Hemiplegia; Types, Causes, Symptom, Diagnosis, Treatment

Hemiplegia








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Hemiplegia is a neurological condition that affects paralysis is on one vertical half of the body. Its most obvious result is a varying degree of weakness and lack of control in one side of the body. It affects everyone differently but its most obvious result is a varying degree of weakness and lack of control in one side of the body. You may be reading this because your child or someone you know has hemiplegia.

Hemiplegia is a condition where half of the body is paralyzed due to damage to the parts of the brain responsible for movement. Hemiparesis and hemiplegia can be caused by different medical conditions, including congenital causes, trauma, tumors, or stroke etc.

Types of Hemiplegia

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1. Alternate hemiplegia  paralysis of one side of the face and the opposite side of the body.
2. Cerebral hemiplegia  that due to a brain lesion.
3. Crossed hemiplegia  alternate hemiplegia.Its affect the alter side of body instated of affect side.
4. Facial hemiplegia  paralysis of one side of the face.
5. Spastic hemiplegia  hemiplegia with spasticity of the affected muscles and increasedtendon reflexes.
6. Spinal hemiplegia  that due to a lesion of the spinal cord.
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Causes of Hemiplegia

Though the arms, legs, and possibly torso are the regions of the body most obviously affected by hemiplegia, in most cases of hemiplegia these body regions are actually perfectly healthy. Instead, the problem resides in the brain, which is unable to produce, send, or interpret signals due to disease or trauma-related damage. Less frequently, hemiplegia results from damage to one side of the spinal cord, but these sorts of injuries more typically produce global problems, not just paralysis on one side of the body.

  • Traumatic brain injuries to one side of the brain only. These may be caused by car accidents, falls, acts of violence, and other factors.
  • Cardiovascular problems, particularly aneurysms and hemorrhages in the brain.
  • Strokes and transient ischemic attacks (better known as TIA or mini-strokes).
  • Infections, particularly encephalitis and meningitis. Some serious infections, particularly sepsis and abscesses in the neck, may spread to the brain if left untreated.
  • Conditions that cause demyelination of the brain, including multiple sclerosis and some other autoimmune diseases.
  • Reactions to surgery, medication, or anesthesia.
  • Loss of oxygen to the brain due to choking or anaphylactic shock.
  • Brain cancers.
  • Lesions in the brain, even if non-cancerous, since these lesions can impede function on one side of the brain.
  • Congenital abnormalities, including cerebral palsy and neonatal-onset multi-inflammatory disease.
  • Rarely, psychological causes; some states of catatonia can cause hemiplegia, and people with parasomnia—a sleep disorder leading to unusual nighttime behavior—may experience nighttime episodes of hemiplegia.
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Some common causes of hemiplegia include:

Stroke: is the commonest cause of hemiplegia. Insufficient blood supply to the brain leads to loss of brain functions. The stroke may be caused by:

