Hemiparesis

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Not to be confused with Spastic hemiplegia. Hemiparesis_sentence_0

Hemiparesis_table_infobox_0

HemiparesisHemiparesis_header_cell_0_0_0
SpecialtyHemiparesis_header_cell_0_1_0 NeurologyHemiparesis_cell_0_1_1
SymptomsHemiparesis_header_cell_0_2_0 Loss of motor skills on one side of bodyHemiparesis_cell_0_2_1
CausesHemiparesis_header_cell_0_3_0 StrokeHemiparesis_cell_0_3_1

Hemiparesis, or unilateral paresis, is weakness of one entire side of the body ( means "half"). Hemiparesis_sentence_1

Hemiplegia is, in its most severe form, complete paralysis of half of the body. Hemiparesis_sentence_2

Hemiparesis and hemiplegia can be caused by different medical conditions, including congenital causes, trauma, tumors, or stroke. Hemiparesis_sentence_3

Signs and symptoms Hemiparesis_section_0

Depending on the type of hemiparesis diagnosed, different bodily functions can be affected. Hemiparesis_sentence_4

Some effects are expected (e.g., partial paralysis of a limb on the affected side). Hemiparesis_sentence_5

Other impairments, though, can at first seem completely non-related to the limb weakness but are, in fact, a direct result of the damage to the affected side of the brain. Hemiparesis_sentence_6

Loss of motor skills Hemiparesis_section_1

People with hemiparesis often have difficulties maintaining their balance due to limb weaknesses leading to an inability to properly shift body weight. Hemiparesis_sentence_7

This makes performing everyday activities such as dressing, eating, grabbing objects, or using the bathroom more difficult. Hemiparesis_sentence_8

Hemiparesis with origin in the lower section of the brain creates a condition known as ataxia, a loss of both gross and fine motor skills, often manifesting as staggering and stumbling. Hemiparesis_sentence_9

Pure Motor Hemiparesis, a form of hemiparesis characterized by sided weakness in the leg, arm, and face, is the most commonly diagnosed form of hemiparesis. Hemiparesis_sentence_10

Pusher syndrome Hemiparesis_section_2

Main article: Pusher syndrome Hemiparesis_sentence_11

Pusher syndrome is a clinical disorder following left or right brain damage in which patients actively push their weight away from the nonhemiparetic side to the hemiparetic side. Hemiparesis_sentence_12

In contrast to most stroke patients, who typically prefer more weight-bearing on their nonhemiparetic side, this abnormal condition can vary in severity and leads to a loss of postural balance. Hemiparesis_sentence_13

The lesion involved in this syndrome is thought to be in the posterior thalamus on either side, or multiple areas of the right cerebral hemisphere. Hemiparesis_sentence_14

With a diagnosis of pusher behaviour, three important variables should be seen, the most obvious of which is spontaneous body posture of a longitudinal tilt of the torso toward the paretic side of the body occurring on a regular basis and not only on occasion. Hemiparesis_sentence_15

The use of the nonparetic extremities to create the pathological lateral tilt of the body axis is another sign to be noted when diagnosing for pusher behaviour. Hemiparesis_sentence_16

This includes abduction and extension of the extremities of the non-affected side, to help in the push toward the affected (paretic) side. Hemiparesis_sentence_17

The third variable that is seen is that attempts of the therapist to correct the pusher posture by aiming to realign them to upright posture are resisted by the patient. Hemiparesis_sentence_18

In patients with acute stroke and hemiparesis, the disorder is present in 10.4% of patients. Hemiparesis_sentence_19

Rehabilitation may take longer in patients that display pusher behaviour. Hemiparesis_sentence_20

The Copenhagen Stroke Study found that patients that presented with ipsilateral pushing used 3.6 weeks more to reach the same functional outcome level on the Barthel Index, than did patients without ipsilateral pushing. Hemiparesis_sentence_21

Pushing behavior has shown that perception of body posture in relation to gravity is altered. Hemiparesis_sentence_22

