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Hemiplegia

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Introduction

Hemiplegia can occur in babies, children or adults, it is when one side of the body is paralysed. It can affect either side of the body & is caused by damage to the brain, such as a stroke.

This can happen in babies, before, during or after birth. The condition can be congenital or acquired. No one knows what causes the damage in these cases.
Hemiplegia can also be acquired. This is caused by damage to the brain, such as a stroke, in childhood or traumatic injury to brain during child birth such as forceps delivery.

This condition can affect any child, but it is slightly more common in premature babies. It is quite a common condition, affecting one in 1000 births.

An injury to the right side of the brain will cause the left side of the body to be paralysed & an injury to the left side of the brain will cause the right side of the body to be paralysed.
Sometimes the condition will only become clear as the baby gets older, such as when they have trouble walking.

Hemiplegia in Children

Signs and symptoms

The main symptom of hemiplegia is weakness or paralysis on one side of the child’s body. The condition can vary in severity & affects each child differently. It will only affect one side of the child’s body. General symptoms include:

  • difficulty walking
  • poor balance
  • little or no use of one hand or leg

The condition affects the brain. This means that there may be other associated symptoms, such as:

  • speech problems
  • visual problems
  • behavioural problems
  • learning difficulties
  • epilepsy
  • developmental delay, for example learning to walk later than other children.

How is it diagnosed?

A doctor will examine the child for signs of paralysis. A Magnetic Resonance Imaging (MRI) & Computerized Tomography (CT) scan of the brain can look for a brain injury.

It is often difficult for a doctor to determine how mild or severe the condition is. It may be a case of having to wait and see how each child develops over time.

How is it treated?

Hemiplegia cannot be cured, but treatment will involve managing the symptoms & improving quality of life.

  • A child’s brain will often re-wire itself to a certain degree. This means that some brain function can be taken over by unaffected parts of the brain.
  • Physiotherapy will help the child to build up the weakened side of their body to improve function.
  • Occupational therapy can teach them how to cope with everyday activities.
  • Speech therapy may also be necessary for some children.
  • As the child gets older it will become clearer how mild or severe their condition is.
  • This will be shown in certain developmental milestones, such as walking, which they may reach slightly later than other children.
  • Children with Hemiplegia will learn their abilities as they develop & grow.
  • Regular physical therapy can help them live a normal life.

Hemiplegia in adults

Hemiplegia in adults can result from a variety of causes:

  • Stroke: In adults stroke is the commonest cause. It is more after the age of 50, but can occur before this age also. Stroke results from insufficient or decreased supply of blood to brain. As a result the cells are deprived of vital oxygen and they progressively die. Blood supply can be restricted due to either:
  1. A clot in blood vessels of brain (thrombus).
  2. An emboli originating elsewhere and lodging itself in blood vessels of brain (embolism)
  3. Leakage of blood from brain vessels (hemorrhage).
  • Severe trauma on head resulting in hemorrhage.
  • Infections such as meningitis, brain abscess & encephalitis.
  • Tumor inside brain.
  • Hypertension & diabetes
  • Diseases that involves nerves such as multiple scelrosis or myelits.

Signs & Symptoms Of Hemiplegia In Adults

The nerves cross its pathway in other direction from certain point from its origin the brain. Thus an injury to right of brain results in left sided Hemiplegia and vice versa. These nerve cells then join the spinal cord.

  • It is usually an acute episode. Patient experiences difficulty in walking, There limbs are paralyzed, they are unable to move one side of their hand & leg. They are not able to balance themselves. The muscles of throat are also paralyzed, & the individual finds difficulty in swallowing. This also causes the speech to become slurred.
  • There is drooping of saliva from angle of mouth & the eyesight is affected. It may lead to drooping of eyelids of one side. There is tingling numbness in affected limbs & loss of bladder & bowel control.
  • Thumb gets folded in palm and fingers clasp the thumb of affected side. His memory becomes poor and is unable to recall past or present events.

The clinical picture itself is suggestive of Hemiplegia, however to find the underlying cause, several tests are done such as CT scan, MRI, blood tests, spinal fluid examination, etc.

Treatment & Physiotherapy For Hemiplegia 

Treatment of hemiplegia requires coordination of several health professionals.
A physiotherapist, occupational therapists, a physician, a surgeon & support from family etc.

  • Treatment is focused to find the causative factor and check its further progression. Secondly after few days, rehabilitation therapy helps to minimize disability.
  • Several medicines are prescribed to control the primary cause such as anti hypertensive, anti-thrombolytic agents to dissolve the clot, drugs to control cerebral edema etc.
  • Intensive physical therapy is begun after few days. Activities such as walking & standing are done repeatedly under the guidance of physiotherapist. It helps to improve the muscular functions which have become rigid. It is aimed to make the patient self sufficient to perform his daily activities.
  • Patient is taught to move his affected arm with his strong arm. With exercise it is possible to maintain flexibility of joints and it also prevents tightening & shortening of muscles. Speech therapy is simultaneously begun to improve communication & speaking skills.

References

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