Monoplegia

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Not to be confused with Spastic monoplegia. Monoplegia_sentence_0

Monoplegia_table_infobox_0

MonoplegiaMonoplegia_header_cell_0_0_0
SpecialtyMonoplegia_header_cell_0_1_0 Neurology Q6901840?uselang=en#P1995Monoplegia_cell_0_1_1

Monoplegia is paralysis of a single limb, usually an arm. Monoplegia_sentence_1

Common symptoms associated with monoplegic patients are weakness, numbness, and pain in the affected limb. Monoplegia_sentence_2

Monoplegia is a type of paralysis that falls under hemiplegia. Monoplegia_sentence_3

While hemiplegia is paralysis of half of the body, monoplegia is localized to a single limb or to a specific region of the body. Monoplegia_sentence_4

Monoplegia of the upper limb is sometimes referred to as brachial monoplegia, and that of the lower limb is called crural monoplegia. Monoplegia_sentence_5

Monoplegia in the lower extremities is not as common of an occurrence as in the upper extremities. Monoplegia_sentence_6

Monoparesis is a similar, but less severe, condition because one limb is very weak, not paralyzed. Monoplegia_sentence_7

For more information, see paresis. Monoplegia_sentence_8

Many conditions that cause paraplegia or quadriplegia begin as monoplegia. Monoplegia_sentence_9

Thus, the diagnosis of spinal paraplegia must also be consulted. Monoplegia_sentence_10

In addition, multiple cerebral disorders that cause hemiplegia may begin as monoplegia. Monoplegia_sentence_11

Monoplegia is also frequently associated with, and considered to be the mildest form of, cerebral palsy. Monoplegia_sentence_12

Signs and symptoms Monoplegia_section_0

There are a number of symptoms associated with monoplegia. Monoplegia_sentence_13

Curling of the hands or stiffness of the feet, weakness, spasticity, numbness, paralysis, pain in the affected limb, headaches, and shoulder pain are all considered to be symptoms of monoplegia. Monoplegia_sentence_14

Patients of monoplegia typically feel symptoms of weakness and loss of sensation in the affected extremity, usually an arm. Monoplegia_sentence_15

Despite these symptoms, the extremity with paralysis continues to maintain a strong pulse. Monoplegia_sentence_16

While chronic progressive brachial monoplegia is uncommon, syringomyelia and tumors of the cervical cord or brachial plexus may be the cause. Monoplegia_sentence_17

The onset of brachial plexus paralysis is usually explosive where pain is the initial feature. Monoplegia_sentence_18

Pain localizes to the shoulder but may be more diffuse, or could be limited to the lower arm. Monoplegia_sentence_19

Pain is severe and often described as sharp, stabbing, throbbing, or aching. Monoplegia_sentence_20

The duration of pain, which is constant, varies from a span of several hours to 3 weeks. Monoplegia_sentence_21

As the pain subsides, weakness usually appears. Monoplegia_sentence_22

In addition, chronicle progressive weakness of one leg suggests a tumor of the spinal cord of the lumbar plexus. Monoplegia_sentence_23

Fever is often the first symptom of lumbar plexus paralysis, followed by pain in one or both legs. Monoplegia_sentence_24

The pain has an abrupt onset and may occur in a femoral or sciatic distribution. Monoplegia_sentence_25

Weakness may develop concurrently with pain or be delayed for as long as 3 weeks. Monoplegia_sentence_26

Furthermore, a monomeric form of spinal muscular atrophy, affecting only one leg or arm, should be considered when progressive weakness is not accompanied by sensory loss. Monoplegia_sentence_27