Patients experience their body as oriented "upright" when the body is actually tilted to the side of the brain lesion. Hemiparesis_sentence_23

In addition, patients seem to show no disturbed processing of visual and vestibular inputs when determining subjective visual vertical. Hemiparesis_sentence_24

In sitting, the push presents as a strong lateral lean toward the affected side and in standing, creates a highly unstable situation as the patient is unable to support their body weight on the weakened lower extremity. Hemiparesis_sentence_25

The increased risk of falls must be addressed with therapy to correct their altered perception of vertical. Hemiparesis_sentence_26

Pusher syndrome is sometimes confused with and used interchangeably as the term hemispatial neglect, and some previous theories suggest that neglect leads to pusher syndrome. Hemiparesis_sentence_27

However, another study had observed that pusher syndrome is also present in patients with left hemisphere lesions, leading to aphasia, providing a stark contrast to what was previously believed regarding hemispatial neglect, which mostly occurs with a right hemisphere lesion. Hemiparesis_sentence_28

Karnath summarizes these two conflicting views, as they conclude that both neglect and aphasia are highly correlated with pusher syndrome possibly due to the close proximity of relevant brain structures associated with these two respective syndromes. Hemiparesis_sentence_29

However, the article goes on to state that it is imperative to note that both neglect and aphasia are not the underlying causes of pusher syndrome. Hemiparesis_sentence_30

Physical therapists focus on motor learning strategies when treating these patients. Hemiparesis_sentence_31

Verbal cues, consistent feedback, practicing correct orientation and weight shifting are all effective strategies used to reduce the effects of this disorder. Hemiparesis_sentence_32

Having a patient sit with their stronger side next to a wall and instructing them to lean towards the wall is an example of a possible treatment for pusher behaviour. Hemiparesis_sentence_33

A new physical therapy approach for patients with pusher syndrome suggests that the visual control of vertical upright orientation, which is undisturbed in these patients, is the central element of intervention in treatment. Hemiparesis_sentence_34

In sequential order, treatment is designed for patients to realize their altered perception of vertical, use visual aids for feedback about body orientation, learn the movements necessary to reach proper vertical position, and maintain vertical body position while performing other activities. Hemiparesis_sentence_35

Classification of pusher syndrome Hemiparesis_section_3

Individuals who present with pusher syndrome or lateropulsion, as defined by Davies, vary in their degree and severity of this condition and therefore appropriate measures need to be implemented in order to evaluate the level of "pushing". Hemiparesis_sentence_36

There has been a shift towards early diagnosis and evaluation of functional status for individuals who have suffered from a stroke and presenting with pusher syndrome in order to decrease the time spent as an in-patient at hospitals and promote the return to function as early as possible. Hemiparesis_sentence_37

Moreover, in order to assist therapists in the classification of pusher syndrome, specific scales have been developed with validity that coincides with the criteria set out by Davies’ definition of "pusher syndrome". Hemiparesis_sentence_38

In a study by Babyar et al., an examination of such scales helped determine the relevance, practical aspects and clinimetric properties of three specific scales existing today for lateropulsion. Hemiparesis_sentence_39

The three scales examined were the Clinical Scale of Contraversive Pushing, Modified Scale of Contraversive Pushing, and the Burke Lateropulsion Scale. Hemiparesis_sentence_40

The results of the study show that reliability for each scale is good; moreover, the Scale of Contraversive Pushing was determined to have acceptable clinimetric properties, and the other two scales addressed more functional positions that will help therapists with clinical decisions and research. Hemiparesis_sentence_41

Causes Hemiparesis_section_4

The most common cause of hemiparesis and hemiplegia is stroke. Hemiparesis_sentence_42

Strokes can cause a variety of movement disorders, depending on the location and severity of the lesion. Hemiparesis_sentence_43

Hemiplegia is common when the stroke affects the corticospinal tract. Hemiparesis_sentence_44

