Hemiplegia: Symptoms, Causes and Physiotherapy Management

Paralysis of one side of the body due to Pyramidal Tract lesion at any point from its origin in the cerebral cortex down to the fifth Cervical segment ( beginning of origin of cervical plexus ).

Hemiplegia

Etiology

• Vascular: Cerebral hemorrhage, Stroke, Diabetic Neuropathy.
• Infective: Encephalitis , Meningitis , Brain abscess.
• Neoplastic: Glioma - Meningioma
• Demylination: Disseminated sclerosis, lesions to the Internal capsule.
• Traumatic: Cerebral lacerations, Subdural Hematoma.
• Rare cause of hemiplegia is due to local anaesthsia injections given intra arterially rapidly, instead of given in a nerve branch.
• Congenital: Cerebral palsy
• Disseminated: Multiple Sclerosis
• Psychological: Parasomnia (Nocturnal hemiplegia ).

Hemiplegia symptoms

Hemiplegia can affect either the left or right side of your body. Whichever side of your brain is affected causes symptoms on the opposite side of your body.

People can have different symptoms from hemiplegia depending on its severity. Symptoms can include:

• Muscle weakness or stiffness on one side
• Muscle spasticity or permanently contracted muscle
• Poor fine motor skills
• Trouble walking
• Poor balance
• Trouble grabbing objects

Children with hemiplegia may also take longer to reach developmental milestones than their peers. They may also use only one hand when playing or keep one hand in a fist.

If hemiplegia is caused by a brain injury, the brain damage can cause symptoms that aren’t specific to hemiplegia, such as:

• Memory problems
• Trouble concentrating
• Speech issues
• Behavior changes
• Seizures

Mechanism

Damage to the CorticospinalTract leads to the injury on the opposite side of the body. This happens because the motor fibres of the Corticospinal Tract, which take origin from the motor cortex in brain, cross to the oppoSite side in the lower part of medulla oblongata and then descend down in spinal cord to supply their respective muscles.

Depending on the Site of lesion in brain, the severity of hemiplegia varies.

Medical diagnosis

History and examination

An accurate history profiling the timing of neurological events is obtained from the patient or from family members in the case of the unconscious or noncommunicative patient.

Of particular importance are the exact time and pattern of symptom occurs . The most common, slowest in hours, wakes up in the morning with weakness, history of TIA, old age is typical with thrombosis.

An embolus occurs rapidly with no warning, history of heart disease, younger age group, no progression (maximum deficit occurs at onset). An abrupt onset with worsening symptoms , history of prolonged hypertension, severe headache described as "worst headache of my life ", altered consciousness, convulsions, vomiting is suggestive of haemorrhage.

The patient 's past history, including episodes of TIAs or head trauma, presence of major or minor risk factors and medications, pertinent family history and recent alterations in patient function ( either transient or permanent ) are thoroughly investigated.

The physical examination of the patient includes an investigation of vital signs ( heart rate, respiratory rate, blood pressure, clubbing ), signs of cardiac decompensation, and function of the cerebral hemispheres, cerebellum, cranial nerves, eyes and sensorimotor system.

Diagnosis

Cerebrospinal imaging

CerebroVascular imaging is the main tool to establish the diagnosis of suspected hemiplegia. Advanced neuroimaging can rapidly indentify the occluded artery and estimate the size of the core and the penumbra.

Computer tomography and MRI scans

For acute care of stroke patients, a number of computed tomography (CT) and magnetic resonance (MR) techniques are essential.

Noncontrast CT excludes other causes of acute neurologic defi cits and intracranial hemorrhage. CT and MR angiography can identify intraVascular clots, and the CT angiography source images improve detection of acute infarction over plain CT. Diffusion MRI estimates the size, location, and age of infarcted core more precisely, and perfusion imaging estimates the ischemic penumbra.

CT and MR imaging techniques are used to provide four types of information that are essential to the care of acute stroke patients.

• They establish the diagnosis of ischemic stroke and exclude other potential causes of an acute neurologic defi cit.
• They identify intracranial hemorrhage.
• They identify the Vascular lesion responsible for the ischemic event.
• They provide additional characterization of brain tissue that may guide stroke therapy by determining the viability of different regions of the brain and distinguishing between irreversibly infarcted tissue and potentially salvageable tissue.

When a stroke has been diagnosed, determining the underlying aetiology is important with regard to secondary stroke prevention. Common techniques include:

• Ultrasound of the carotid arteries to determine carotid stenosis
• Electrocardiogram (ECG) to detect arrhythmias of the heart which may send clots in the heart to the blood vessels of the brain
• Holter monitor to identify intermittent arrhythmias
• Angiogram of the blood vessels of the brain to detect possible aneurysms or arteriovenous malformations and
• Blood test to examine the presence of hypercholesterolemia (high cholesterol).

Types of hemiplegia

The following are movement disorders that can cause hemiplegia symptoms.

Facial hemiplegia

People with facial hemiplegia experience paralyzed muscles on one side of their face. Facial hemiplegia may also be coupled with a slight hemiplegia elsewhere in the body.

Spinal hemiplegia

Spinal hemiplegia is also referred to as Brown-Sequard syndrome. It involves damage on one side of the spinal cord that results in paralysis on the same side of the body as the injury. It also causes loss of pain and temperature sensation on the opposite side of the body.

Contralateral hemiplegia

This refers to paralysis on the opposite side of the body that brain damage occurs in.

Spastic hemiplegia

This is a type of cerebral palsy that predominately affects one side of the body. The muscles on the affected side are constantly contracted or spastic.

Alternating hemiplegia of childhood

Alternating hemiplegia of childhood usually affects children younger than 18 months old. It causes recurring episodes of hemiplegia that affect one or both sides of the body.

Hemiplegia treatment

Treatment options for hemiplegia depend on the cause of the hemiplegia and the severity of symptoms. People with hemiplegia often undergo multidisciplinary rehab involving physical therapists, rehabilitation therapists, and mental health professionals.

Physiotherapy

Working with a physiotherapist allows people with hemiplegia to develop their balance ability, build strength, and coordinate movement. A physiotherapist can also help stretch out tight and spastic muscles.

Modified constraint-induced movement therapy (mCIMT)

Modified constraint-induced movement therapy involves restraining the side of your body unaffected by hemiplegia. This treatment option forces your weaker side to compensate and aims to improve your muscle control and mobility.

One small studyTrusted Source published in 2018 concluded that including mCIMT in stroke rehabilitation may be more effective than traditional therapies alone.

Assistive devices

Some physical therapists may recommend the use of a brace, cane, wheelchair, or walker. Using an assistive device may help improve muscular control and mobility.

It’s a good idea to consult a healthcare professional to find which device is best for you. They may also recommend modifications you can make to your home such as raised toilet seats, ramps, and grab bars.

Mental imagery

Imagining moving the paralyzed half of your body may help activate the parts of the brain responsible for movement. Mental imagery is often paired with other therapies and is rarely used by itself.

One meta-analysis looking at the results of 23 studies found that mental imagery may be an effective treatment option for regaining strength when combined with physical therapy.

Electrical stimulation

A medical professional can help stimulate muscular movement by using electrical pads. The electricity allows muscles that you can’t move consciously to contract. Electrical stimulation aims to reduce imbalances in the affected side of the brain and improve brain plasticityTrusted Source.