Causes Monoplegia_section_1

Some potential causes of monoplegia are listed below. Monoplegia_sentence_28

Monoplegia_ordered_list_0

  1. Cerebral palsyMonoplegia_item_0_0
  2. Physical trauma to the affected limbMonoplegia_item_0_1
  3. Central nervous mass lesion, including tumor, hematoma, or abscessMonoplegia_item_0_2
  4. Complicated migraineMonoplegia_item_0_3
  5. EpilepsyMonoplegia_item_0_4
  6. Head or spinal traumaMonoplegia_item_0_5
  7. Hereditary brachial neuritisMonoplegia_item_0_6
  8. Hereditary neuropathy with liability to pressure palsyMonoplegia_item_0_7
  9. Neonatal brachial plexus paralysisMonoplegia_item_0_8
  10. NeuropathyMonoplegia_item_0_9
  11. PlexopathyMonoplegia_item_0_10
  12. Traumatic peroneal neuropathyMonoplegia_item_0_11
  13. Vaccine-associated paralytic poliomyelitisMonoplegia_item_0_12
  14. Hemiparetic seizuresMonoplegia_item_0_13
  15. Monomeric spinal muscular atrophyMonoplegia_item_0_14
  16. StrokeMonoplegia_item_0_15

Specifically, monoplegia in the lower extremities is typically caused by Brown Sequard syndrome and hematomas in the frontoparietal cortex near the middle that could produce a deficit such as this, but this is a very uncommon occurrence. Monoplegia_sentence_29

Mechanism Monoplegia_section_2

In monoplegia, the spine and the proximal portion of nerves are usually the abnormal sites of limb weakness. Monoplegia_sentence_30

Monoplegia resulting from upper extremity impairments following a stroke occurs due to direct damage to the primary motor cortex, primary somatosensory cortex, secondary sensorimotor cortex, sensorimotor cortical areas, subcortical structures, and/or the corticospinal tract. Monoplegia_sentence_31

It is often found that impairments following stroke are either caused by damage to the same or adjacent neurological structures. Monoplegia_sentence_32

A combination of these impairments is more likely than just one in isolation. Monoplegia_sentence_33

Damage to the corticospinal system results in an inability to activate muscles with enough force or in a coordinated manner, which can lead to paresis, loss of fractional movement, and abnormal muscle tone. Monoplegia_sentence_34

Damage to the somatosensory cortical areas causes loss of somatosensation which results in an impaired ability to monitor movement. Monoplegia_sentence_35

Considering monoplegia as it relates to cerebral palsy, in premature infants, the most common cause of cerebral palsy is periventricular hemorrhagic infarction. Monoplegia_sentence_36

In term infants, the underlying causes are often cerebral malformations, cerebral infarction, and intracerebral hemorrhage. Monoplegia_sentence_37

Delayed crawling or walking are the usual concerns that arise in infants with paralysis of the limb. Monoplegia_sentence_38

In these cases, abnormalities of the legs are the main focus of the attention. Monoplegia_sentence_39

Diagnosis Monoplegia_section_3

Monoplegia is diagnosed by a physician after a physical examination and sometimes after further neurologic examination as well. Monoplegia_sentence_40

As monoplegia is fairly rare, after physical examination of a patient complaining of monoplegia, sometimes weakness of an additional limb is also identified and the patient is diagnosed with hemiplegia or paraplegia instead. Monoplegia_sentence_41

After neurologic examination of the limb, a diagnosis of a monoplegic limb can be given if the patient receives a Medical Research Council power grade of 0, which is a measurement of the patient's limb strength. Monoplegia_sentence_42

Needle Electromyography is often used to study all limbs, essentially showing the extent in each limb involvement. Monoplegia_sentence_43

Furthermore, magnetic resonance imaging (MRI) is the diagnostic modality of choice for investigating all forms of hemiplegia. Monoplegia_sentence_44

It is especially informative to show migrational defects in hemiplegic cerebral palsy associated with seizures. Monoplegia_sentence_45

An approach called single-pulse transcranial magnetic stimulation (spTMS) has also been used to help diagnose motor deficits such as monoplegia. Monoplegia_sentence_46