Other causes of hemiplegia include spinal cord injury, specifically Brown-Séquard syndrome, traumatic brain injury, or disease affecting the brain. Hemiparesis_sentence_45

A permanent brain injury that occurs during the intrauterine life, during delivery or early in life can lead to hemiplegic cerebral palsy. Hemiparesis_sentence_46

As a lesion that results in hemiplegia occurs in the brain or spinal cord, hemiplegic muscles display features of the upper motor neuron syndrome. Hemiparesis_sentence_47

Features other than weakness include decreased movement control, clonus (a series of involuntary rapid muscle contractions), spasticity, exaggerated deep tendon reflexes and decreased endurance. Hemiparesis_sentence_48

The incidence of hemiplegia is much higher in premature babies than term babies. Hemiparesis_sentence_49

There is also a high incidence of hemiplegia during pregnancy and experts believe that this may be related to either a traumatic delivery, use of forceps or some event which causes brain injury. Hemiparesis_sentence_50

There is tentative evidence of an association with undiagnosed celiac disease and improvement after withdrawal of gluten from the diet. Hemiparesis_sentence_51

Other causes of hemiplegia in adults include trauma, bleeding, brain infections and cancers. Hemiparesis_sentence_52

Individuals who have uncontrolled diabetes, hypertension or those who smoke have a higher chance of developing a stroke. Hemiparesis_sentence_53

Weakness on one side of the face may occur and may be due to a viral infection, stroke or a cancer. Hemiparesis_sentence_54

Common Hemiparesis_section_5

Hemiparesis_unordered_list_0

Mechanism Hemiparesis_section_6

Movement of the body is primarily controlled by the pyramidal (or corticospinal) tract, a pathway of neurons that begins in the motor areas of the brain, projects down through the internal capsule, continues through the brainstem, decussates (or cross midline) at the lower medulla, then travels down the spinal cord into the motor neurons that control each muscle. Hemiparesis_sentence_55

In addition to this main pathway, there are smaller contributing pathways (including the anterior corticospinal tract), some portions of which do not cross the midline. Hemiparesis_sentence_56

Because of this anatomy, injuries to the pyramidal tract above the medulla generally cause contralateral hemiparesis (weakness on the opposite side as the injury). Hemiparesis_sentence_57

Injuries at the lower medulla, spinal cord, and peripheral nerves result in ipsilateral hemiparesis. Hemiparesis_sentence_58

In a few cases, lesions above the medulla have resulted in ipsilateral hemiparesis: Hemiparesis_sentence_59

Hemiparesis_unordered_list_1

  • In several reported cases, patients with hemiparesis from an old contralateral brain injury subsequently experienced worsening of their hemiparesis when hit with a second stroke in the ipsilateral brain. The authors hypothesize that brain reorganization after the initial injury led to more reliance on uncrossed motor pathways, and when these compensatory pathways were damaged by a second stroke, motor function worsened further.Hemiparesis_item_1_10
  • A case report describes a patient with a congenitally uncrossed pyramidal tract, who developed right-sided hemiparesis after a hemorrhage in the right brain.Hemiparesis_item_1_11

Diagnosis Hemiparesis_section_7

Hemiplegia is identified by clinical examination by a health professional, such as a physiotherapist or doctor. Hemiparesis_sentence_60

Radiological studies like a CT scan or magnetic resonance imaging of the brain should be used to confirm injury in the brain and spinal cord, but alone cannot be used to identify movement disorders. Hemiparesis_sentence_61

Individuals who develop seizures may undergo tests to determine where the focus of excess electrical activity is. Hemiparesis_sentence_62

Hemiplegia patients usually show a characteristic gait. Hemiparesis_sentence_63

The leg on the affected side is extended and internally rotated and is swung in a wide, lateral arc rather than lifted in order to move it forward. Hemiparesis_sentence_64

The upper limb on the same side is also adducted at the shoulder, flexed at the elbow, and pronated at the wrist with the thumb tucked into the palm and the fingers curled around it. Hemiparesis_sentence_65

