Hemiplegia

In medical terminology, paralyzing of one side of the body is referred to as hemiplegia. The arms, legs, and facial muscles on the left or right side may be affected. It is not a distinct illness; rather, it is a symptom of other conditions. Brain tumors, traumatic brain injuries, and strokes are among the conditions that can cause hemoplegia. Depending on what caused it, it might be either temporary or permanent.

Certain dysfunctions that some stroke patients have significantly affect their personal lives, work, and day-to-day activities. A common issue is a loss in balancing function.

When you are unable to move your muscles voluntarily, you are paralyzed. Paralysis is caused by an issue with the nervous system.
Nerves that are not injured send signals to the muscles. Muscles respond to these signals and move. Certain parts of your body cannot be moved if you are paralyzed.

Hemiplegia: What is it?

Hemiplegia is the term for paralysis or weakness on one side of the body. Because the word “hemi” is Greek in origin and means “half,” it refers to that Hemiplegia affects only one half of the body. The main cause of Hemiplegia is brain damage, though there are a number of other potential underlying causes as well, such as genetics.

Hemiplegia is the term for the paralysis of the muscles of one’s arms, legs, and lower face on one side of the body. Along with movement problems, there can be also additional memory, cognitive, and sensory weaknesses. Stroke is the most common cause of Hemiplegia because it damages the corticospinal pathways in one hemisphere of the brain. Hemiplegia can also result from infections, brain tumors, and trauma like spinal cord injuries.

Hemiplegia and hemiparesis are frequently applied similarly since they both result in comparable symptoms. On one side of the body, hemiparesis is characterized by mild paralysis, while hemiplegia can result in complete paralysis on one side of the body along with difficulties in speaking or breathing. Depending on the cause, it might be long-term or short-term.

Hemiplegia is treated with a combination of therapies that focus on regaining motor function and treating the underlying cause. Physiotherapy, particularly reflective treatment, can help limbs affected by hemiplegia because it improves motor function.

Hemiplegia types:

The following are conditions related to movement that may result in hemiplegia.

• Contralateral Hemiplegia

A person who has paralysis on the side of their body opposite (contralateral) to the side where they suffered brain damage is said to have contralateral hemiplegia. When the left hemisphere of the brain is injured, the right side of the body’s muscles become paralyzed, a condition known as contralateral hemiplegia.

• Spastic Hemiplegia

Hemiplegia of a type known as “spastic hemiplegia” is frequently associated with cerebral palsy. Spastic hemiplegia is the medical term for weakness or paralysis on the side of the body that is opposite the brain hemisphere that was injured prior to, during, or soon after birth. The arm is typically more affected than the leg in this type of cerebral palsy, which is the most prevalent.

When someone with cerebral palsy experiences spasticity, it is referred to as “spastic.” Muscles that contract involuntarily are examples of spasticity. People who have flaccid hemiplegia have loose, floppy muscles on the affected side, whereas people with spastic hemiplegia have stiff movements.

• Facial Hemiplegia

Facial hemiplegia is the condition in which one side of the face has impaired or paralyzed muscles. It could happen together with hemiplegia in other parts of the body or be the sole sign of nerve damage.

Facial drooping on one side is one of the most obvious symptoms of a stroke. Once the stroke is treated and normal blood flow to the brain is restored, facial hemiplegia may be temporary. There is a chance that mild hemiplegia in another part of the body will coexist with facial hemiplegia.

• Spinal Hemiplegia

Brown-Sequard syndrome is another name for spinal hemiplegia. It is characterized by damage to one side of the spinal cord that causes paralysis on the affected side of the body. Additionally, it results in the loss of feeling for pain and temperature on the other side of the body.

What are the differences between Hemiplegia on the Right and Left?

A condition known as Hemiplegia is characterized by damage to one side of the body; therefore, the term “left hemiplegia” or “right hemiplegia” may be used to describe the affected side.

Yes, it depends on the particular nerve injury that each person has. As was previously said, the right side of the brain regulates the left side of the body, while the left side regulates the right. Therefore, injury to the right hemisphere of the brain is more likely to result in left hemiparesis than damage to the left (and vice versa for damage to the left hemisphere).

A traumatic brain injury (TBI) of any kind can result in partial or complete paralysis due to the trauma, in addition to a variety of other symptoms. It is therefore imperative to have a comprehensive medical evaluation following any major head trauma or incident affecting the nervous system.

