Combined Effects of Brunnstorm Movement Therapy and Low-Level Laser Therapy on Upper Limb Function and Hand Dexterity in Chronic Stroke Patient

Main Article Content

Sehar Shaheen
Binash Afzal
Muhammad Tahir
Usama Mahmood
Faraya Yousaf
Fariha Tariq


Background: Stroke remains a leading cause of disability worldwide, necessitating innovative rehabilitation strategies to enhance recovery and improve quality of life. The integration of Brunnstrom movement therapy and low-level laser therapy (LLLT) presents a novel approach to addressing the complexities of stroke rehabilitation, focusing on improving upper limb function and hand dexterity.

Objective: This study aimed to evaluate the combined effects of Brunnstrom movement therapy and LLLT on upper limb function and hand dexterity in chronic stroke patients, providing insights into potentially enhancing rehabilitation outcomes.

Methods: A randomized controlled trial was conducted involving 48 chronic stroke patients, divided equally into two groups to receive either Brunnstrom movement therapy or LLLT. The study spanned six months, with assessments including the Modified Ashworth Scale (MAS), Nine-Hole Peg Test, Box and Block Test, Fugl-Meyer Assessment, and Handheld Dynamometer. Data were analyzed using SPSS version 25, employing descriptive statistics, chi-square tests, and Mann-Whitney U tests to compare outcomes between groups.

Results: Significant improvements were noted in both groups, with the LLLT group showing superior performance in the Nine-Hole Peg Test (p<0.001), Box and Block Test (p<0.001), and Fugl-Meyer Assessment (p<0.001) compared to baseline. The MAS scores indicated a significant reduction in muscle spasticity over time in both groups, with the LLLT group exhibiting a more substantial decrease (p=0.003 at week 6).

Conclusion: The study demonstrated that combining Brunnstrom movement therapy with LLLT could significantly enhance upper limb function and hand dexterity in chronic stroke patients. These findings advocate for the integration of innovative and non-invasive therapies into rehabilitation programs, potentially setting a new benchmark in stroke recovery practices.

Article Details

How to Cite
Shaheen , S., Afzal , B., Tahir, M., Mahmood, U., Yousaf, F., & Tariq, F. (2024). Combined Effects of Brunnstorm Movement Therapy and Low-Level Laser Therapy on Upper Limb Function and Hand Dexterity in Chronic Stroke Patient. Journal of Health and Rehabilitation Research, 4(1), 1457–1462.
Author Biographies

Sehar Shaheen , Riphah International University Pakistan.

DPT, MSNMPT, Riphah international University, Pakistan.

Binash Afzal , Riphah International University Pakistan.

BSPT, MSNMPT, Riphah international University, Pakistan.

Muhammad Tahir, Link Medical Center Lahore Pakistan.

Physical Therapist, Link Medical Institute Lahore, Pakistan.

Usama Mahmood, University of Montgomery Sahiwal Pakistan.

Doctor of Physical Therapy, Lecturer University of Montgomery Sahiwal, Pakistan.

Faraya Yousaf, University of Lahore Teaching Hospital Pakistan.

Physical therapist, Doctor of physiotherapy, Master of Science, in Musculoskeletal physiotherapy, University of Lahore Teaching Hospital, Pakistan.

Fariha Tariq, University of Lahore- Lahore Pakistan.

Doctor of Physical Therapy, University of Lahore, Pakistan.


Makki ARK, Tahir M, Amin U, Tabassum MMB, Kamran M, Tahir F. Mechanism of Meniscal Injury and its Impact on Performance in Athletes: Meniscal Injury in Athletes. The Healer Journal of Physiotherapy and Rehabilitation Sciences. 2022;2(3):232-7.

Waqas M, Rai AT, Vakharia K, Chin F, Siddiqui AHJJons. Effect of definition and methods on estimates of prevalence of large vessel occlusion in acute ischemic stroke: a systematic review and meta-analysis. 2020;12(3):260-5.

Justice D, Awori J, Carlson S, Chang KW, Yang LJ. Use of Neuromuscular Electrical Stimulation in the Treatment of Neonatal Brachial Plexus Palsy: A.

Chen X, Liu Z, Miao J, Zheng W, Yang Q, Ye X, et al. High stress hyperglycemia ratio predicts poor outcome after mechanical thrombectomy for ischemic stroke. 2019;28(6):1668-73.

Cho S-M, Moazami N, Katz S, Bhimraj A, Shrestha NK, Frontera JAJNc. Stroke risk following infection in patients with continuous-flow left ventricular assist device. 2019;31:72-80.

Cortés-Vicente E, Guisado-Alonso D, Delgado-Mederos R, Camps-Renom P, Prats-Sánchez L, Martínez-Domeño A, et al. Frequency, risk factors, and prognosis of dehydration in acute stroke. 2019;10:305.

Gong P, Liu Y, Gong Y, Chen G, Zhang X, Wang S, et al. The association of neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, and lymphocyte to monocyte ratio with post-thrombolysis early neurological outcomes in patients with acute ischemic stroke. 2021;18(1):1-11.

Tahir A, Fatima A, Khan MT. Association of depression in patients with fibromyalgia syndrome. Pakistan Journal of Rehabilitation. 2022;11(1):174-83.

Mendelson SJ, Prabhakaran SJJ. Diagnosis and management of transient ischemic attack and acute ischemic stroke: a review. 2021;325(11):1088-98.

Bhattacharya R, Zekavat SM, Haessler J, Fornage M, Raffield L, Uddin MM, et al. Clonal hematopoiesis is associated with higher risk of stroke. 2022;53(3):788-97.