Assessment tools Hemiparesis_section_8

There are a variety of standardized assessment scales available to physiotherapists and other health care professionals for use in the ongoing evaluation of the status of a patient’s hemiplegia. Hemiparesis_sentence_66

The use of standardized assessment scales may help physiotherapists and other health care professionals during the course of their treatment plant to: Hemiparesis_sentence_67

Hemiparesis_unordered_list_2

  • Prioritize treatment interventions based on specific identifiable motor and sensory deficitsHemiparesis_item_2_12
  • Create appropriate short- and long-term goals for treatment based on the outcome of the scales, their professional expertise and the desires of the patientHemiparesis_item_2_13
  • Evaluate the potential burden of care and monitor any changes based on either improving or declining scoresHemiparesis_item_2_14

Some of the most commonly used scales in the assessment of hemiplegia are: Hemiparesis_sentence_68

Hemiparesis_unordered_list_3

The FMA is often used as a measure of functional or physical impairment following a cerebrovascular accident (CVA). Hemiparesis_sentence_69

It measures sensory and motor impairment of the upper and lower extremities, balance in several positions, range of motion, and pain. Hemiparesis_sentence_70

This test is a reliable and valid measure in measuring post-stroke impairments related to stroke recovery. Hemiparesis_sentence_71

A lower score in each component of the test indicates higher impairment and a lower functional level for that area. Hemiparesis_sentence_72

The maximum score for each component is 66 for the upper extremities, 34 for the lower extremities, and 14 for balance. Hemiparesis_sentence_73

Administration of the FMA should be done after reviewing a training manual. Hemiparesis_sentence_74

Hemiparesis_unordered_list_4

This test is a reliable measure of two separate components evaluating both motor impairment and disability. Hemiparesis_sentence_75

The disability component assesses any changes in physical function including gross motor function and walking ability. Hemiparesis_sentence_76

The disability inventory can have a maximum score of 100 with 70 from the gross motor index and 30 from the walking index. Hemiparesis_sentence_77

Each task in this inventory has a maximum score of seven except for the 2 minute walk test which is out of two. Hemiparesis_sentence_78

The impairment component of the test evaluates the upper and lower extremities, postural control and pain. Hemiparesis_sentence_79

The impairment inventory focuses on the seven stages of recovery from stroke from flaccid paralysis to normal motor functioning. Hemiparesis_sentence_80

A training workshop is recommended if the measure is being utilized for the purpose of data collection. Hemiparesis_sentence_81

Hemiparesis_unordered_list_5

The STREAM consists of 30 test items involving upper-limb movements, lower-limb movements, and basic mobility items. Hemiparesis_sentence_82

It is a clinical measure of voluntary movements and general mobility (rolling, bridging, sit-to-stand, standing, stepping, walking and stairs) following a stroke. Hemiparesis_sentence_83

The voluntary movement part of the assessment is measured using a 3-point ordinal scale (unable to perform, partial performance, and complete performance) and the mobility part of the assessment uses a 4-point ordinal scale (unable, partial, complete with aid, complete no aid). Hemiparesis_sentence_84

The maximum score one can receive on the STREAM is a 70 (20 for each limb score and 30 for mobility score). Hemiparesis_sentence_85

The higher the score, the better movement and mobility is available for the individual being scored. Hemiparesis_sentence_86

Treatment Hemiparesis_section_9

Treatment for hemiparesis is the same treatment given to those recovering from strokes or brain injuries. Hemiparesis_sentence_87

Health care professionals such as physical therapists and occupational therapists play a large role in assisting these patients in their recovery. Hemiparesis_sentence_88

Treatment is focused on improving sensation and motor abilities, allowing the patient to better manage their activities of daily living. Hemiparesis_sentence_89

Some strategies used for treatment include promoting the use of the hemiparetic limb during functional tasks, maintaining range of motion, and using neuromuscular electrical stimulation to decrease spasticity and increase awareness of the limb. Hemiparesis_sentence_90

