The Flexion Synergy Can Be Good

In Stage 1 the arm is totally limp.  Stage 2 is exciting because stroke survivors see small limb movements.  In Stage 2 I could fling my hand onto my thigh, but my hand slid off.  When I was able-bodied I thought keeping my hand on my lap was effortless, but it requires shoulder and elbow strength.  Stage 3 is bad because an abnormal synergy produces only one movement pattern which dictates the one place you can put your hand.  

The photo shows the stab-yourself-in-the-stomach version of the flexion synergy.  There are many versions so your movement pattern may look different.  The flexion synergy is also bad because to move one joint you have move the whole arm whether you want to or not.  This is exhausting.  When Stage 3 becomes full blown the hand is fisted and the arm is close to the body.

I made Stage 3 functional with the help of an electrical stimulation device called NeuroMove which has a biofeedback component and a spring-loaded hand splint called SaeboFlex.  They helped me retrain my brain to open my hand a few inches so it can receive an object from my sound hand.  Hand-to-hand transfers let my affected hand hold an object close to my body so my sound hand can manipulate the object.  Hand-to-hand transfers made me independent in over 30 bimanual tasks like taking the cap off a deoderant bottle.

Stage 4 brings shoulder, elbow, and forearm motions that move the hand farther away from the body.  Keeping a hand open while reaching for an object is a skill able-bodied people use thousands of times.  My emerging Stage 4 skills are: 1) keeping my hand open when I reach at waist height while standing and 2) partially rotating my forearm to orient my hand to the different positions objects require.  My hand is still synergy bound so I cannot open my hand unless I also move my shoulder.

Stage 5 means you can move one joint without moving all the other joints in a limb.  I was stunned to learn my hand is useful without achieving Stage 5.  As an OT I knew stroke survivors walk using the extension synergy in the leg, but I was taught the flexion synergy in the arm is bad.  I had to have a stroke to see the flexion synergy in the arm in a more positive light.  homeafterstroke.blogspot.com