Puri S, Kovela RK, Qureshi MI, Dadgal R, Timothy R, Samal SJJoPRI. Effect of Brunnstrom Movement Therapy Combined with Neurodevelopmental Therapy on Balance and Mobility in a Patient with Acute Stroke: An Interesting Case Report. 2022;34(2A):6-9.

Akter R, Sharma N, Ahmed S, Srivastav AKJJoB, Therapies M. Combined effect of Brunnstrom's hand rehabilitation and functional electrical stimulation for improving hand function in patients with chronic stroke: A randomized controlled trial. 2023.

Korkmaz N, Gurcay E, Demir Y, Tezen Ö, Korkmaz İ, Atar MÖ, et al. The effectiveness of high-intensity laser therapy in the treatment of post-stroke patients with hemiplegic shoulder pain: a prospective randomized controlled study. Lasers in Medical Science. 2022;37(1):645-53.

Sui M, Jiang N, Yan L, Zhang C, Liu J, Yan T, et al. Analysis of Muscular Electrical Activity and Blood Perfusion of Upper Extremity in Patients with Hemiplegic Shoulder Pain: A Pilot Study. Neural Plasticity. 2022;2022.

Huang Y. Investigation of robot assisted sensorimotor upper limb rehabilitation after stroke. 2020.

Asghar M, Safdar Z, Tahir M. Quality of life and functional Outcomes among Burn Patients: A Cross Sectional Survey. Journal of Health and Rehabilitation Research. 2023;3(2):293-8.

Huang J, Lin M, Fu J, Sun Y, Fang Q, editors. An immersive motor imagery training system for Post-Stroke rehabilitation combining VR and EMG-based Real-Time feedback. 2021 43rd Annual International Conference of the IEEE Engineering in Medicine & Biology Society (EMBC); 2021: IEEE.

Saikaley M, Iruthayarajah J, Pauli G, Iliescu A, Cotoi A, Viana R, et al. Hemiplegic Shoulder Pain and Complex Regional Pain Syndrome. Stroke Rehabilitation Clinician Handbook. 2020.

Lefaucheur J-P, Aleman A, Baeken C, Benninger DH, Brunelin J, Di Lazzaro V, et al. Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS): An update (2014–2018). Clinical neurophysiology. 2020;131(2):474-528.

Hussain MA, Sajid M, Hafeez S, Sarfraz M, Rashid R, Riaz A, et al. RELATIONS OF COLORECTAL CANCER WITH GENDER, AGE AND LIFESTYLE DIFFERENCE OVER AGE 45 YEARS SCREENED BY COLONOSCOPY IN LAHORE FROM 2022-2023. Journal of Population Therapeutics and Clinical Pharmacology. 2024;31(1):1328-38.

Omer A, Moghadam BA, Shadmehr A, Hafeez T, Azfar H, Arif M, et al. Effects of Kinesio Taping and Modified Constraint-Induced Movement Therapy on Upper Extremity Function, Quality of Life, and Spasticity in Individuals Recovering from Stroke. Journal of Health and Rehabilitation Research. 2024;4(1):167-72.

Safdar Z, Asghar M, Tahir M. Level of Quality of Life among Post Stroke Patients; A Cross Sectional Survey. Journal of Health and Rehabilitation Research. 2023;3(2):299-304.

Tahir M, Maqsood M, Azhar N, Safdar Z, Amin U, Waheed TS. Association of Knee Pain in Long Standing and Sitting among University Teachers: Association of Knee Pain in University Teachers. The Healer Journal of Physiotherapy and Rehabilitation Sciences. 2023;3(1):314-21.

Tahir M, Tariq F, Saeed HW, Nauman M, Usman M, Ali S. Impact of Air Pollution on Respiratory Health of Traffic Wardens in Lahore: Air Pollution and Respiratory Health. The Healer Journal of Physiotherapy and Rehabilitation Sciences. 2023;3(7):703-9.


POELMANS B, Petré L. The dosage dependent effects of upper limb rehabilitation in chronic neurological patients. 2017.

Dawson AC. Upper limb movement control after stroke and in healthy ageing: does intensive upper limb neurorehabilitation improve motor control and reduce motor impairment in the chronic phase of stroke? : UCL (University College London); 2023.

Shahid J, Kashif A, Shahid MK. A Comprehensive Review of Physical Therapy Interventions for Stroke Rehabilitation: Impairment-Based Approaches and Functional Goals. Brain Sciences. 2023;13(5):717.

Rayegani S, Raeissadat S, Sedighipour L, Mohammad Rezazadeh I, Bahrami M, Eliaspour D, et al. Effect of neurofeedback and electromyographic-biofeedback therapy on improving hand function in stroke patients. Topics in stroke rehabilitation. 2014;21(2):137-51.

Kiper P, Godart N, Cavalier M, Berard C, Cieślik B, Federico S, et al. Effects of Immersive Virtual Reality on Upper-Extremity Stroke Rehabilitation: A Systematic Review with Meta-Analysis. Journal of clinical medicine. 2023;13(1):146.

Pelliccio M, Neckel N, Nichols D, Hidler J. LOWER LIMB STRENGTH and COORDINATION PATTERNS OF CHRONIC STROKE SUBJECTS IN A FUNCTIONAL POSTURE. Journal of Neurologic Physical Therapy. 2005;29(4):198.

Koo WR, Jang BH, Kim CR. Effects of anodal transcranial direct current stimulation on somatosensory recovery after stroke: a randomized controlled trial. American journal of physical medicine & rehabilitation. 2018;97(7):507-13.

Most read articles by the same author(s)