  • A clot formed within the blood vessel blocking the blood supply -> a thrombus
  • A thrombus breaks away from its site of origin and forms a block elsewhere in the circulation -> an emboli
  • A bleed from a blood vessel supplying the brain -> a hemorrhage
  • A thrombus breaks away from its site of origin and forms a block elsewhere in the circulation. -> an emboli
  • A bleed from a blood vessel supplying the brain -> a hemorrhage
  • Traumatic brain injuries to one side of the brain only. These may be caused by car accidents, falls, acts of violence, and other factors.
  • Cardiovascular problems, particularly aneurysms and hemorrhages in the brain.
  • Infections, particularly encephalitis and meningitis. Some serious infections, particularly sepsis and abscesses in the neck, may spread to the brain if left untreated.
  • Migraine syndrome -> recurrent headaches of severe intensity occasionally accompanied by sensations of numbness and tingling in one half of the body.
  • Conditions that cause demyelination of the brain, including multiple sclerosis and some other autoimmune diseases.
  • Reactions to surgery, medication, or anesthesia.
  • Loss of oxygen to the brain due to choking or anaphylactic shock.
  • Brain cancers.
  • Lesions in the brain, even if non-cancerous, since these lesions can impede function on one side of the brain.
  • Congenital abnormalities, including cerebral palsy and neonatal-onset multi-inflammatory disease.
  • Rarely, psychological causes; some states of catatonia can cause hemiplegia, and people with parasomnia—a sleep disorder leading to unusual nighttime behavior—may experience nighttime episodes of hemiplegia.
  • Head injury
  • Diabetes
  • Brain tumor
  • Infections -> meningitis, encephalitis ,  meningitis, brain abscess
  • Migraine syndrome -> recurrent headaches of severe intensity occasionally accompanied by sensations of numbness and tingling in one half of the body.
  • Inflammation of the blood vessels -> vasculitis
  • Diseases affecting the nerves -> like Multiple Sclerosis; acute necrotizing myelitis.
  • Conditions presenting from birth -> cerebral palsy. Lack of blood supply damages nerve cells in the brain. Birth trauma, difficult labor, perinatal strokes in infants within 3 days of birth can all cause cerebral palsy.
  • Hereditary diseases -> leukodystrophies. This is a rare disorder affecting the myelin sheath which covers and protects nerve cells in the brain. The condition usually appears in infancy or childhood.
  • Vascular – cerebral hemorrhage
  • Neoplastic – glioma-meningioma
  • Demyelination – disseminated sclerosis, lesions to the internal capsule
  • Traumatic – cerebral lacerations, subdural hematoma rare cause of hemiplegia is due to local anesthetic injections given intra-arterially rapidly, instead of given in a nerve branch.
  • Congenital – cerebral palsy, Neonatal-Onset Multisystem Inflammatory Disease (NOMID)
  • Disseminated – multiple sclerosis
  • Psychological – parasomnia (nocturnal hemiplegia)
  • Severe headache
  • Impairment or loss of vision
  • Memory loss
  • Confusion
  • Loss of balance or co-ordination
  • Poor balance and dizziness
  • Sudden numbness, paralysis or weakness of an arm, leg or side of the face.
  • Slurred or abnormal speech
  • Loss of consciousness
  • Incontinence

Symptoms of Hemiplegia

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The main symptom of hemiplegia is weakness or paralysis on one side of the child’s body. The condition can vary in severity and affects each child differently. It will only affect one side of the child’s body. General symptoms include

You may also have problems with your senses, communication, and drowsiness:

  • Seeing zigzag lines, double vision, or blind spots
  • Extreme sensitivity to light, sound, and smell
  • Language difficulties, such as mixing words or trouble remembering a word
  • Slurred speech
  • Confusion
  • Loss of consciousness or coma
  • Difficulty walking
  • Poor balance
  • Little or no use of one hand or leg
  • Speech problems
  • Visual problems
  • Behavioural problems
  • Learning difficulties
  • Epilepsy
  • Developmental delay, for example learning to walk later than other children

Diagnosis of Hemiplegia

To diagnose a stroke doctor hemiplegia will usually make an assessment using several of the following

Initial Treatment of Hemiplegia

Immediate treatment is aimed at limiting the size of the stroke and preventing further stroke. Acute stroke therapies try to stop a stroke while it is happening by quickly dissolving the blood clot causing an ischaemic stroke or by stopping the bleeding of a hemorrhagic stroke.  This will involve administering medications and may involve surgery in some cases.

Medications

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  • Thrombolytic therapy – These medications dissolve blood clots allowing blood flow to be re-established
  • Anticoagulants (eg: heparin) – These medications help to prevent blot clots getting bigger and prevent new blood clots from forming
  • Antihypertensives  In cases of hemorrhagic stroke these medications may be prescribed to help lower high blood pressure
  • Medications – to reduce swelling in the brain and medications to treat underlying causes for the stroke eg: heart rhythm disorders may also be given.
  • Blood thinners to reduce cardiovascular blockages and decrease the chances of future strokes.
  • Antibiotics, usually delivered intravenously, to combat brain infections.
  • Surgery to remove swelling on the brain or objects lodged in the brain.
  • Muscle relaxant drugs.
  • Surgery to address secondary issues, particularly involuntary muscle contractions, spinal damage, or damage to the ligaments or tendons on the unaffected side of the body.
  • Physical therapy designed to help the brain work around the injuries. Physical therapy can also strengthen the unaffected side and help you reduce the loss of muscle control and tone.
  • Support groups, family education, and advocacy.
  • Psychotherapy to help you deal with the psychological effects of the disease.
  • Exercise therapy to help you remain healthy in spite of your disability.

