a stroke happens. The sooner a person gets treatment, the better their chances of reducing brain damage and improving recovery. 

The Seven Stroke Recovery Stages:  Motor Movement

Understanding the stages of stroke recovery can provide a clearer roadmap for stroke survivors and their caregivers. 

Each stage represents a milestone, bringing hope and progress, even if it sometimes feels slow. Recovery is a unique journey for everyone, but knowing what to expect can help manage expectations and set achievable goals.

Stage 1: Flaccidity 

Flaccidity, the first stage of stroke recovery, occurs immediately after a stroke. 

This stage is marked by severe muscle weakness and limpness. Due to the damage caused by the stroke, the brain can’t send proper signals to the muscles. As a result, the affected muscles can’t contract properly, leading to a complete lack of movement in some cases.

Stroke survivors in this stage often experience weak, floppy limbs, making moving the affected parts of their body difficult. This can result in trouble sitting up, maintaining balance, and an increased risk of falls. 

Simple tasks like eating or getting dressed can become extremely challenging, adding to the frustration and helplessness many feel during this time.

Early medical intervention is crucial during the flaccidity stage. Physical therapy should start as soon as possible to stimulate the muscles and nerves. Therapists may use passive range-of-motion exercises, moving the patient’s limbs to prevent stiffness and maintain circulation. 

Stage 2: Spasticity Appears

In the second stage of stroke recovery of motor function, spasticity begins to appear. 

Spasticity is characterized by increased muscle tone and stiffness due to abnormal nerve signals. This stage is marked by the brain starting to send some signals to the muscles again, though not in a coordinated manner. 

Spasticity is the opposite of flaccidity — the muscles become tight and rigid.

During this stage, stroke survivors might notice their muscles becoming stiff and difficult to move. This can make everyday activities (like walking or grasping objects) challenging and sometimes painful. 

Increased muscle tone can also lead to involuntary muscle contractions and spasms, which can be uncomfortable and frustrating.

Managing spasticity is essential to prevent long-term complications. Physical and occupational therapists play a crucial role in this stage by helping to stretch and strengthen the affected muscles. 

They may use techniques such as guided exercises, splinting, and positioning to maintain range of motion and reduce stiffness. Medications may also be prescribed to help control muscle tone and spasms.

Stage 3: Increased Spasticity

As stroke motor recovery progresses to the third stage, spasticity continues to increase. 

This stage is characterized by heightened muscle tone and stiffness, making movement even more challenging. The brain attempts to reestablish communication with the muscles. However,  the signals remain uncoordinated and excessive, causing the muscles to contract too much.

During this stage, stroke survivors may experience more pronounced muscle tightness and rigidity. This can lead to joint pain and difficulty performing everyday tasks like walking, dressing, or using utensils. The increased spasticity can also cause involuntary movements, further complicating recovery.

A comprehensive approach is essential to manage this increased spasticity. Physical and occupational therapy are crucial, focusing on exercises that stretch and strengthen the muscles while improving coordination. Therapists might also introduce neuromuscular electrical stimulation (NMES) to help retrain the muscles and improve motor control.

By actively participating in their rehabilitation, stroke survivors can work towards better muscle control and reduced stiffness. This paves  the way for further improvements in the next stages of recovery.

Stage 4: Decreased Spasticity

There is a noticeable decrease in spasticity in the fourth stroke recovery of the motor function stage. 

 A person may experience reduced muscle stiffness and improved control over voluntary movements. The brain is beginning to send more coordinated signals to the muscles, allowing for better movement and function.

Stroke survivors often experience increased ease of movement and reduced involuntary muscle contractions. This improvement can make everyday tasks, such as walking, dressing, and eating, more manageable. 

However, movements may still be slow and somewhat awkward, and muscle weakness may persist.

Rehabilitation efforts continue to be crucial in this stage. Physical and occupational therapists work with stroke survivors to refine their motor skills and build muscle strength. 

Therapy focuses on exercises that enhance coordination, balance, and fine motor skills. Techniques such as task-specific training, where patients practice activities relevant to their daily lives, are often used to improve functional abilities.

Assistive devices like braces or walkers may be introduced or continued to support mobility and safety. As spasticity decreases, the goal is to encourage independence while ensuring that movements remain controlled and safe.

Stage 5: Complex Movement Combinations

In the fifth stage of stroke motor movement recovery, survivors begin to develop more complex movement combinations. 

This stage is marked by the ability to perform more coordinated and purposeful movements, although they may still be slow and require significant effort. The brain’s ability to send clearer signals to the muscles improves, allowing for better task control and execution.