At the more advanced level, using constraint-induced movement therapy will encourage overall function and use of the affected limb. Hemiparesis_sentence_91

Mirror Therapy (MT) has also been used early in stroke rehabilitation and involves using the unaffected limb to stimulate motor function of the hemiparetic limb. Hemiparesis_sentence_92

Results from a study on patients with severe hemiparesis concluded that MT was successful in improving motor and sensory function of the distal hemiparetic upper limb. Hemiparesis_sentence_93

Active participation is critical to the motor learning and recovery process, therefore it’s important to keep these individuals motivated so they can make continual improvements. Hemiparesis_sentence_94

Also speech pathologists work to increase function for people with hemiparesis. Hemiparesis_sentence_95

Treatment should be based on assessment by the relevant health professionals, including physiotherapists, doctors and occupational therapists. Hemiparesis_sentence_96

Muscles with severe motor impairment including weakness need these therapists to assist them with specific exercise, and are likely to require help to do this. Hemiparesis_sentence_97

Medication Hemiparesis_section_10

Drugs can be used to treat issues related to the Upper Motor Neuron Syndrome. Hemiparesis_sentence_98

Drugs like Librium or Valium could be used as a relaxant. Hemiparesis_sentence_99

Drugs are also given to individuals who have recurrent seizures, which may be a separate but related problem after brain injury. Hemiparesis_sentence_100

Intra-muscular injection of Botulinum toxin A is used to treat spasticity that is associated with hemiparesis both in cerebral palsy children and stroke in adults. Hemiparesis_sentence_101

It can be injected into a muscle or more commonly muscle groups of the upper or lower extremities. Hemiparesis_sentence_102

Botulinum toxin A induces temporary muscle paralysis or relaxation. Hemiparesis_sentence_103

The main goal of Botulinum toxin A is to maintain the range of motion of affected joints and to prevent the occurrence of fixed joint contractures or stiffness. Hemiparesis_sentence_104

Surgery Hemiparesis_section_11

Surgery may be used if the individual develops a secondary issue of contracture, from a severe imbalance of muscle activity. Hemiparesis_sentence_105

In such cases the surgeon may cut the ligaments and relieve joint contractures. Hemiparesis_sentence_106

Individuals who are unable to swallow may have a tube inserted into the stomach. Hemiparesis_sentence_107

This allows food to be given directly into the stomach. Hemiparesis_sentence_108

The food is in liquid form and instilled at low rates. Hemiparesis_sentence_109

Some individuals with hemiplegia will benefit from some type of prosthetic device. Hemiparesis_sentence_110

There are many types of braces and splints available to stabilize a joint, assist with walking and keep the upper body erect. Hemiparesis_sentence_111

Rehabilitation Hemiparesis_section_12

Rehabilitation is the main treatment of individuals with hemiplegia. Hemiparesis_sentence_112

In all cases, the major aim of rehabilitation is to regain maximum function and quality of life. Hemiparesis_sentence_113

Both physical and occupational therapy can significantly improve the quality of life. Hemiparesis_sentence_114

Physical therapy Hemiparesis_section_13

Physical therapy (PT) can help improve muscle strength & coordination, mobility (such as standing and walking), and other physical function using different sensorimotor techniques. Hemiparesis_sentence_115

Physiotherapists can also help reduce shoulder pain by maintaining shoulder range of motion, as well as using Functional electrical stimulation. Hemiparesis_sentence_116

Supportive devices, such as braces or slings, can be used to help prevent or treat shoulder subluxation in the hopes to minimize disability and pain. Hemiparesis_sentence_117

Although many individuals suffering from stroke experience both shoulder pain and shoulder subluxation, the two are mutually exclusive. Hemiparesis_sentence_118

A treatment method that can be implemented with the goal of helping to regain motor function in the affected limb is constraint-induced movement therapy. Hemiparesis_sentence_119