Pathophysiology:

Although the exact cause of Hemiplegia is not always known, brain lack of oxygen results in the death of brain neurons. Usually, the opposite side of the body is affected when the corticospinal tract is damaged.

For example, when someone has a brain damage to their right side of the brain, they may experience left-sided hemiplegia. The reason for this is that the motor fibers of the corticospinal tract, also referred to as pyramidal fibers, start in the motor cortex of the brain and go to the lower medulla oblongata, where they cross over to the opposite side and then lower into the spinal cord to supply the corresponding muscles. Depending on where the brain injury occurred, different degrees of hemiplegia result.

Different degrees of weakness in one half of the body will result from a lesion at the cortex or subcortical level, while complicated hemiplegia, or total loss of power in all the muscles in one half of the body, will result from a lesion in the internal capsule, where all the motor fibers are concentrated in a small area.

Hemiplegia causes:

Hemiplegia can result from a number of conditions and diseases.

• Brain infections

An infection may cause irreversible harm to the brain’s cortex. Though some diseases may also have fungal or viral origins, bacteria are the primary cause of most ailments. One illness that can cause significant damage to the brain is meningitis.

• Genetics

Children with alternating hemiplegia may be affected by an extremely rare mutation in the ATP1A3 gene. There are the signs and symptoms of intermittent hemiplegia. About a million people have been diagnosed with this disease. A rare condition known as AHC causes a child to occasionally become paralyzed or weak on one side of their body. Both sides could become paralyzed. 

• Brain injury

A destructive blow to the head can result in irreversible brain damage. Hemiplegia may occur if the trauma only affects one side of the brain. Car crashes, sports injuries, and assaults are among the common causes of trauma.

• Brain Tumors

Among the physical problems that brain tumors may cause is hemiplegia. As the tumor grows, the symptoms of hemiplegia may worsen. Brain tumors can produce hemiplegia in addition to other symptoms. The symptoms could get worse when the tumor gets bigger since it might damage the brain.

• Lack of Brain Oxygen

When oxygen is not reaching to the brain through breathing, drowning, anaphylactic shock, or cardiovascular problems, permanent brain damage may result. The consequence of this could be hemiplegia.

• Side effects from medication or surgery

The neurological system may suffer permanent damage as a result of anesthesia, drugs, or surgical reactions. This is extremely uncommon, although it can cause hemiplegia or other forms of paralysis or weakness in the body.

Signs and symptoms of Hemiplegia:

The right or left side of the body might be affected by hemiplegia. Damage to the right side of the brain causes paralysis, but damage to the left side of the brain causes symptoms.

The intensity of symptoms might differ, as can how each person is affected.

They might consist of;

• Difficulty in grasping objects and walking.
• A decreased capacity to co-ordinate.
• Muscle exhaustion.
• Seizures, speech problems, and behavioural abnormalities are possible symptoms.
• Confusion, restlessness in thoughts; issues with memory, focus, and attention.

Additionally, a traumatic brain injury may cause symptoms that are specific to the injury.

These could include signs and symptoms like;

• Alterations in behaviour.
• Speaking problems.
• Challenges with attention to detail, memory, concentration, or understanding.
• Anxiety, confusion, and restlessness.

Diagnosis:

Hemiplegia  can be evaluated through a physical examination. Your doctor will test your muscular strength and reflexes with a rubber reflex hammer. As you attempt to impede their advances, they might also push against your limbs.

Furthermore, the following diagnostic procedures and imaging tests may be recommended by your doctor;

• Radio waves and magnetic fields are combined in magnetic resonance imaging (MRI) to produce a three-dimensional image.

• Computed tomography (CT) scans from X-rays are used to create three-dimensional images.

• Muscle activity is tracked using electromyography (EMG), which uses a tiny needle electrode.

• Always look for immediate medical attention if you experience weakness or loss of function in any limb. If your muscles are weak or paralyzed, get treatment immediately.

Hemiplegia Complication:

Your weakness may lead to the development of secondary conditions like hemiplegia and hemiparesis. These problems do not appear immediately . Rather, they may appear months following your initial bout of weakness or paralysis.

• Issues with bowel control
• When a blood clot obstructs a large vein, it causes deep vein thrombosis (DVT).
• Blood pressure spikes quickly in autonomic dysreflexia.
• Depressive States
• Respiratory issues
• Skin sores that appear while lying in bed are referred to as pressure wounds, bedsores, or pressure ulcers.
• Muscles that are inflexible, taut, and rigid.
• A weakening of the muscles

Treatment:

The cause and severity of the symptoms determine the treatment options for hemiplegia. Physical therapists, rehabilitation therapists, and mental health specialists typically provide multidisciplinary care to individuals with hemiplegia.

