Practice Exam 3: Question #16 Brunnstrom Stages

[Kadi]

Hi there, I am confused on how to know that they are in stage 3 vs stage 4… There isn’t enough information in the question to accurately choose. Scoring 2 on the Ashworth scale says that there is an increase in tone, but affected part is moved easily.
Brunnstrom stage 3: increase in spasticity- focus on preventing contractures, Stage 4: decrease in spasticity- focus on AROM and coordination.
the patient is working on walking- struggling with gait mechanics, so the fact that the answer is not stage 5 makes sense, but the fact that they are working on their coordination of walking, to me, hints at stage 4, not stage 3.
If only 1 of the 2 choices (stage 3 or 4) were an option, then it would be more of a clear question, but I don’t understand how you determine between stage 3 or 4 with the information given.

[Jonathan Zins]

Hi Kadi, great question! You are absolutely right that stage 3 has increased spasticity and stage 4 indicates spasticity is beginning to decrease. This is a tricky “attention to detail” question, which the GCS can be known for. The choices for this question are (A) Stage 3, (B) Stage C4, (C) Stage 5, and (D) Stage 1. The only correct answer is (A) Stage 3 because the Brunnstrom scale does not have a “C4” stage. If the answer choice had simply said “stage 4” you would be correct that there is not enough information to differentiate. To get this correct, you have to eliminate option B because it is not consistent with the scoring of the scale.

This is a tough one, but the way you explained your rationale and demonstrated your foundational knowledge of the Brunnstrom scale tells me you will do great on test day. Best of luck and keep up the excellent work! 🙂

[Kadi]

These are the answers I see:

Jacey is a 75yo female who is assessed in the home health setting following discharge home after a 4 week stay in skilled nursing. She experienced a massive hemorrhagic stroke 6 weeks (about 1 and a half months) ago. She was taken to the emergency room within 2 hours of onset of symptoms. Initial symptoms were facial droop and right sided weakness. Gait assessment reveals forward trunk flexion, circumduction on the right lower extremity, hyperextension of the right knee, and plantar flexion of the right foot with toe clawing. Her Ashworth Scale score for the lower right extremity is 2. During the interview, the patient answers in one-word responses to simple questions with some stuttering/slowing of speech, but her daughter primarily performs the interview.

What Brunnstrom stage is the client most likely in?

a. Stage 5
b. Stage 4
c. Stage 3
d. Stage 1

Stage 3 is the stage of increased spasticity when effected muscles tighten more and can be difficult to relax. Her Ashworth scale indicates she is not flaccid (Stage 1), but she is unable to complete complex movements (stage 5) given her gait circumduction.

I don’t see the “C4” like you are saying?

[Jonathan Zins]

Hi Kadi,

Thank you for following up with this. I looked further on the site and you are correct! Thank you so much for catching this typo and we will get that fixed today.

We really appreciate your attention to detail and helping get this corrected for future students. Keep up the EXCELLENT work!

-Jonathan Zins PT, DPT, GCS

[Kadi]

THANK YOU!

[Author]

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