This is done by evaluating the functional level of the corticospinal tract through stimulation of the corticospinal lesions in order to obtain neurophysiologic evidence on the integrity of the corticospinal tracts. Monoplegia_sentence_47

Single-pulse transcranial magnetic stimulation provides neuropsychological feedback such as motor-evoked potentials (MEPs) and central motor conduction time (CMCT). Monoplegia_sentence_48

This feedback can then be compared to the normal limits of patients who do not show evidence of deficits in the corticospinal tracts. Monoplegia_sentence_49

Treatment Monoplegia_section_4

There is no cure for monoplegia, but treatments typically include physical therapy and counseling to help recover muscle tone and function. Monoplegia_sentence_50

Recovery will vary depending on diagnosis of temporary, partial or complete paralysis. Monoplegia_sentence_51

Much of the therapies focus on the upper limb due to the fact that monoplegia in the upper limbs is much more common than in the lower limbs. Monoplegia_sentence_52

It has been found that intense activity-based and goal-directed therapy, such as constraint-induced movement therapy and bimanual therapy, are more effective than standard care. Monoplegia_sentence_53

Studies suggest the less affected hand could provide a template for improving motor performance of the more affected hand, and provides a strong rationale for the development of bimanual training approaches. Monoplegia_sentence_54

In addition to that, there is strong evidence to support that occupational therapy home programs that are goal-directed could be used to supplement hands-on direct therapy. Monoplegia_sentence_55

Constraint-induced movement therapy (CIMT) is specifically targeted at upper limb monoplegia as a result of a stroke. Monoplegia_sentence_56

In CIMT the unaffected arm is restrained, forcing the use and frequent practice of the affected arm. Monoplegia_sentence_57

This approach to therapy is carried out during ordinary and daily activities by the affected person. Monoplegia_sentence_58

It has been found that CIMT is more effective at specifically improving arm movement than a physiotherapy approach or no treatment at all. Monoplegia_sentence_59

This type of therapy has proved to provide an only moderate improvement in patients with monoplegia. Monoplegia_sentence_60

More research needs to be conducted in order to establish the lasting benefit of constraint-induced movement therapy. Monoplegia_sentence_61

Brain computer interface (BCI) systems have been proposed as a tool for rehabilitation of monoplegia, specifically in the upper limb after a stroke. Monoplegia_sentence_62

BCI systems provide sensory feedback in the brain via functional electrical stimulation, virtual reality environments, or robotic systems, which allows for the use of brain signals. Monoplegia_sentence_63

This is extremely crucial because the networking in the brain is often compromised after a stroke, leading to impaired movement or paralysis. Monoplegia_sentence_64

BCI systems allow for detection of intention to move through the primary motor cortex, then provide the matched sensory stimulation according to feedback that is provided. Monoplegia_sentence_65

This leads to activity-dependent plasticity within the user, requiring them to pay careful attention to tasks that require the activation or deactivation of specific brain areas. Monoplegia_sentence_66

BCI systems utilize different sources of information for feedback, including electroencephalography (EEG), magnetoencephalography, functional magnetic resonance imaging, near-infrared spectroscopy, or electrocorticography. Monoplegia_sentence_67

Among all of these, the EEG signals are the most useful for this type of rehabilitation because they are highly accurate and stable. Monoplegia_sentence_68

Another form of treatment for monoplegia is functional electrical stimulation (FES). Monoplegia_sentence_69

It is targeted at patients who acquired monoplegia through incidents such as a spinal cord injury, stroke, multiple sclerosis, or cerebral palsy and utilizes electrical stimulation in order to cause the remaining motor units in the paralyzed muscles to contract. Monoplegia_sentence_70

As in traditional muscular training, FES improves the force with which the unaffected muscles contract. Monoplegia_sentence_71

For less severely affected patients, FES allows for greater improvement in range of motion than traditional physical therapy. Monoplegia_sentence_72


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