Stroke recovery pattern

1. According to Twitchell, when do DTR return? When does clonus usually appear? When do the first intentional movements appear?
2. What is a positive predictor of return of hand movement?
3. What are predictors of poor prognosis?
4. What are Brunnstrom's 7 stages of stroke recovery?

Answers:
1. DTR return within 48 hrs. Clonus is seen at 1-38 days post-onset. Movement returns at 6-33 days post onset.
2. If there is recovery of the hand at 4 weeks, there is a good chance of recovery.
3. Complete arm paralysis at onset (only 9% have hand fxn recovery), severe proximal spasticity, prolonged flaccid period, late return of proprioceptive facilitation (tapping) response, late return of shoulder flexors/adductors (>13 days).
4. Flaccidity --> Spasticity, min voluntary movement, basic synergy --> control over synergy, increased spasticity --> break in synergy, decreased spasticity --> continued decr synergy and spasticity --> disappearance of spasticity, increased coordination --> normal function.