During this stage, stroke survivors often find that they can start to perform everyday activities with more ease. Tasks such as dressing, cooking, and writing become more achievable as fine motor skills and coordination improve. 

However, there may still be challenges with precise movements and strength, requiring ongoing effort and practice.

Rehabilitation in this stage focuses on refining motor skills and increasing the complexity of movements. Physical and occupational therapists introduce exercises that challenge coordination, balance, and dexterity. 

Activities that mimic real-life tasks help survivors regain independence in their daily lives. Introducing constraint-induced movement therapy (CIMT) may encourage the use of the affected limb, promoting further recovery.

Adaptive tools and techniques can also support daily activities. For example, specially designed utensils or tools can help with tasks that require fine motor skills. Therapists work with survivors to find the best strategies and devices to enhance their abilities and confidence.

Stage 6: Spasticity Disappears

Spasticity largely disappears in the sixth stage of stroke motor movement recovery, and movement becomes more fluid and natural. 

This stage is a major milestone! The brain and muscles have developed a much better ability to communicate and coordinate. 

While there may still be some residual weakness or difficulty, the improvements in muscle control are significant.

During this stage, stroke survivors often experience a return to more normal movement patterns. Previously challenging tasks (such as walking, dressing, and using the hands) become much easier. 

There is also a noticeable reduction in involuntary muscle contractions and stiffness, allowing for smoother and more coordinated actions.

Rehabilitation is vital in this stage, focusing on strengthening muscles and enhancing endurance. Physical and occupational therapists work with survivors to fine-tune their motor skills and build confidence in their abilities. Exercises may also become more complex and demanding, aiming to restore as much function as possible.

Therapists also emphasize activities that promote overall fitness and well-being, such as aerobic exercises, balance training, and flexibility routines. The goal is to support a return to normal daily activities and encourage a healthy, active lifestyle.

Stage 7: Normal Function Returns

In the seventh and final stage of stroke motor movement recovery, many stroke survivors achieve near-normal or normal function. 

This stage represents the culmination of hard work, perseverance, and consistent rehabilitation efforts. The brain and muscles have successfully relearned how to communicate effectively, resulting in smooth, coordinated movements.

During this stage, stroke survivors often find that they can perform daily activities with minimal or no assistance. Tasks such as walking, dressing, cooking, and other routine activities become almost as easy as before the stroke. 

Muscle strength and endurance are also significantly improved, and the risk of involuntary movements or spasticity is minimal.

Rehabilitation in this stage focuses on maintaining and enhancing the skills gained throughout recovery. Physical and occupational therapists continue to work with survivors to fine-tune their abilities and ensure they can handle more complex and demanding activities. Exercises may include advanced strength training, coordination drills, and activities that challenge balance and flexibility.

The emphasis is also on preventing setbacks and promoting long-term health. Therapists may provide guidance on maintaining an active lifestyle, incorporating regular physical activity, and adopting healthy habits. 

Reaching this stage is a significant achievement, and it’s important to recognize and celebrate the progress made. Stroke survivors and their caregivers can take pride in the journey and the hard work that has led to this point! 

It’s also important to remember that stroke recovery isn’t always linear — not everyone progresses similarly. Some stages may last longer than others, depending on the person and the severity of the stroke. 

Stroke Recovery Tips for Caregivers and Family

Caring for a loved one recovering from a stroke can be both rewarding and challenging. Your support is crucial in their recovery journey!

How to Support a Loved One Through Each Stage of Recovery

• Be patient and encouraging: Recovery takes time, and progress can be slow. Celebrate small victories and encourage your loved one to stay positive.
• Educate yourself: Learn about each stage of recovery so you know what to expect and how to support your loved one.
• Participate in therapy: Attend therapy sessions to understand the exercises and techniques. This will  help you assist with therapy and safety at home.
• Create a safe environment: Ensure the home is safe and accessible. Remove tripping hazards, install grab bars, and make necessary modifications to support mobility.
• Promote independence: Encourage your loved one to do as much as they can independently, even if tasks take longer. This helps build confidence and fosters independence.

Practical Advice for Managing Daily Challenges

• Establish a routine: A consistent daily schedule can provide structure and help manage time more effectively.
• Use assistive devices: Tools like walkers, shower chairs, and adaptive utensils can make daily tasks easier and safer.
• Stay organized: Keep medical records, therapy schedules, and medication lists well-organized to ensure nothing is overlooked.
• Take care of yourself: Caregiving can be demanding. Make sure to take breaks, seek support, and care for your  health and well-being.
• Communicate openly: Keep the lines of communication open with your loved one and their healthcare team. Discuss any concerns or changes you notice.