Treatment of Hemiplegia

Brain cells do not generally regenerate. Following a stroke, surviving brain cells can take over the function of areas that are dead or damaged, but only to a certain degree. The adaptive ability of the brain requires the relearning of various skills.

As each person who suffers a stroke is affected differently, individual rehabilitation plans are developed in conjunction with the patient, family and healthcare team. These aim to teach skills and maximize function so that the person can achieve maximum independence.

Physiotherapy

Treatment of hemiplegia requires coordination of several health professionals. A physiotherapist, occupational therapists, a physician, a surgeon and support from family etc.

  • Treatment is focused to find the causative factor and check its further progression. Secondly after few days, rehabilitation therapy helps to minimize disability.
  • Several medicines are prescribed to control the primary cause such as anti hypertensive, anti-thrombolytic agents to dissolve the clot, drugs to control cerebral edema etc.
  • Intensive physical therapy is begun after few days. Activities such as walking, standing are done repeatedly under the guidance of physiotherapist. It helps to improve the muscular functions which have become rigid. It is aimed to make the patient self sufficient to perform his daily activities.
  • Patient is taught to move his affected arm with his strong arm. With exercise it is possible to maintain flexibility of joints and it also prevents tightening and shortening of muscles. Speech therapy is simultaneously begun to improve communication and speaking skills.
  • Speech therapy – to improve communication
  • Occupational therapy – to improve daily functions such as eating, cooking, toileting and washing.
Recovery can take months and it may be several days or weeks after the stroke before doctors are able to give an accurate prediction for recovery.

Occupational therapy

Occupational therapy 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. Therapists may also recommend a hand splint for active use or for stretching at night. Some therapists actually make the splint; others may measure your child’s hand and order a splint. 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.

Rehabilitation & Thearapy for Hemiplegia

1. Improving motor control

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a.Neurofacilitatory Techniques

In Stroke Physical Therapy these therapeutic interventions use sensory stimuli (e.g. quick stretch, brushing, reflex stimulation and associated reactions) ,which are based on neurological theories, to facilitate movement in patients following stroke (Duncan,1997). The following are the different approaches: –

i.Bobath

Berta & Karel Bobath’s approach focuses to control responses from damaged postural reflex mechanism. Emphasis is placed on affected inputs facilitation and normal movement patterns (Bobath, 1990).

ii.Brunnstrom

Brunnstrom approach is one form of neurological exercise therapy in the rehabilitation of stroke patients. The relative effectiveness of Neuro-developmental treatment (N.D.T.) versus the Brunnstrom method was studied by Wagenaar and colleagues (1990) from the perspective of the functional recovery of stroke patients. The result of this study showed no clear differences in the effectiveness between the two methods within the framework of functional recovery.

iii.Rood

Emphasise the use of activities in developmental sequences, sensation stimulation and muscle work classification. Cutaneous stimuli such as icing, tapping and brushing are employed to facilitate activities.

iv. Proprioceptive neuromuscular facilitation (PNF)

Developed by Knott and Voss, they advocated the use of peripheral inputs as stretch and resisted movement to reinforce existing motor response. Total patterns of movement are used in treatment and are followed in a developmental sequence.

It was shown that the commutative effect of PNF is beneficial to stroke patient (Wong, 1994). Comparing the effectiveness of PNF, Bobath approach and traditional exercise, Dickstein et al (1986)demonstrated that no one approach is superior to the rest of the others (AHCPR, 1995).

b. Learning theory approach

i. Conductive education

In Stroke Physical Therapy, Conductive education is one of the methods in treating neurological conditions including hemiplegic patients. Cotton and Kinsman (1984) demonstrated a neuropsychological approach using the concept of CE for adult hemiplegia. The patient is taught how to guide his movements towards each task-part of the task by using his own speech – rhythmical intention.

ii. Motor relearning theory

Carr & Shepherd, both are Australian physiotherapists, developed this approach in 1980. It emphasizes the practice of functional tasks and the importance of relearning real-life activities for patients. Principles of learning and biomechanical analysis of movements and tasks are important. (Carr and Shepherd, 1987)

