The 7 Brunnstrom Stages of Stroke Recovery
The Brunnstrom stages describe a common pattern of motor recovery after stroke, from little or no voluntary movement toward more selective and coordinated movement. Clinicians may use the stages to describe changes in the arm, hand and leg, but they are not a timetable and they do not predict exactly how far or how quickly one person will recover.
Important: sudden facial drooping, arm weakness, speech difficulty, loss of balance or a severe unexplained headache may be signs of a new stroke. Call emergency services immediately. Do not wait to see whether the symptoms improve.
What are the Brunnstrom stages?
The framework is based on seven stages of motor recovery. Early stages are characterized by flaccidity or movement dominated by mass patterns called synergies. Later stages describe decreasing spasticity and the return of more selective movement. A peer-reviewed review of post-stroke hand assessment summarizes these seven stages, while other research notes that the Brunnstrom stages are one clinical framework among several—not a complete measure of strength, dexterity, sensation or daily independence.
| Stage | Typical motor pattern | What this can mean for the arm and hand |
|---|---|---|
| 1 | Flaccidity | Little or no voluntary movement is present. The arm and hand may feel limp, and careful positioning is important. |
| 2 | Spasticity begins to appear | Small amounts of movement may emerge, often together with reflex activity or early synergy patterns. |
| 3 | Spasticity may become more marked | Voluntary movement is possible mainly within synergy patterns. The hand may remain tightly flexed and releasing an object can be difficult. |
| 4 | Spasticity begins to decrease | Some movements outside the basic synergy patterns become possible, although control may still be limited. |
| 5 | More complex movement combinations appear | Selective movement improves and synergy patterns have less influence, but fine motor control may still be difficult. |
| 6 | Spasticity is minimal or absent | Joint movements become more independent and coordination approaches normal, though speed or dexterity may remain reduced. |
| 7 | Coordinated voluntary movement | Movement is close to the person's pre-stroke pattern. Not everyone reaches this stage, and meaningful gains can still occur without reaching it. |
Do people move through all seven stages?
Not always. Recovery varies with stroke severity, lesion location, health conditions, time since stroke, access to rehabilitation and many other factors. Some people progress quickly, some remain in one stage for a long period and some show different stages in the shoulder, arm, wrist and hand at the same time.
The Brunnstrom scale also does not capture everything that matters. Clinicians may combine it with measures such as the Fugl-Meyer Assessment, Action Research Arm Test, grip or pinch testing, sensation testing and observation of daily activities. A 2024 systematic review found substantial variation in upper-extremity recovery and emphasized the importance of baseline severity and other clinical factors.
What should rehabilitation focus on at each stage?
The safest plan is individualized by a qualified rehabilitation professional. In general, treatment may include positioning, range-of-motion work, task-specific practice, repeated movement, strength and coordination activities, sensory training and strategies for daily tasks. The choice and dose depend on the person's movement, spasticity, pain, cognition, sensation and medical status—not only the Brunnstrom stage.
When the hand is flaccid or movement is very limited
Protect the shoulder and hand, avoid forceful pulling, and follow the positioning and movement plan provided by the clinical team. Passive or assisted movement may be used when appropriate, but it should be comfortable and controlled.
When spasticity or a clenched hand is present
Do not force the fingers open. A therapist can help identify triggers, protect the skin, check pain and joint range, and decide whether stretching, splinting, medication or other treatment is appropriate. Read our guide to understanding a clenched hand after brain injury.
When selective movement begins to return
Practice can gradually emphasize meaningful tasks such as reaching, grasping, releasing and manipulating objects. Quality of movement still matters; more repetitions are not automatically better if the exercise causes pain, fatigue or unsafe compensation.
Where can rehabilitation devices fit?
Robotic gloves, mirrors, splints and other devices may support a clinician-directed practice plan, but no product can determine a person's recovery stage or guarantee recovery. Suitability depends on hand size, affected side, available movement, tone, skin condition, cognition and the specific training goal.
For general home-practice ideas, see our gentle hand rehabilitation exercise guide. To compare Syrebo glove functions without treating the selector as medical advice, use the Syrebo Glove Selector. For research summaries and study limitations, visit the Clinical Evidence section.
Frequently asked questions
How long does each Brunnstrom stage last?
There is no fixed duration. The stages describe movement patterns, not a calendar. A person's rehabilitation team can track changes over time with standardized assessments.
Is more spasticity a sign that recovery is improving?
Spasticity can appear during recovery, but it should not be described as automatically positive. It can interfere with comfort, hygiene, sleep and movement. New or worsening stiffness, pain or skin problems should be discussed with a qualified clinician.
Can recovery continue months or years after stroke?
Yes, meaningful improvement may continue beyond the early months, although the rate and amount vary. Consistent, appropriately dosed practice and follow-up assessment remain important.
Can I identify my own stage?
A self-check can miss important issues such as shoulder instability, contracture, sensory loss or unsafe movement. Ask an occupational therapist, physical therapist or other qualified rehabilitation professional for an assessment.
Evidence and limitations
- Objectivizing Measures of Post-Stroke Hand Rehabilitation through Multi-Disciplinary Scales — includes a summary of the seven Brunnstrom stages and discusses the need to combine measures.
- Spasticity, Motor Recovery, and Neural Plasticity after Stroke — reviews the relationship between spasticity and motor recovery.
- Stroke-related motor outcome measures — compares upper-extremity measures with the neurophysiological aspects of recovery.
- Upper-extremity motor recovery after stroke — 2024 systematic review and meta-analysis of recovery in usual-care groups.
This article is for general education and does not provide a diagnosis or individual treatment plan. Seek urgent medical care for possible stroke symptoms, and consult a qualified healthcare professional for rehabilitation decisions.
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