Hemiplegia – Types, Causes and Treatment

Definition

Hemiplegia refers to the severe or complete loss of motor function on one side of the body. Depending on the side of the body that is affected, hemiplegia is further classified as right or left hemiplegia. Hemiplegia is usually caused by brain damage localized to the cerebral hemisphere opposite the affected side. For example, injury to the left side of the brain will cause right hemiplegia and vice versa. Less frequently, brain stem lesions, peripheral nervous system disorders, cervical spinal cord injury and other conditions may present as hemiplegia.

Hemiplegia may appear soon after birth (i.e., up to approximately two years of life), where it is known as congenital hemiplegia, or hemiplegic cerebral palsy. On the other hand, acquired hemiplegia presents later in life as a result of injury or other pathology.

Types of Hemiplegia and Mechanism

Many different types of hemiplegia have already been stated in the above text. Some of them can be listed below as follows:

  • Facial Hemiplegia: When the muscles of the face are paralysed on one side of the face it is known as facial hemiplegia. This can also occur along with minor paralysis on the rest of the body parts.
  • Spinal Hemiplegia: When there is damage to the spinal cord on one side of the body, it results in paralysis of the same side of the body, it is known as spinal hemiplegia. There is loss of pain and temperature sensation on the opposite side of the body as well.
  • Contralateral Hemiplegia: This condition arises when there is damage to one hemisphere of the brain and it results in the paralysis of the opposite half of the body.
  • Spastic Hemiplegia: Spastic hemiplegia is a condition when there is a continuous contraction in the muscles of the body. It is a disease caused due to damage to the neuromuscular network of cells.

As is visible, depending on the type of hemiplegia diagnosed, different body functions are affected. Some of the effects of the condition due to the damage are to be expected like partial paralysis while other ailments even though at first might appear to be non-related to any weakness in the limb can be the direct result of the damage to any side of the brain.

Relation of Brain Anatomy with Hemiplegia

  • The brain is divided into two cerebral hemispheres, joined along the midline by a band of fibers that bind the two sides together. This structure, which functions like a glue, is known as the corpus callosum.
  • It should be noted that one side of the brain is responsible for the movements of the opposite side of the body. Thus, the left side of the brain controls the right side of the body and vice versa.
  • Therefore, if the left side of the brain is damaged, the right side of the body will be paralyzed, on in other words, hemiplegia will be on the right (opposite or contralateral)-half of the body.

Causes of Hemiplegia

Hemiplegia and hemiparesis often have the same causes; however, use of one term or the other depends on the severity of muscle weakness and dysfunction resulting from central nervous system (brain or spinal cord) injury.

Brain damage can disrupt many functions, including movement control, sensation, coordination, and thinking skills. Damage may alter or destroy the brain’s underlying neural pathways, the structures responsible for sending messages related to controlling the rest of the body. Abnormalities in brain areas responsible for controlling movement and muscle tone are primarily responsible for causing hemiparesis or hemiplegia.

Hemiparesis or hemiplegia may occur as a result of the following diagnoses:

  • Stroke: It is one of the most common causes of one-sided bodily weakness. The severity of muscle weakness that you experience can depend on the size and location damage within the brain
  • Traumatic brain injury (TBI): A TBI can cause permanent brain damage. If the trauma only affects one side of the brain, hemiplegia can result on the opposite side of the body. Common causes of trauma include car accidents, falls, or blows to the head.
  • Spinal cord injury (SCI): SCI has many presentations. Depending on where the spinal cord was damaged, resultant weakness may affect only one side of the body.
  • Brain Tumors: Brain tumors can lead to a variety of physical problems including hemiplegia. Symptoms of hemiplegia may get worse as the tumor grows and invades brain areas that control movement.
  • Additional Causes: Multiple sclerosis, muscular dystrophy, cerebral palsy, amyotrophic lateral sclerosis (ALS)

Hemiplegia symptoms

Generally, complete paralysis exists on one side of the body as a result of hemiplegia; however, symptoms might vary from person to person based on their individual case. Generally speaking, symptoms may include:

  • Muscle stiffness or weakness on one half of the body
  • Favoring one side of the body
  • Keeping one hand fisted
  • Difficulty balancing and walking
  • Lack of fine motor skills
  • Developmental delays, especially with motor skills

Hemiplegia results from a brain injury, and brain injuries display a variety of symptoms throughout the body. In addition to weakness or paralysis, brain injuries have the capability of affecting memory, speech, concentration, behavior, social communication, attention, sensory effects (like vision), and incidence of seizures.

