HEMIPLEGIA

What is hemiplegia?

Childhood hemiplegia (sometimes called hemiparesis) is a condition affecting one side of the body (Greek ‘hemi’ = half). We talk about a right or left hemiplegia, depending on the side affected. It is caused by damage to some part of the brain, which may happen before, during or soon after birth, when it is known as congenital hemiplegia, or later in childhood, in which case it is called acquired hemiplegia. Generally, injury to the left side of the brain will cause a right hemiplegia and injury to the right side a left hemiplegia. Childhood hemiplegia is a relatively common condition, affecting up to one child in 1,000.

How does hemiplegia occur?

The causes of congenital hemiplegia are mostly unknown, and usually parents become aware of their child’s hemiplegia gradually during his or her infancy. There is a higher risk in premature babies, and it is unclear whether a difficult birth may be an occasional factor.

Congenital Hemiplegia

In this type, damage to a part of the brain may occur before, during or soon after birth. The cause of congenital Hemiplegia is unknown.

Acquired Hemiplegia

This type of Hemiplegia is seen later in life. The obstruction in the flow of blood to the brain may occur due to Stroke, accident or infection.

Stroke: it is the most common cause of Hemiplegia. The formation of a blood clot decreases the flow of blood to the brain. As a result, Hemiplegia occurs. Stroke may even cause a condition of the brain called Cerebral Palsy, which may then lead to Hemiplegia.

Accident: Any accident or trauma to the head may lead to bleeding from the vessels supplying the brain, thereby causing Hemiplegia.

Infection: Swellings resulting from infections such as Encephalitis (infection of the brain) and Meningitis (infection of the outer layer of the brain) may also lead to obstruction in the supply of blood to the brain.

Various other causes may lead to Hemiplegia, e.g. Tumor (cancer), Migraine, Multiple Sclerosis, etc.

Risk Factors

Congenital Hemiplegia

Premature babies

Difficulty at the time of birth

Acquired Hemiplegia

High Blood Pressure

High cholesterol

Obesity

Smoking

High alcohol consumption

Sedentary lifestyle



What are the effects of hemiplegia?

It is difficult to generalise: hemiplegia affects each child differently. The most obvious result is a varying degree of weakness and lack of control in the affected side of the body, rather like the effects of a stroke. In one child this may be very obvious (he or she may have little use of one hand, may limp or have poor balance); in another child it will be so slight that it only shows when attempting specific physical activities.

Common musculoskeletal problems in hemiplegia

The shoulder is adducted and internally rotated, the elbow is flexed and pronated, the wrist and fingers are flexed, the thumb is in the palm. The hip is flexed and internally rotated, the knee is flexed or extended, the ankle is in plantar flexion. The foot is generally in varus, although valgus deformity may also be seen. The hemiplegic side is short and atrophic depending on the severity of involvement.

Musculoskeletal problems in hemiplegia

Upper extremity

Shoulder - Internal rotation, Adduction
Elbow - Pronation, Flexion
Wrist – Flexion
Hand – Flexion , Thumb-in-palm

Lower extremity

Hip – Flexion, Internal rotation
Knee – Flexion, Extension
Ankle – Plantar flexion
Foot – Varus

Treatment consists of physiotherapy, occupational therapy, bracing, botulinum toxin injections and orthopaedic surgery. Some children may need speech therapy and antiepileptic medication.

Treatment in hemiplegia

Physiotherapy – Prevent contractures, Strengthen weak muscles, Establish a better walking pattern
Occupational therapy – Functional use of upper extremity, Activities of daily living
-Bracing
-Lower extremity –> Solid or hinged AFOs
-Upper extremity –> Functional or resting hand splints
Botulinum toxin A
-Lower extremity – Rectus femoris and gastroc spasticity
-Upper extremity – Pronator flexor spasticity
-Orthopaedic surgery – Correction of Pes equinovarus, Stiff knee, Femoral anteversion

Referrences:
http://www.cerebralpalsysymptoms.org/types-of-cp/hemiplegia/
http://www.hemihelp.org.uk/families