Disagreement about use of voluntary control

Voluntary control is commonly been used for motor assessment in stroke rehab. It is commonly been taught in all colleges for in neuro assessment.

Original Brunnstrom Grading = Stages of Recovery 

Grade I- no movement or minimum movement possible in short range

Grade II- developing spasticity, partial synergy movement through half range.

Grade III- developed spasticity, full synergy movement through full synergy range.

Grade IV- Out of synergy movement possible.

Grade V- isolated movement possible

Grade VI – normal movement possible.

But there are many problems in practice of use of this in assessment.

Problem 1: There is poor reliability of voluntary control. there is lot of discrepancy between the grading when two assessors evaluate the same time same patients. some time this poor reliability play a major role discrepancy between the examiner and the student. now you tell if the student make some mistake during grading using this scale. Is it the scale is at fault or the student? GOD please help the poor student.


Problem 2:Disagreement about the many scaling methods.

Proposed scaling method are: some PT’s use six point scale 1-6. But many people use seven point scale 0-6. zero as no movement and grade 1 as min voluntary contraction. this way it will be a seven point scale 0-1-2-3-4-5-6. where as in the original Brunnstrom grading it was only 1-6. now the question arise that – no movement and  min voluntary contraction should be graded as zero 0 & 1or 1.


Problem 3: Separate voluntary cotrol for each joint (shoulder/ elbow/ wrist/hip/ knee/ ankle } and and each movement of flexion, extension, abduction or so on.

Can anyone tell me, in which book where this type of assessment methods given.? So that we can use this as reference. As per my knowledge no book has given this type of assessment methods. It is just a method to add to confusion to  already complicated scale.

Problem 4: This commonly taught and practice in education system with different ways, whichever is convenient to use. there is no standardization. for every new argument about scale there is new answer  and origin of new method of scaling.

Problem  5: There are many good valid and reliable scales are available but there use is less common than voluntary control scaling. Other  scale STREAM format Motor assessment scale, Fugl Mayer scale which are reliable, valid, and given the details of scaling

Published by GajananBhalerao

DR. GAJANAN BHALERAO (PT) MPTh Neuro, NDT Adult (USA), Motor relearning (Australia), Aquatic therapist (Switzerland). Associate professor at Sancheti Institute College of physiotherapy, Shivajinagar, Pune. Founder Director of "School of neuro rehab and aquatic therapy" , speciality centre for neuro rehabilitation of stroke, brain and spinal cord injury. Mobile : 9822623701 Email:Gajanan_bhalerao@yahoo.com, gajanan.neurophysio@gmail.com

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