Hemiplegia : Physiotherapy Treatment

HEMIPLEGIA

Hemiplegia 

• paralysis of one side of the body; usually caused by a brain lesion, such as a tumor, or by stroke.
•  The paralysis occurs on the side opposite the brain disorder; this is explained by the fact that motor axons from the cerebral cortex enter the medulla oblongata and form two well-defined bands known as the pyramidal tracts.  
• The majority of the fibers in these tracts cross to the opposite side; therefore damage to the right cerebral hemisphere affects motor control of the left half of the body.
• TYPES OF HEMIPLEGIA:
• 
  
  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. facial hemiplegia:  paralysis of one side of the face.
  4. spastic hemiplegia:  hemiplegia with tone of the affected muscles increased and increased tendon reflexes.
  5. spinal hemiplegia:  that due to an injury to the spinal cord.
   

Gait Training Stick

 CAUSES:

Many conditions give rise to hemiplegia. Generally, an injury to the right side of the brain will cause a left-sided hemiplegia while an injury to the left side of the brain will cause a right-sided hemiplegia.

• 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
• Head injury
• Diabetes
• Brain tumor
• Infections : meningitis, encephalitis
• 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. 

SYMPTOMS:

• Difficulty in walking.
• Problems in balance, losses balance when trying to walk
• Difficulty in swallowing
• Trouble with vision. Blurred vision or weakness of the eyes.
• Speech becomes difficult.
• Numbness, tingling or loss of sensations on one half of the body.
• Loss of control over bladder and bowel movements leading to an inability to hold on to stool or urine.
• Unable to perform tasks like holding objects, tying laces, dressing oneself, buttoning etc.
• Feeling depressed
• Heightened emotional sensitivity with inability to handle stressful situations.
• Memory seems poor. Unable to recall recent or past events concerning people, places and activities.

 PHYSIOTHERAPY TREATMENT:
There are various physiotherapy approaches to the rehabilitation of patient with hemiplegia.
Bobath approach: its based on normal movement or neuro development approach.The main aim is to prevent abnormal movement and adverse plastic adaptations and to facilitate normal movement.

Brunstorn approach: he makes use of abnormal synergies and incorporate them into functional activities.
Motor relearning program: this was described by carr-shephered in the year 1987.this training of motor control is based on an understanding of kinematics and kinetics of normal movement, motor control process and motor learning.
Roods approach: this was mainly done to achieve purposeful muscular contraction by stimulating the skin through facilitating strokes on the skin.

GOALS OF THE PHYSIOTHERAPY TREATMENT:

  1. PREVENT UNAWARENESS OF THE HEMIPLEGIC SIDE.

  2. DECREASE THE TENDACY TO DEVELOP SYNERGY IN THE CHRONIC STAGE.

  3. PREVENTION OF ANY JOINT STIFFNESS.

  4. PREVENTION OF COMPLICATIONS DUE TO IMMOBILISATION LIKE CHEST COMPLICATION.

   5. EARLY WEIGHT BEARING.

   6. PSYCHOLOGICAL COUSELLING.

   7. EDUCATION TO THE FAMILY.

• Positioning:

  Positioning of the patient in proper way is essential to control the development of spasticity and to help in faster imrovement in the later stages. 

• Mobilisation and stretching exercises:

  During flaccid stage mobilization in the form of gentle passive exercises and stretching exercise of various muscles should be given as they are very prone to develop tightness.

  muscles like tendo achilles, hamstring, quadriceps, adductors, tensor fascia lata,biceps, wrist flexors etc. should be stretched.

  passive exercises should be given of all the movements at all the joints for at least 10 repetations three to four times in a day.

  some form of splints may be given to maintain the body parts in the desired position.

  commonly dorsiflexion splint or L splint may be given to prevent the foot from going into planter flexion attitude.similarly wrist extension splint is given to maintain the wrist and fingers in the extension position.

  

  L SPLINT

  

  WRIST EXTENSION SPLINT

• Weight bearing activities:

  weight bearing exercises are necessory to promote development of tone in the muscles and also to maintain the absorption of calcium into the bones.

 Thus patient should be given activities like bridging, supine on elbows, sitting with weight bearing on affected arm, and standing .

Treatment for spasticity:

normalisation of the tone can be achieved by reducing the tone of the muscles and strengthening the weak antagonist muscles. tone of muscles can be reduced by following treatments:

• gentle rhythmic passive movements.

• sustained gradual stretching either manualy or by using splints.

• Prolong icing  over the spastic muscle bulk for about 15 to 20 minutes.

• reflex inhibiting postures. 

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