There is no evidence adequately supporting the superiority of one type of exercise approaches over another. However, the aim of the therapeutic approach is to increase physical independence and to facilitate the motor control of skill acquisition and there is strong evidence to support the effect of rehabilitation in terms of improved functional independence and reduced mortality.

c. Functional electrical stimulation (FES)

FES is a modality that applied a short burst of electrical current to the hemiplegic muscle or nerve. In Stroke Physical Therapy, FES has been demonstrated to be beneficial to restore motor control, spasticity, and reduction of hemiplegic shoulder pain and subluxation. It is concluded that FES can enhance the upper extremity motor recovery of acute stroke patient (Chae et al., 1998; Faghri et al., 1994; Francisco, 1998). Alfieri (1982) and Levin et al (1992) suggested that FES could reduce spasticity in a stroke patient. A recent meta-analysis of the randomized controlled trial study showed that FES improves motor strength (Glanz 1996). A study by Faghri et al (1994) have identified that FES can significantly improve arm function, electromyographic activity of posterior deltoid, the range of motion and reduction of severity of subluxation and pain of hemiplegic shoulder.

d. Biofeedback

Biofeedback is a modality that facilitates the cognizant of electromyographic activity in selected muscle or awareness of joint position sense via visual or auditory cues. In Stroke Physical Therapy the result of studies in biofeedback is controversial. A meta-analysis of 8 randomized controlled trials of biofeedback therapy demonstrated that electromyographic biofeedback could improve motor function in stroke patient (Schleenbaker, 1993). Another meta-analysis study on EMG has shown that EMG biofeedback is superior to conventional therapy alone for improving ankle dorsiflexion muscle strength (Moreland et al., 1998. Erbil and co-workers (1996) showed that biofeedback could improve earlier postural control to improve impaired sitting balance. A conflicting meta-analysis study by Glanz et al (1995) showing that biofeedback was not efficacious in improving range of motion in ankle and shoulder in a stroke patient. Moreland (1994) conducted another meta-analysis concluded that EMG biofeedback alone or with conventional therapy did not superior to conventional physical therapy in improving upper- extremity function in the adult stroke patient.

2. Hemiplegic shoulder management

Shoulder subluxation and pain of the affected arm is not uncommon in at least 30% of all patient after stroke (RCP, 1998) ,whereas subluxation is found in 80% of stroke patients (Najenson et al., 1971). It is associated with severity of disability and is common in patients in rehabilitation setting. Suggested interventions are as follows:

a. Exercise

Active weight bearing exercise can be used as a means of improving motor control of the affected arm; introducing and grading tactile, proprioceptive, and kinesthetic stimulation; and preventing edema and pain. In Stroke Physical Therapy, Upper extremity weight bearing can be used to lengthen or inhibit tight or spastic muscles while simultaneously facilitating muscles that are not active (Donatelli, 1991). According to Robert (1992), the amount of shoulder pain in hemipelgia was related most to loss of motion. He advocated that the provision of ROM exercise (caution to avoid imprigement) as treatment as early as possible.

b. Functional electrical stimulation

Functional electrical stimulation (FES) is an increasingly popular treatment for the hemiplegic stroke patient. It has been applied in stroke physical therapy for the treatment of shoulder subluxation (Faghri et al.,1994), spasticity (Stefanovska et al., 1991) and functionally, for the restoration of function in the upper and lower limb (Kralji et al., 1993). In Stroke Physical Therapy, Electrical stimulation is effective in reducing pain and severity of subluxation, and possibly in facilitating recovery of arm function (Faghri, et al., 1994; Linn, et al., 1999).

c. Positioning & proper handling

In Stroke Physical Therapy, proper positioning and handling of hemiplegic shoulder, whenever in bed, sitting and standing or during lifting, can prevent shoulder injury is recommended in the AHCPR & SIGN guidelines for stroke rehabilitation. In Stroke Physical Therapy, positioning can be therapeutic for tone control and neuro-facilitation of stroke patients (Davies, 1991). Braus et al 94 found shoulder hand syndrome reduced from 27% to 8% by instruction to every one including family on handling technique.

