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Hemiplegic Limb Synergies in Stroke Patients

Welmer, Anna-Karin PT, MSc; Holmqvist, Lotta Widén PT, PhD; Sommerfeld, Disa K. PT, PhD

American Journal of Physical Medicine & Rehabilitation: February 2006 - Volume 85 - Issue 2 - p 112-119
doi: 10.1097/01.phm.0000197587.78140.17
Research Article: Hemiplegia

Welmer AK, Widén Holmqvist L, Sommerfeld DK: Hemiplegic limb synergies in stroke patients. Am J Phys Med Rehabil 2006;85:112–119.

Objective: To describe the extent to which the voluntary movements of hemiparetic stroke patients are restricted to the hemiplegic limb synergies (which are marked by the inability to master individual joint movements) described by Brunnström. The study also aimed to describe the extent to which the synergies are related to functioning.

Design: In a prospective observational study design, 64 consecutive hemiparetic stroke patients were assessed with Brunnström’s hemiplegic limb synergies, the modified Ashworth scale for spasticity, the Rivermead mobility index, and the Barthel ADL index.

Results: Three months after stroke, 8 of the 64 patients were moving completely or partly within the synergies. All patients whose movements were restricted to the synergies also exhibited spasticity. Hemiparetic patients whose movements were restricted to the synergies had significantly worse functioning scores than hemiparetic patients whose movements were not restricted to the synergies although severe disabilities were seen in both groups.

Conclusions: Three months after stroke, the voluntary movements of only 13% of hemiparetic stroke patients were restricted to the synergies. The synergies were associated with spasticity and activity limitations. The use of the synergies might only be suitable for a small fraction of hemiparetic patients—namely, those displaying spasticity.

From the Neurotec Department, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden (AKW, LWH); the Vårdal Institute, Lund, Sweden (AKW); and the Department of Geriatric Medicine, Danderyd Hospital, Stockholm, Sweden (DKS).

There is no conflict of interest relating to this manuscript.

All correspondence and requests for reprints should be addressed to Anna-Karin Welmer, Neurotec Department, Division of Physiotherapy 23100, Karolinska Institutet, SE- 141 83 Huddinge, Sweden.

© 2006 Lippincott Williams & Wilkins, Inc.