Hemiplegia

Overview

The most common type of paralysis in humans is hemiplegia, which affects the face, arm, and leg on one side of the body. Diseases affecting the cortex, cerebral white matter, and the internal capsule typically appear as weakness or paralysis of the opposite side's face, arm, and leg. Vascular disorders of the cerebrum and brainstem are the most common causes of hemiplegia. Trauma is the second leading cause, followed by brain tumor, encephalitis or abscess, and demyelinating illnesses.

A person might suffer from a variety of disabilities as a result of a spinal cord injury (SCI) or traumatic brain injury (TBI). Because of their similar names, hemiplegia and hemiparesis are two illnesses that many people misunderstand.

What is Hemiplegia?

Hemiplegia (also known as hemiparesis) is a disorder induced by a brain injury that causes weakness, stiffness (spasticity), and loss of control in one side of the body. The term is derived from the Greek word hemi, which means "half."

Injury to areas of the brain that regulate movements of the limbs, body, and face causes hemiplegia. This damage can occur before, during, or shortly after birth (up to two years of age), and is known as congenital hemiplegia (or unilateral cerebral palsy). This is known as acquired hemiplegia if it occurs later in life as a result of an injury or disease.

We also discuss right or left hemiplegia, depending on which side is afflicted. In general, injury to the left side of the brain results in right hemiplegia, whereas injury to the right side results in left hemiplegia.

Hemiplegia is a very uncommon illness that affects up to one kid in every 1,000. Around 80% of instances are congenital, while 20% are acquired. Each child is affected differently by hemiplegia.

You may be told that hemiplegia is a kind of cerebral palsy, which is a descriptive term for a broader range of disorders in which movement and posture are impaired due to brain damage. These conditions are permanent and non-progressive, which means they do not worsen with time. They may change appearance over time, due in part to the child's growth and development.

Right Hemiplegia vs Left Hemiplegia

Left hemiplegia refers to paralysis of the left side of the body, whereas right hemiplegia refers to paralysis of the right side of the body. Right or left hemiplegia, like hemiparesis, can be induced by neural system injury.

An incomplete spinal cord injury (SCI) is a common cause of left or right hemiplegia. Because just a portion of the spinal cord is cut in an incomplete SCI, there may still be some function below the damage site. An incomplete spinal cord damage in the cervical spinal cord, for example, may paralyze the left side of the body while leaving the right-side functioning – however, this is not certain because the precise nerves destroyed may change the symptoms of the injury.

Hemiplegia Causes

A variety of disorders can result in hemiparesis or hemiplegia. Strokes, brain injuries, spinal cord injuries, infections, and a variety of other disorders affecting the central nervous system are examples of hemiparesis and hemiplegia causes.

Hemiparesis and hemiplegia are both nervous system illnesses that do not result from damage to the afflicted side of the body. A damage to the spinal cord or brain, for example, interferes with the body's capacity to transmit or receive signals to the injured region. While neither the left nor right sides of the body have been physically injured, the spinal cord injury may result in hemiparesis or hemiplegia.

A stroke is the most prevalent cause of these injuries. Strokes disrupt blood flow to the brain. Hemiparesis or hemiplegia may arise if a region of the brain that controls movement or perception is damaged. The impacted region is generally the opposite of the damaged side of the brain, therefore an injury to the right side of the brain will have an effect on the left side of the body.

Some other causes of hemiparesis and hemiplegia include:

• Brain and Nervous System Infections

Encephalitis and meningitis are two examples of infections. If left untreated, some dangerous infections, notably sepsis and neck abscesses, can migrate to the brain. This can not only result in hemiplegia, but it can also impair a person's capacity to think and even result in death.

• Brain Trauma

Traumatic brain injuries on one side of the brain are included. TBIs can be caused by vehicle accidents, falls, violent acts, and other circumstances.

• Genetic Disorders/Congenital Diseases

Cerebral palsy and neonatal-onset multi-inflammatory illness are examples of congenital defects. Genetic abnormalities can affect nervous system development and result in syndromes such as hemiplegia, paraplegia, or quadriplegia.