Possible Stroke Recovery Setbacks

Stroke recovery is a journey filled with ups and downs. It’s important to understand that setbacks are a natural part of this process. 

Here’s how to recognize and manage common setbacks and why resilience and support systems are crucial.

Common Setbacks During Stroke Recovery

• Fatigue: Many stroke survivors experience extreme tiredness, which can slow progress and make daily activities more difficult.
• Depression and anxiety: Emotional challenges are common and can impact motivation and overall well-being.
• Physical complications: Issues like muscle stiffness, joint pain, or infections can arise and hinder recovery.
• Communication difficulties:  Different kinds of expressive aphasia – the ability to communicate one’s wants and needs and receptive aphasia – the ability to understand language may be affected by stroke and may represent remarkable frustration for the person recovering and for their family and caregivers.  
• Cognitive difficulties: Problems with memory, attention, and thinking can affect the ability to perform daily tasks.
• Plateaus: Recovery can sometimes stall, making it feel like no progress is being made.

How to Manage and Overcome Setbacks

• Rest and self-care: Ensure adequate rest and self-care to manage fatigue. Encourage naps and relaxation techniques to conserve energy.
• Seek professional help: Don’t hesitate to seek help from mental health professionals for depression and anxiety. Counseling and medication can make a big difference.
• Address physical issues promptly: Work with healthcare providers to address any physical complications immediately. Consistent therapy can help manage stiffness and pain.
• Cognitive rehabilitation: Access a specialized stroke rehabilitation provider who can design opportunities to engage in targeted activities and exercises that create and strengthen new neural pathways in  the brain. Cognitive therapy can help improve memory and thinking skills.
• Stay positive and patient: Understand that plateaus are normal. Keep a positive mindset and continue with therapy. Small, steady progress adds up over time!

Stroke Recovery Stages FAQs

How long does it take for the brain to settle after a stroke?

The brain stabilizes within the first few days to weeks after a stroke, but gains in function can continue for years following the initial event.  . 

Recovery varies greatly.

Some people may see improvements within the first few weeks, while others may take months or much longer. Every recovery journey is unique, and ongoing therapy can help maximize progress and minimize long term disability.

What helps stroke patients recover faster?

Several factors can help stroke patients recover faster, such as:

• Early and consistent rehabilitation is key. Physical and occupational therapy can help rebuild strength and coordination.  Speech and language therapy can help to improve communication and cognition.   
• A healthy diet and adequate rest are also crucial. 
• Creating a supportive and encouraging environment can boost motivation and emotional well-being, which are vital for recovery.

How long does each stage of stroke recovery usually take?

The duration of each stage of stroke recovery varies widely among individuals. 

Some people may move through the stages in a few weeks, while others may take months or even longer. 

Factors such as the severity of the stroke, the individual’s overall health, and the quality of rehabilitation all affect the recovery timeline. 

Patience and persistence are important, as progress can be slow but steady!

What are the signs of progress in stroke recovery?

Signs of progress in stroke recovery include improved muscle strength, increased ability to perform daily tasks, better coordination, and improved communication and cognitive functions. 

Small milestones (like moving a finger or taking a few steps) are significant achievements. Emotional improvements, such as reduced anxiety and better mood, also indicate progress.

Can stroke recovery continue after the first year?

Yes, stroke recovery can continue well beyond the first year. 

While most significant improvements often occur in the first three to six months, many stroke survivors continue to make progress for years. Consistent therapy, staying active, and maintaining a healthy lifestyle can support ongoing recovery.

What are the common emotional challenges during stroke recovery?

Common emotional challenges during stroke recovery include depression, anxiety, frustration, and a sense of loss. 

These feelings can stem from changes in physical abilities and lifestyle. It’s important to address these emotional challenges with the help of mental health professionals, support groups, and open communication with loved ones.

Get the Stroke Recovery Support Your Loved Ones Need

Various forms of therapy, such as physical therapy, occupational therapy, speech-language therapy, medical care, and counseling, can assist the recovery process. 

NeuroRestorative helps people of all ages recovering from stroke symptoms return to their communities so they can live safely and independently while enjoying quality of life.

NeuroRestorative provides a personalized treatment plan that best caters to every person’s needs and goals.

Discover more about how we can help today! Call 800-743-6802 or visit us at our website: 

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