d. Neuro-facilitation

e. Passive limb physiotherapy

Maintenance of full pain-free range of movement without traumatizing the joint and the structures can be carried out. In Stroke Physical Therapy, at no time should pain in or around the shoulder joint be produced during treatment. (Davies, 1991).

f. Pain relief physiotherapy

Passive mobilisation as described by Maitland, can be useful in gaining relief of pain and range of movement (Davies, 1991). In Stroke Physical Therapy other treatment modalities such as thermal, electrical, cryotherapy etc. can be applied for shoulder pains of musculoskeletal in nature.

g. Reciprocal pulley

 The use of reciprocal pulley appears to increase risk of developing shoulder pain in stroke patients. It is not related to the presence of subluxation or to muscle strength. (Kumar et al., 1990)

h. Sling

In Stroke Physical Therapy the use of sling is controversial. No shoulder support will correct glenohumeral joint subluxation. However, it may prevent the flaccid arm from hanging against the body during functional activities, thus decreasing shoulder joint pain. They also help to relieve downward traction on the shoulder capsule caused by the weight of the arm (Hurd, Farrell, and Waylonis, 1974 ; Donatelli ,1991).

3. Limb physiotherapy

Limb physiotherapy/Stroke Physical Therapy includes passive, assisted-active and active range-of-motion exercise for the hemiplegic limbs. This can be an effective management for prevention of limb contractures and spasticity and is recommended within AHCPR (1995). Self-assisted limb exercise is effective for reducing spasticity and shoulder protection (Davis, 1991). Adams and coworkers (1994) recommended passive full-range-of-motion exercise for parlysed limb for potential reduction of complication for stroke patients

4. Chest physiotherapy

In Stroke Physical Therapy, evidence shows that both cough and forced expiratory technique (FET) can eliminate induced radio aerosol particles in lung field. Directed coughing and FET can be used as a technique for bronchial hygiene clearance in stroke patient.

5. Positioning

 In Stroke Physical Therapy consistent “reflex-inhibitory” patterns of posture in resting is encouraged to discourage physical complication of stroke and to improve recovery (Bobath, 1990).

Meanwhile, therapeutic positioning is a widely advocated strategy to discourage the development of abnormal tone, contractures, pain and respiratory complications. It is an important element in maximizing the patient’s functional gains and quality of life.

6. Tone management

A goal of Stroke Physical Therapy interventions has been to “normalize tone to normalize movement.” Therapy modalities for reducing tone include stretching, prolonged stretching, passive manipulation by therapists, weight bearing, ice, contraction of muscles antagonistic to spastic muscles, splinting, and casting. Research on tone-reducing techniques has been hampered by the inadequacies of methods to measure spasticity (Knutsson and Martensson, 1980) and the uncertainty about the relationship between spasticity and volitional motor control (Knutsson and Martensson, 1980; Sahrmann and Norton, 1977). Manual stretch of finger muscles, pressure splints, and dantrolene sodium do not produce apparent long-term improvement in motor control (Carey, 1990; Katrak, Cole, Poulus, and McCauley, 1992; Poole, Whitney, Hangeland, and Baker, 1990). Dorsal resting hand splints reduced spasticity more than volar splints, but the effect on motor control is uncertain (Charait, 1968) while TENS stimulation showed improvement for chronic spasticity of lower extremities (Hui-Chan and Levin, 1992).

7. Sensory re-education

Bobath and other therapy approaches recommend the use of sensory stimulation to promote sensory recovery of stroke patients.

8. Balance retraining

Re-establishment of balance function in patients following stroke has been advocated as an essential component in the practice of stroke physical therapy (Nichols, 1997). Some studies of patients with hemiparesis revealed that these patients have greater amount of postural sway, asymmetry with greater weight on the non-paretic leg, and a decreased ability to move within a weight-bearing posture (Dickstein, Nissan, Pillar, and Scheer, 1984; Horak, Esselman, Anderson, and Lynch, 1984). Meanwhile, research has demonstrated moderate relationships between balance function and parameters such as gait speed, independence, wheelchair mobility, reaching, as well as dressing (Dickstein et al., 1984; Horak et al., 1984; Bohannon, 1987; Fishman, Nichols, Colby, and Sachs, 1996; Liston and Brouwer, 1996; Nichols, Miller, Colby and Pease, 1996). Some tenable support on the effectiveness of treatment of disturbed balance can be found in studies comparing effects of balance retraining plus physiotherapy treatment and physiotherapy treatment alone.