Physiotherapy for Hemiplegia:

The affected side of the body will function better and move more normally with the help of physiotherapy, becoming more independent with daily tasks.

Hemiplegia patients’ physiotherapy may include;

• Improve muscle function through the core stability exercise
• Performing functional tasks repeatedly on the affected arm in order to strengthen upper limb function and stimulate motor pathways.
• Stretches that improve trunk, arm, and leg strength and alleviate pain and stiffness. These can be either passive or vigorous.
• Exercises involving the affected upper limb bearing weight.
• Retraining one’s gait, whether or not to use support.
• To encourage becoming independent, practice transfers like getting in and out of bed, using the restroom, and climbing stairs.
• Exercises which improve balance and core stability.
• Suggestions for orthotic devices.

Assistance devices:

Mobility devices can help you maintain an independent and active lifestyle even if you have hemiparesis or hemiplegia.

Using a walker, cane, brace, electric or manual wheelchair, or other assistive device may be advised by some physiotherapists. Muscle control and movement can be improved with the use of an assistive device. To find out which device is right for you, it is best to see a medical professional. Additionally, they might suggest modifications to the home like grab bars, ramps, and higher toilet seats.

Occupational Therapy:

Occupational therapy is a type of care that helps patients learn how to perform daily activities and tasks, such as taking care of themselves. Occupational therapists may employ movement therapy induced by modified constraints. Intense upper-limb muscle training is used in this therapy to improve back function in the affected arm. This strategy can also be used by physiotherapists as well.

Electrical stimulation:

By using electrical pads, a medical professional can assist in stimulating muscle movement. Muscles that are not conscious of movement can contract thanks to electricity. The goal of electrical stimulation is to improve brain plasticity and lessen imbalances in the impacted side of the brain.

Core muscle training:

1. The patient was instructed to lie down in a supine lying position , with the pelvis lifted to a horizontal posture and kept there, and the lower limbs’ knee joints protected by inelastic suspension straps.
2. With the pelvis raised to a horizontal position and maintained there, the waist held in place by elastic suspension straps, and the affected lower leg ankle joint suspended by inflexible suspension straps, the patient is in the supine position.
3. lying positionThe patient was in a supine lying, with the pelvis lifted to a horizontal position and kept there, the waist hold by elastic suspension straps, the affected lower leg ankle joint suspended by inelastic suspension straps.

Mental preparation:

Mental practice, sometimes called visualization, is the act of practicing a movement that you would like to improve. Studies have shown that when a person visualizes moving, changes occur in the motor and premotor regions of the brain’s cortex that control movement.

Hemiplegics can benefit greatly from this therapy due to its availability. It is best for people to mentally practice their rehabilitation exercises before beginning them. practicing mentally in addition to physically produces greater benefits than practicing physically alone.

Sensory retraining:

Some hemiplegia patients experience sensory abnormalities following a stroke, such as numbness or “pins-and-needles” sensations. The brain receives critical information from sensory nerve fibers, which also help in brain reorganization. The nervous system has a large number of sensory receptors. A rehabilitation method known as sensory retraining provides methods to activate each and every one of these receptors, which in turn activates the brain. This therapy promotes neuroplasticity and improves the brain’s capacity to process sensation.

Joint position systems are among the body’s most significant sense-making receptors. The body uses sense of balance, or sense of where its joints are in space, to locate them without the help of visual signals. Studies suggest that stimulation may improve the recovery from strokes.

What is the preventive measure for Hemiplegia?

Hemiplegia frequently develops suddenly. As such, it cannot be totally prevented. But, you can lessen your risk of getting hemiplegia by avoiding circumstances or events that can cause it.

Among the actions you can do are;

• Take control of your medical conditions

.You may be more at risk for illnesses or injuries that could result in hemiplegia if you have long-term conditions such as Type 2 diabetes, high blood pressure, or epilepsy. Lowering your chance of experiencing this symptom requires taking care of these conditions. It’s also critical to manage illnesses like multiple sclerosis that can gradually harm your brain or spinal cord.

• Consume a well-balanced diet and keep yourself at a healthy weight.