Risk factors

Anyone can get this condition at any age. However, one’s chances of having the condition increase if you have certain risk factors. Some risk factors can be managed or changed, while others can’t.

Risk factors that can be medically managed, altered, or treated include:

  • Hypertension: A blood pressure of 140/90 and above can damage the arteries that supply blood to the brain.
  • Smoking: This doubles your risk of hemiplegia.
  • Heart disease: It is the second most significant factor contributing to hemiplegia and stroke and is the primary cause of death for stroke patients. Heart disease and hemiplegia have many similar risk factors.
  • High blood lipids and cholesterol: Excessive cholesterol and triglyceride levels cause hardening and thickening of the arteries by plaque buildup. Plaque is a deposit of calcium, cholesterol, and fatty substances. When plaque accumulates inside the artery walls, it reduces or cuts off blood flow to the brain, resulting in damage to a part of the brain.

The risk factors that one can’t change include:

  • Genetics or heredity: Individuals in a family with a history of hemiplegia and stroke are at a higher risk.
  • Gender: Men are more susceptible than women; however, more women than men die from the condition.
  • Older age: For every ten years after age 55, one’s risk of hemiplegia doubles.

Hemiplegia complications

Hemiplegics may face additional complications beyond the basic symptoms of hemiplegia. These secondary effects of hemiplegia can include:

  • Problems with bladder or bowel control;
  • Unexplained pain on their paralyzed side;
  • Development of sores on their bodies;
  • Poor blood circulation from inactivity;
  • Depression and mood swings;
  • Septic infections from untreated sores; and
  • Muscular atrophy.

Diagnosis of Hemiplegia

Evaluation of hemiplegia and hemiparesis involves a physical exam. Your healthcare provider will test your reflexes and muscle strength using a rubber reflex hammer. They may also press on your limbs while you do your best to resist their efforts.

In addition, your doctor may order the following imaging tests and diagnostic procedures:

  • X-ray
  • Computed tomography (CT scan), X-ray images that are converted to a 3D image
  • Magnetic resonance imaging (MRI), magnetic fields and radio waves that produce a 3D image
  • Myelography, contrast dye and X-Ray or CT scan to view the spinal canal
  • Electromyography (EMG), a small needle electrode that measures muscle activity
  • Nerve conduction study (NCS), which measures the speed of electrical signals traveling through your nerves
  • Complete blood count (CBC), a blood test that checks the levels of blood cells and platelets

Weakness or loss of function in your limbs always requires immediate attention. If you experience muscle weakness or paralysis, seek medical attention right away.

Treatment

At this time, there is no cure for hemiplegia and victims may often be impaired permanently. Therefore, recovery plans typically focus on assisting the individual in regaining their independence, mobility, and confidence to improve their quality of life. Treatment options for hemiplegia are dependent on the extent of the damage and the location of the injury.

Physiotherapy: Victims with hemiplegia may undergo physiotherapy to regain mobility and balance, learn to walk, strengthen their muscles, and improve coordination.

Occupational therapy: With occupational therapy, hemiplegia victims are able to learn to adjust to the function of their injury and retrain to perform daily, everyday tasks.

Modified constraint-induced movement therapy (mCIMT): This type of physical therapy involves restraining the side of the body that has not been paralyzed in order to allow the injured side to compensate and improve function, strength, and mobility. Research has shown that mCIMT has a positive impact on individuals with upper body hemiplegia.