9. Fall prevention

In Stroke Physical Therapy, falls are one of the most frequent complications( Dromerick and Reading, 1994), and the consequences of which are likely to have a negative effect on the rehabilitation process and its outcome. According to the systematic review of the Cochrane Library (1999), which evaluatedthe effectiveness of several fall prevention interventions in the elderly, there was significant protection against falling from interventions which targeted multiple, identified, risk factors in individual patients. The same is true for interventions which focused on behavioural interventions targeting environmental hazards plus other risk factors

10. Gait re-education

Recovery of independent mobility is an important goal for the immobile patient, and much therapy is devoted to gait-reeducation. Bobath assume abnormal postural reflex activity is caused of dysfunction so gait training involved tone normalization and preparatory activity for gait activity. In contrast Carr and Shepherd advocates task-related training with methods to increase strength, coordination and flexible MS system to develop skill in walking while Treadmill training combined with use of suspension tube. Some patient’s body weight can effective in regaining walking ability, when used as an adjunct to convention therapy 3 months after active training (Visintin et al., 1998; Wall and Tunbal 1987; Richards et al., 1993).

11. Functional Mobility Training

To handle through the functional limitations of stroke patients, functional tasks are taught to them based on movement analysis principles. In Stroke Physical Therapy these tasks include bridging, rolling to sit to stand and vice versa, transfer skills, walking and stairing etc (Mak et al., 2000).

Published studies report that many patients improve during rehabilitation. The strongest evidence of benefit is from studies that have enrolled patients with chronic deficits or have included a no-treatment control group (Wade et al., 1992; Smith and Ashburn et al., 1981).

Meanwhile, early mobilization helps prevent compilations e.g. DVT, skin breakdown contracture and pneumonia. Evidence have shown better orthrostatic tolerance (Asberg, 1989) and earlier ambulation (Hayes and Carroll, 1986).

12. Upper limb training

By 3 months poststroke, approximately 37% of the individuals continues to have decreased upper extremities (UE) function. Recovery of UE function lags behind that of the lower extremities because of the more complex motor skill required of the UE in daily life tasks. That means many individuals who have a stroke are at risk for lowered quality of life.

Many approaches to the physical rehabilitation of adults post-stroke exist that attempt to maximize motor skill recovery. However the literature does not support the efficacy of any single approach. The followings are the current approaches to motor rehabilitation of the UE.

a. Facilitation models

They are the most common methods of intervention for the deficits in UE motor skills including Bobath, proprioceptive neuromuscular facilitation, Brunnstrom’s movement therapy and Rood’s sensorimotor approach. There is some evidence that practice based on the facilitation models can result in improved motor control of UE ( Dickstein et al,1986, Grade A; Wagenaar et al, 1990 ). However, intervention based on the facilitation models has not been effective in restoring the fine hand coordination required for the performance of actions ( Kraft, Fitts & Hammond, 1992; Butefisch et al, 1995 ).

b. Functional electric stimulation

In Stroke Physical Therapy, Functional electric stimulation (FES) can be effective in increasing the electric activity of muscles or increased active range of motion in individuals with stroke ( Dimitrijevic et al., 1996; Fields, 1987; Faghri et al., 1994,; Kraft, Fitts and Hammond, 1992 ). Some evidence shown that FES may be more effective than facilitation approaches ( Bowman, Baker and Waters, 1979; Hummelsheim, Maier-Loth and Eickhof, 1997 ).

c. Electromyographic biofeedback

In Stroke Physical Therapy, biofeedback can contribute to improvements in motor control at the neuromuscular and movement levels ( Kraft, Fitts and Hammond, 1992; Moreland and Thomson, 1994; Wissel et al., 1989; Wolf and Binder-MacLoed, 1983; Wolf, LeCraw and Barton,1989; Wolf et al., 1994 ). Some studies have shown improvments in the ability to perform actions during post-testing after biofeedback training ( Wissel et al.,1989; Wolf and Binder-MacLoed, 1983; Moreland and Thomson, 1994). However, the ability to generalize these skills and incorporate them into daily life is not measured.