Hemiplegia can be caused by a variety of heart and circulation-related diseases, including stroke, which damages the brain. One of the key strategies to lower your chance of developing hemiplegia is to prevent stroke and related issues.

• Use protective equipment

You can reduce your risk of head, neck, and back injuries that could cause hemiplegia by wearing safety equipment. Helmets and safety measures like seat belts fall under this category.

• Never neglect infections

Infections, especially those affecting the eyes and hearing, can cause haemiplegia when they move to the brain. By treating infections as soon as you can and following as closely as possible to the recommended course of action, you can reduce the likelihood that this will occur.

Increasing Mobility With Hemiplegia:

One side of the body being paralyzed is known as hemiplegia, and it usually follows injury to the brain or spinal cord. Repetitive exercises are part of the treatment to rewire the brain. While exercise is one of the best ways to recover from an injury, you can get even better results by adding other modalities like electrical stimulation and mental practice to your traditional therapy regimen.

Since each neurologic injury has its own unique characteristics, each patient can benefit from a customized treatment strategy. Collaborate closely with your therapists and make every effort to maintain consistency in your exercise regimen. By doing this, the likelihood of hemiplegics regaining movement will be increased.

Summary:

When a weakness results in paralysis, it is called hemiplegia.
Although there are many potential causes of these diseases, most often they arise from disorders or injuries to the brain or spinal cord. People can occasionally regain their mobility with the assistance of physical and occupational therapy. Assistive technologies and mobility aids allow people to maintain their own independence and level of activity.

One symptom of hemiplegia is paralysis on one side of the body, either the left or the right. Being a significant stroke symptom, hemiplegia almost always indicates that you need to go get urgent health care. Hemiplegia can be frightening or disturbing in many circumstances, particularly when it happens unexpectedly. However, if a person receives medical attention right away, stroke the most common cause of hemiplegia can frequently be reversed. It’s crucial not to put off getting medical attention if you have hemiplegia because there are numerous other causes that are also curable or reversible.

FAQ:

References:

• As of January 27, 2020, Yet man, D. Causes and Treatments of Hemiplegia: Partial Paralysis. https://www.healthline.com/health/hemiplegia#causes | Healthline

• On February 12, 2024, Goriya, D. The causes, signs, and treatments of hemiplegia. Exercise and Physical Therapy Management. Hemiplegia at Physical Therapy USA

• On October 6, 2022, Fletcher, J. Everything about hemiplegia that you ought to know. The treatment for hemiplegia can be found at https://www.medicalnewstoday.com.

• As stated by Chitti (2024b, September 7). The best physiotherapy clinic in Ahmedabad. A mobile clinic for physical therapy. MobilePhysiotherapyClinic.in

• Contralateral hemoplegia is defined as paralysis of the left hemisphere of the brain (https://www.flintrehab.com/hemiplegia/#:~:text=Cerebralhemiplegia).

• Chen X, Lv Y, Gan Z, and Tian W. impact on hemiplegic stroke patients with core muscle stability rehabilitation training. Pakistan J Med Sci. 2020 Mar-Apr;36(3):461-466. 10.12669/pjms.36.3.1466 is the DOI. PMCID: PMC7150409; PMID: 32292453.

• Expert, C. C. M (2024c, May 1). Cleveland Clinic, “Hemiaplegia.” https://my.clevelandclinic.org/health/symptoms/23542-hemiplegia

• Hemiplegia, n.d. Hemiplegia on Physio pedia, https://www.physio-pedia.com

• Hemiplegia, Muscular Disorders, Neurological Symptoms, What We Treat, Physio.co.uk (n.d.-b). Hemiplegia: https://www.physio.co.uk/what-we-treat/neurological/symptoms/exercise-problems.php

• Image 1, Hemiplegia (undated). Hemaplegia can be found at https://icloudhospital.com/specialties
• Image 2, Specialist, C. C. M. (2024d, May 1). Cleveland Clinic Hemiplegia https://my.clevelandclinic.org/health/symptoms/23542-hemiplegia
• Image 3, 2022, July 30; Nandhana. Slide show: hemiplegia.pdf. Available at https://www.slideshare.net/slideshow/hemiplegiapdf/252366802 on SlideShare.
• Image 4, November 11, 2021: S. Tsimidopoulou. The definition and management of spastic hemiplegia. The website stasism.com describes spastic hemiplegia and its treatment.
• Image 6, What separates left- and right-sided brain damage MEDizzy (n.d.). [Medizzy.com/feed/21978829]