This consists of constraining the unaffected limb, forcing the affected limb to accomplish tasks of daily living. Hemiparesis_sentence_120

Occupational therapy Hemiparesis_section_14

Occupational therapists may specifically help with hemiplegia with tasks such as improving hand function, strengthening hand, shoulder and torso, and participating in activities of daily living (ADLs), such as eating and dressing. Hemiparesis_sentence_121

Therapists may also recommend a hand splint for active use or for stretching at night. Hemiparesis_sentence_122

Some therapists actually make the splint; others may measure your child’s hand and order a splint. Hemiparesis_sentence_123

OTs educate patients and family on compensatory techniques to continue participating in daily living, fostering independence for the individual - which may include, environmental modification, use of adaptive equipment, sensory integration, etc. Hemiparesis_sentence_124

Orthotic Intervention Hemiparesis_section_15

Orthotic devices are one type of intervention for relieving symptoms of hemiparesis. Hemiparesis_sentence_125

Commonly called braces, orthotics range from 'off the shelf' to custom fabricated solutions, but their main goal is alike, to supplement diminished or missing muscle function and joint laxity. Hemiparesis_sentence_126

A wide range of orthotic treatment can be designed by a Certified Orthotist (C.O.) Hemiparesis_sentence_127

or Certified Prosthetist Orthotist (C.P.O). Hemiparesis_sentence_128

Orthotics may be made of metal, plastic, or composite material (such as fiberglass, dyneema (HMWPE,) carbon fiber; etc) and design may be changed to address many different conditions. Hemiparesis_sentence_129

and range from the level of ankle to the hip depending on the level of intervention, support, or control needed., Hemiparesis_sentence_130

Prognosis Hemiparesis_section_16

Hemiplegia is not a progressive disorder, except in progressive conditions like a growing brain tumour. Hemiparesis_sentence_131

Once the injury has occurred, the symptoms should not worsen. Hemiparesis_sentence_132

However, because of lack of mobility, other complications can occur. Hemiparesis_sentence_133

Complications may include muscle and joint stiffness, loss of aerobic fitness, muscle spasms, bed sores, pressure ulcers and blood clots. Hemiparesis_sentence_134

Sudden recovery from hemiplegia is very rare. Hemiparesis_sentence_135

Many of the individuals will have limited recovery, but the majority will improve from intensive, specialised rehabilitation. Hemiparesis_sentence_136

Potential to progress may differ in cerebral palsy, compared to adult acquired brain injury. Hemiparesis_sentence_137

It is vital to integrate the hemiplegic child into society and encourage them in their daily living activities. Hemiparesis_sentence_138

With time, some individuals may make remarkable progress. Hemiparesis_sentence_139

Popular culture Hemiparesis_section_17

Hemiparesis_unordered_list_6

  • In Barbara Kingsolver's novel, The Poisonwood Bible, the character Adah is incorrectly diagnosed, in childhood, as having hemiplegia.Hemiparesis_item_6_18
  • Rock band HAERTS released an EP called Hemiplegia via Columbia Records in 2013.Hemiparesis_item_6_19
  • In the 1994 Jodie Foster film Nell, the title character portrayed by Foster has developed her own language (idioglossia), developed in part due to the distinct speech patterns of her mother, caused by her hemiplegia due to a stroke.Hemiparesis_item_6_20
  • In the anime series Mobile Suit Gundam: Iron-Blooded Orphans, the protagonist Mikazuki Augus is paralyzed in the entire right half of his body after a fierce battle with the Mobile Armor Hashmal. In order to defeat the Mobile Armor, he was forced to deactivate the safety limiter on his Gundam's neural interface and overloading the connection between him and the Mobile Suit for the necessary power.Hemiparesis_item_6_21

See also Hemiparesis_section_18

Hemiparesis_unordered_list_7


Credits to the contents of this page go to the authors of the corresponding Wikipedia page: en.wikipedia.org/wiki/Hemiparesis.