d. Constraint-induced therapy

Constraint-Induced (CI) therapy was designed to overcome the learned nonuse of the affected UE. In the most extreme form of CI therapy, individual post-stroke are prevented from using the less affected UE by keeping it in a splint and sling for at least 90% of their waking hours. Studies have found that the most extreme of CI therapy can effect rapid improvement in UE motor skill ( Nudo et al., 1996; Taub and Wolf, 1997; Taub et al., 1993; Wolf et al., 1989 ) and that is retained for at least as long as 2 years ( Taub and Wolf, 1997 ). However, CI therapy, currently are effective only in those with distal voluntary movement ( Taub and Wolf, 1997 ).

13. Mobility appliances and equipment

Small changes in an individual’s local ‘environment’ can greatly increase independence, use of a wheelchair or walking stick. However, little research has been done for these ‘treatments’. It is acknowledged that walking aids and mobility appliances may benefit selected patients.

Tyson and Ashburn (1994) showed that walking aids had effect in poor walkers – a benefical effect on gait (Level of evidence = III, Recommendation = Grade B). Lu and coworkers (1997) concluded that wrist crease stick is better than stick measured to greater trochanter. (Level of evidence = IIb, Recommendation = Grade A

14. Acupuncture 

The World Health Organisation (WHO) has listed acupuncture as a possible treatment for pariesis after stroke. Studies had sown its beneficial effects in strike rehabilitation.

Chen et al. (1990) had performed a controlled clinical trial of acupuncture in 108 stroke patients. They stated that the total effective rate of increasing average muscle power by at least one grade was 83.3% in the acupuncture group compared with the controlled group which was 63.4% (p<0.05).

Hua et al. (1993) had reported a significant difference in changes of neurological score between the acupuncture group and the control group after 4 weeks of treatment in a RCT and no adverse effects were observed in patients treated with acupuncture.

15. Vasomotor training 

Early stimulation of the muscle pump can reduce the venous stasis and enhance the general circulation of the body. It then hastens the recovery process.

16. Oedema management

Use of intermittent pneumatic pump, elastic stocking or bandages and massage can facilitate the venous return of the oedematous limbs. Therefore, the elasticity and flexibility of  musculoskeletal system can be maintained and enhance recovery process and prevent complications like pressure ulcer.

Homeopathic medicines for Hemiplegia

Homeopathic medicines cannot cure hemiplegia. However, the medicines can be administered to improve the state of paralysis, improve blood circulation, help control loss of power, improve power of muscles to come extent and improve overall health of the patient.

Some common medicines for hemiplegia and such states of paralysis are:

  • Plumbum Metallicum: This medicine is sourced by processing and potentising the metal lead. It helps the neuro-muscular system of the body. It is administered with the intention to improve some muscles power. Plumbum met, as it is called, may be indicated all kinds of paralysis such as hemiplegia, paraplegia and quadriplegia. As said earlier, it cannot cure paralysis as such.
  • Causticum: Similar to above medicine, Causticum is also a friend to all paralysis patients. It is aimed at improving some muscle power and not cure it.
  • Nux vomica: This herbal medicine helps in the early stages of hemiplegia and not after some months or years.
  • Lathyrus sativus: This is another example of a toxin transformed to medicine. It is safe, There is some spasticity and stiffness in some muscles, in the cases of hemiplegia, where Lathyrus may be called for.
  • Gelsemium: This plant remedy is useful for early cases of paralysis including hemiplegia. It is supposed to improve the muscle strength in the cases of paralysis.

Prevention

Reducing the number of controllable risk factors is the best way to prevent a stroke.  This can include:

  • Stopping smoking
  • Losing weight
  • Eating a balanced diet low in sodium and saturated and trans fat
  • Moderating alcohol intake (no more than 2 small drinks per day)
  • Exercising regularly in order to stay physically fit
  • Maintaining good control of existing medical conditions such as diabetes, high blood pressure and high cholesterol.

Referances

stroke

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