• Brain Tumors

Cancerous brain growths can put pressure on distinct areas of the brain that are involved in motor control. Brain tumors, if left untreated, can develop and worsen symptoms over time, as well as influence things other than muscular function.

• Brain Lesions

Hemiplegia or hemiparesis can be caused by brain lesions. This is due to the fact that these lesions might impair function on one side of the brain. Lesions are patches of brain tissue that have been injured by an accident or illness. These are sometimes mistaken with brain tumors, although lesions are not the same.

A lesion differs from a tumor in that it does not normally continue to grow on its own (unless repeated injuries occur at the site of the lesion because of strokes or infections).

• Brain Diseases

Multiple sclerosis and other autoimmune disorders are examples of brain diseases that induce demyelination of the brain. Many brain illnesses can produce brain lesions or other difficulties that result in hemiplegia or hemiparesis.

• Psychological Conditions

Psychological reasons, such as catatonia, can produce hemiplegia in rare cases. People suffering from parasomnia, a sleep condition that causes atypical nocturnal activity, may have hemiplegia at night.

• Loss of Oxygen to the Brain

A lack of oxygen to the brain caused by choking, drowning, anaphylactic shock, or cardiovascular issues can cause lasting brain damage. This, in turn, can result in hemiplegia.

How does hemiplegia occur?

The majority of the time, the reasons of congenital hemiplegia are unknown. Typically, parents become aware of their child's hemiplegia during infancy or early childhood, when the child's difficulties moving on one side progressively becomes apparent.

There is a larger risk in extremely preterm newborns and in numerous pregnancies, and it is unclear if a difficult birth is a contributing factor. However, in most cases, the damage happens at some time during pregnancy, and experts have yet to identify any contributing variables. According to certain research, there may be an elevated risk in societies where near cousin marriage is widespread.

Parents frequently worry that they are to blame, but this does not appear to be the case, since it appears to be primarily a matter of coincidence. A study of twins with hemiplegia found that nothing the mother (or father) did or did not do during the pregnancy altered the child's hemiplegia.

Brain damage causes acquired hemiplegia. The most frequent cause is a stroke (which occurs when a hemorrhage or blood clot affects part of the brain), although it can also be caused by a head injury or illness.

What are the Different Types of Hemiplegia?

While hemiplegia is commonly defined as paralysis on one side of the body, there are other kinds of hemiplegia, some of which are more limited in scope than others. Among the several varieties of hemiplegia are:

• Facial Hemiplegia

This is a kind of partial hemiplegia in which the muscles on one side of the face are paralyzed. It is also known as partial facial paralysis. This is frequently caused by a stroke or other type of brain damage. Facial hemiplegia may be linked with total or incomplete hemiplegia in other parts of the body.

• Spinal Hemiplegia

Hemiplegia induced by a spinal cord injury (typically above the C6 segment of the spinal column) is known as spinal hemiplegia. In most cases, SCI-related hemiplegia is caused by an incomplete SCI rather than a full SCI. Complete spinal cord injury, in which the spinal cord is totally severed, typically result in total paralysis on both sides of the body below the lesion site.

• Contralateral Hemiplegia

Contralateral hemiplegia is caused by brain injury on the opposite side of the body from where the brain damage happened. This is normal in situations of hemiplegia caused by brain injury since the right side of the brain regulates motor function on the left side of the body.

• Cerebral Hemiplegia

When hemiplegia is caused by cerebral palsy (or other brain diseases), it is referred to as cerebral hemiplegia. Cerebral hemiplegia symptoms are frequently comparable to other types of hemiplegia but severity and duration may differ depending on the disease causing the paralysis.

• Spastic Hemiplegia

A kind of hemiplegia in which the muscles on one side of the body are always contracted. This type of hemiplegia can cause persistent muscular soreness, limb abnormalities (in severe cases), and difficulties walking or maintaining motor control. The intensity (as well as the length) of spastic hemiplegia symptoms might vary from case to case.

Symptoms of Hemiplegia

Because paralysis can alter over time, not all patients with hemiplegia are entirely immobile or lose feeling on the afflicted side. However, if the paralysis is not severe, a doctor will most likely diagnose hemiparesis rather than hemiplegia. Hemiplegia symptoms include:

• Difficulty moving, or the inability to move, one side of the body.
• Difficulty with bowel or bladder control.
• Changes or loss in sensation on one side of the body.
• Keeping one hand in a fist.
• Difficulty swallowing or with speech.
• Breathing difficulties.

