Hemiplegia is a medical condition that affects one side of the body and results in weakness or complete paralysis (in most severe form of disease) of the affected side of body. It is caused by damage to parts of brain that control movements of the limbs, trunk and face (on the affected side). This can happen before birth or at the time of birth (Congenital Hemiplegia) or after birth (Acquired Hemiplegia).
Causes of Hemiplegia
Injury to the nerve pathways (brain and spinal cord) that execute information of movement, from brain to muscles get disturbed and thus result in weakness or paralysis of the affected side. The injury to left side of brain will affect the right side of the body and vice versa.
- Stroke is the most common cause of Hemiplegia. It happens because of inadequate blood supply to brain or when a blood vessel in the brain ruptures resulting in deprivation of oxygen and glucose to brain cells required for their proper functioning.
- Trauma resulting in head injury.
- Brain tumours.
- Infections such as Meningitis, Encephalitis and Brain abscess.
- Diseases affecting the nerves e.g. Multiple sclerosis and Acute necrotizing myelitis.
- Vasculitis (inflammation of blood vessels) of brain.
- Congenital Hemiplegia my occur because of birth trauma, perinatal strokes in infants and sometimes due to Heredity, Leukodystrophy is the medical condition that affects the myelin sheath of neurons(nerve cells) and can result in Hemiplegia.
Hemiplegia leads to inability in controlling the voluntary movements of a muscle or a group of muscles on the affected side of the body and thus results in:
- Weakness of muscles (Muscle Spasticity).
- Loss of muscle strength (Muscle Atrophy).
- Seizures (sometimes).
Muscle spasticity and muscle atrophy lead to:
- Difficulty in walking, talking and swallowing.
- Difficulty in balancing and coordination.
- Difficulty in holding things and tasks involving both hands.
- Loss of control over bladder and bowel movements.
- Numbness, tingling or loss of sensations on the affected side.
- Muscle fatigue.
- Depression and anxiety.
Treatment and Management
Treatment and Management of hemiplegic patients are largely based on the cause and severity of the symptoms. That is, medicines for lowering BP and cholesterol in the case of stroke and surgical intervention in case of trauma, tumours, and abscess or to remove blockages and haemorrhages (in stroke).
Once the patient’s medical condition stabilizes, the next step is rehabilitation with the physical therapy to help prevent muscle and joint stiffness, improve movement and aid in recovery.
- Exercises for hemiplegia aim on ‘Stretching and Strengthening’ the affected side of the body. Depending on the extent of movement the exercises can be passive (performed with the help of physiotherapist/caregiver), active- assistive (assisted by physiotherapist/caregiver) or active (performed by patient alone).Types of exercises:
- Range of motion: Physiotherapy for hemiplegia at home mostly starts with the “range of motion’’ exercises on upper extremities so as to help the patient in performing everyday activities. Upper extremity exercises include head and neck exercises, shoulder, elbow and wrist rotations, movements and stretching to improve dexterity in affected hand and fingers. In less severe cases where the aim is to strengthen the weakened muscles, sports e.g. basketball is also proved to be helpful.
- Flexibility training: To improve blood circulation that helps in regaining balance and coordination.
- Electrical stimulation and strengthening exercises: Active range of strengthening exercises and electrical stimulation can strengthen the muscles and improve movements significantly.
- Modified constraint-induced therapy and Motor imagery exercises to improve movements in limbs.
- Compensatory devices such as walkers, wheel-chairs, elbow brace or ankle foot orthoses(AFO) to increase movement and provide support to weakened muscles and prevent contractures.
The rehabilitation for hemiplegic patients also involves speech therapy to improve the communication of patient and psychological support to deal with the depression.
Apart from this the basic home care for seniors also involves giving them healthy and balanced diet, implementing some home safety measures to prevent falls and encouraging their every small improvement and supporting them to participate in physical therapy throughout, at the same time giving them emotional support to help fight disease related depression. Altogether these help in greater independence, improved communication and increased self confidence to perform everyday activity on their own and hence rapid recovery.