Assistive devices: Many individuals with hemiplegia may need to rely on equipment and assistive devices to promote walking, muscle function, and balance. Assistive devices may include a cane, brace, wheelchair, or walker.

Electrical stimulation: In some cases, particularly those where the hemiplegia is caused by a brain injury, a specialist may utilize electrical stimulation to contract and stimulate the muscles that the body is otherwise unable to control.

Medication

Flunarizine can help reduce the frequency, severity, and duration of attacks of paralysis and muscle stiffness. While it is not FDA approved or marketed in the U.S., we are able to offer it through a special permissions process. Other medications given during an attack induce sleep, which often relieves symptoms. And children who also have epilepsy may need medication to manage seizures.

Vagus Nerve Stimulation

People with AHC are prone to epilepsy, and seizures may be difficult to control. An implanted device called a vagus nerve stimulator (VNS) provides electrical stimulation along the vagus nerve, which can often be helpful in drug-resistant epilepsy.

Ketogenic Diet

Studies have shown that a diet of very low carbohydrates and high amounts of fat can reduce seizures in children with epilepsy.

Surgical Interventions

Surgical interventions are those procedures where a hemiplegic is operated on to address a critical issue. These are frequently performed for hemiplegics who have suffered a major injury to their brain or spinal cord that caused their hemiplegia and need surgery to prevent further damage.

Remove Swelling or Objects Lodged in the Brain

Surgery is often performed on people with traumatic brain injuries to reduce swelling from blood collection (hematomas) in the brain or to remove foreign objects lodged in the skull cavity. This can help alleviate pressure on the parts of the brain controlling motor function—which can help reduce symptoms for some hemiplegics.

Removing foreign objects, in particular, can be critical for preventing infections that can cause further damage to the brain.

Addressing Secondary Issues Such as Spinal Damage, Muscle Contractions, or Ligament Damage

Surgeons may operate on a hemiplegic patient to address secondary concerns with the patient’s health, such as damage to the spine (like a herniated disc), abnormal muscle contractions, and damage to the ligaments or tendons of the body.

Surgery to address these issues is particularly common for cases where the hemiplegia was caused by a catastrophic injury and may require months of recovery time.

Rehabilitation and exercise to treat hemiplegia

When hemiplegia isn’t temporary, healthcare providers often recommend rehabilitation in addition to other treatments. Rehabilitation can take place in a hospital (inpatient rehabilitation), clinic or office (outpatient rehabilitation), or at home. Rehabilitation generally includes:

  • Physical therapy: Focused on leg function, standing, walking and balance.
  • Occupational therapy: Focused on arm/hand function and other activities of daily life.
  • Prescription of equipment, to enhance safety and the ability to function inside and outside of your home.
  • Managing symptoms associated with hemiplegia, such as spasticity and depression.
  • Guidance and resources to address the consequences of hemiplegia, for example, returning to work or applying for disability benefits.

There’s ample evidence that exercise helps optimize health and the ability to function after hemiplegia. Exercising may be more challenging with hemiplegia. This is why rehabilitation therapists usually develop exercise programs adapted to a person’s needs and abilities.

Hemiplegia Simulation Suit

Prevention of Hemiplegia

It is not always possible to prevent hemiplegia from developing, but a person can take some measures to reduce their risk.

People can help avoid blunt force trauma to the head by:

  • Wearing a helmet at construction sites, while riding a bike, or when on a motorcycle
  • Wearing appropriate safety equipment on work sites and when playing contact sports
  • Wearing seatbelts in automobiles

To help prevent stroke, a person can make lifestyle changes to benefit the heart. This can include:

  • Achieving and maintaining a moderate weight
  • Eating a diet rich in nutrients and fiber
  • Taking regular exercise

Further measures include:

  • Quitting smoking, if necessary
  • Avoiding excessive alcohol
  • Managing diabetes, blood pressure, and cholesterol levels
  • Getting regular check-ups for cholesterol and blood pressure
  • Taking heart medication as prescribed
  • Following recommendations for treating any underlying heart disease

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