Hemiplegia can progress over time, causing some regions of the afflicted side to be more severely impaired than others.

Is there a Therapy for Hemiplegia?

Unfortunately, no one therapy works for all hemiplegics. Instead, treatment choices will differ based on the underlying cause of the hemiplegia and the severity of the ailment.

Some potential therapies for hemiplegia include:

Medical Interventions

Medical therapies for hemiplegia are intended to enhance the health of the hemiplegic or to slow the advancement of a disease that may be causing hemiplegia. Medical intervention therapy for hemiplegics include:

• Blood Thinners

Blood thinners are a typical kind of hemiplegia therapy in situations when the hemiplegia was caused by an ischemic stroke. Anticoagulants, or blood thinners, can be used to prevent blood clots in the brain, lowering the risk of future strokes.

People using blood thinners, on the other hand, should exercise caution since they might induce excessive bleeding after an injury.

• Muscle Relaxants

Muscle relaxants may be provided to a spastic hemiplegic to assist the muscles on their paralyzed side relax. For certain hemiplegics, this can help avoid stiffness and discomfort.

• Antibiotics

When a bacterial infection produces a brain or spinal cord injury, one of the first treatments that a doctor may offer is an antibiotic such as amoxicillin. Antibiotics assist the body in fighting off bacteria-based illnesses, hence preventing infection progression.

This is frequently done as the initial step in a therapeutic program prior to surgery to facilitate surgical interventions.

Electrical Stimulation

When therapists employ electrodes to deliver low-level electrical currents directly to a person's muscles, this is referred to as electrical stimulation. Electrical stimulation may be used to stimulate paralyzed muscles to contract in hemiplegics.

This stimulation can assist to minimize muscular spasms, prevent muscle atrophy, and, in certain situations, improve muscle control.

Modified Constraint-Induced Movement Therapy

The use of a "safety mitt" to bind a hemiplegic's less-impaired limbs is part of modified constraint-induced movement therapy (mCIMT). This glove is worn by the patient for several hours every day for several weeks as they perform repetitive tasks.

Surgical Interventions

Surgical interventions are operations that are performed on a hemiplegic to treat a major condition. These are usually performed on hemiplegics who have experienced a serious brain or spinal cord injury that produced their hemiplegia and require surgery to avoid additional harm.

• Remove Swelling or Objects Lodged in the Brain

Surgery is frequently performed on persons who have suffered traumatic brain injuries to minimize swelling caused by blood collection (hematomas) in the brain or to remove foreign objects stuck in the skull space. This can help relieve pressure on the regions of the brain that govern motor function, reducing symptoms in certain hemiplegics.

Removing foreign items, in particular, can be crucial in avoiding infections that might lead to severe brain damage.

• Addressing Secondary Issues Such as Spinal Damage, Muscle Contractions, or Ligament Damage

Surgeons may operate on a hemiplegic patient to treat secondary health issues, such as injury to the spine (such as a herniated disc), aberrant muscle contractions, and damage to the body's ligaments or tendons.

Surgery to treat these difficulties is especially prevalent in situations of hemiplegia caused by a catastrophic injury, which may necessitate months of recovery time.

Therapeutic Interventions

Aside from surgery and medication, hemiplegics may require various sorts of rehabilitation (both mental and physical) to help them adjust to their new way of life. There are several types of therapeutic intervention, such as:

• Physiotherapy and Physical Therapy

Physical therapy is a frequent continuous practice used to help persons with paralysis of various types improve their overall health. Physical therapy is frequently used by hemiplegics to assist avoid muscular atrophy, minimize the incidence of sores, and enhance cardiovascular health.

Physical therapy is concerned with detecting and treating particular mobility disorders as well as increasing the patient's physical health. Physical therapists (PTs) frequently assist hemiplegics in developing physical performance and high behaviors.

• Occupational Therapy

Occupational therapy and physical therapy are quite similar. However, the primary goal of an occupational therapist (OT) is to assist patients return to their regular everyday lives rather than to improve their health.

Whereas a physical therapist may focus on strengthening exercises to avoid atrophy, an occupational therapist may teach a hemiplegic how to cook or assist them in remodeling their house to make it more accessible.

• Psychotherapy

A hemiplegic may require specialist psychiatric therapy following their injury to help them manage with their physical and mental changes, in addition to attending a support group for general counsel and emotional support.

A psychiatrist can use psychotherapy sessions to diagnose a patient's mental health and uncover particular difficulties that may require more therapy.

Assistive Device and Assistive Technology Use

Many people who are paralyzed utilize assistive equipment and technology to retain their independence after being paralyzed. To make life with hemiplegia simpler, hemiplegics may employ motorized wheelchairs, adjustable desks/tables, touchscreen devices, voice-controlled smart home devices, and other equipment.

What is the Difference between Hemiplegia and Hemiparesis?

Hemiparesis and hemiplegia are both symptoms of central nervous system damage. Both obstruct movement and feeling. Both can be difficult to cure and frequently substantially limit normal functioning.

Despite the differences in symptoms, the two illnesses are fundamentally distinct manifestations of the same underlying issue. Hemiparesis results from mild to moderate nerve or brain injury, whereas hemiplegia results from moderate to severe nerve or brain damage. Furthermore, the same injury might result in both symptoms at different periods. This is especially true when nerves are constricted or the spinal cord is enlarged, as variations in swelling or compression can cause symptoms to vary.

It is hard to predict whether a patient will have hemiparesis or hemiplegia early in the course of an injury.

• Hemiparesis is characterized by weakness on one side of the body. A person with hemiparesis may be unable to move their arm or may experience tingling or other strange feelings on only one side.
• Hemiplegia is paralysis on one side of the body. Though preconceptions of paralysis indicate that the capacity to move is fully lost, the truth is a little more nuanced. People who are paralyzed may maintain some feeling, and their level of paralysis may alter over time. As a result, distinguishing between hemiparesis and hemiplegia can be difficult, especially in the case of mild hemiplegia and severe hemiparesis.

Hemiplegia Vs Cerebral Palsy

Traumatic injuries that produce hemiplegia can also cause a number of other disorders. Cerebral palsy, which is described as "a wide term relating to anomalies of motor control or movement of the body caused by an injury to a child's brain," may be confused with hemiplegia. The conflation is simple to create since both states impair motor control.

The main distinction is that hemiplegia is defined as paralysis of one side of the body. Meanwhile, cerebral palsy can compromise motor control in several areas of the body without respect to side.

A doctor may use the term "hemiplegic cerebral palsy" when diagnosing a patient who has cerebral palsy symptoms as well as weakness or paralysis on one side of the body.

Is Hemiplegia Permanent?

Hemiplegia is a lifelong condition; most people will have to live with the condition for the rest of their lives if they suffer a TBI or SCI that develops hemiplegia or hemiparesis.

There are, however, therapeutic choices for hemiplegics that may be successful in alleviating their symptoms. Mobility aids may also assist hemiplegics live healthy, independent, and active lives.

Complications of Hemiplegia

Beyond the fundamental symptoms of hemiplegia, hemiplegics may suffer extra difficulties. Hemiplegia can have the following secondary effects:

• Problems with bladder or bowel control;
• Unexplained pain on their paralyzed side;
• Development of sores on their bodies;
• Poor blood circulation from inactivity;
• Depression and mood swings;
• Septic infections from untreated sores; and
• Muscular atrophy.

Conclusion 

Hemiplegia is a condition in which one side of the body is completely or almost completely paralyzed. This considerably or completely inhibits someone's capacity to move the afflicted portions willingly. Hemiparesis, on the other hand, is a one-sided weakness. In other words, some motor strength remains in the weaker location, although daily functioning may still be impaired.

Because hemiplegia is caused by brain injury, it affects more than simply motor pathways and motor development. Moreover, despite the growing brain's efforts to transfer functions to undamaged regions, almost half of children have additional disorders. 

Hemiplegia cannot be healed, although much may be done to mitigate its symptoms and assist youngsters in reaching their full potential. Understanding hemiplegia and knowing how to assist your child reach his or her full potential are critical.