Either hemiparesis or hemiplegia can result from a variety of medical causes, including congenital conditions, trauma, tumors, traumatic brain injury and stroke.
[1] People with hemiparesis often have difficulties maintaining their balance due to limb paralysis, leading to an inability to properly shift body weight.
Hemiparesis with origin in the lower section of the brain creates a condition known as ataxia, a loss of both gross and fine motor skills, which often manifests as a staggering and stumbling gait.
[2] The pusher syndrome is present in 10.4% of patients with acute stroke and hemiparesis,[5] and may increase the time needed for physical rehabilitation.
When they stand up, the pushing creates a highly unstable situation as they are unable to support their body weight on the weakened lower extremity.
The resulting increased risk of falls must be addressed with therapy aimed at correcting their altered proprioceptive perception of vertical.
[2] Physical therapists treating patients with pusher syndrome focus on motor learning strategies that reduce its ill effects, such as the use of verbal cues, consistent feedback, and practice correcting orientation and shifting weight,[7] for example sitting with their stronger side next to a wall and repeatedly leaning towards the wall, thus gradually re-training the brain to recognize true vertical.
[2] Individuals who present with pusher syndrome or lateropulsion, as defined by Davies, vary in their degree and severity of this condition and therefore appropriate measures need to be implemented in order to evaluate the level of "pushing".
As a lesion that results in hemiplegia occurs in the brain or spinal cord, hemiplegic muscles display features of the upper motor neuron syndrome.
There is also a high incidence of hemiplegia during pregnancy and experts believe that this may be related to either a traumatic delivery, use of forceps or some event which causes brain injury.
[12] Movement of the body is primarily controlled by the pyramidal (or corticospinal) tract, a pathway of neurons that begins in the motor areas of the brain, projects down through the internal capsule, continues through the brainstem, decussates (or cross midline) at the lower medulla, then travels down the spinal cord into the motor neurons that control each muscle.
[citation needed] In a few cases, lesions above the medulla have resulted in ipsilateral hemiparesis: Hemiplegia is identified by clinical examination by a health professional, such as a physiotherapist or doctor.
The leg on the affected side is extended and internally rotated and is swung in a wide, lateral arc rather than lifted in order to move it forward.
The upper limb on the same side is also adducted at the shoulder, flexed at the elbow, and pronated at the wrist with the thumb tucked into the palm and the fingers curled around it.
[19] There are a variety of standardized assessment scales available to physiotherapists and other health care professionals for use in the ongoing evaluation of the status of a patient's hemiplegia.
[21] It measures sensory and motor impairment of the upper and lower extremities, balance in several positions, range of motion, and pain.
It is a clinical measure of voluntary movements and general mobility (rolling, bridging, sit-to-stand, standing, stepping, walking and stairs) following a stroke.
Treatment is focused on improving sensation and motor abilities, allowing the patient to better manage their activities of daily living.
Results from a study on patients with severe hemiparesis concluded that MT was successful in improving motor and sensory function of the distal hemiparetic upper limb.
[32] Active participation is critical to the motor learning and recovery process, therefore it's important to keep these individuals motivated so they can make continual improvements.
Muscles with severe motor impairment including weakness need these therapists to assist them with specific exercise, and are likely to require help to do this.
[36] Intra-muscular injection of botulinum toxin A is used to treat spasticity that is associated with hemiparesis both in cerebral palsy children and stroke in adults.
[37][38] A randomized trial pointed out that individualized homeopathic medication in addition to the standard physiotherapy might have some effect in post-stroke hemiparesis.
[41] Supportive devices, such as braces or slings, can be used to help prevent or treat shoulder subluxation[42] in the hopes to minimize disability and pain.
[43] A treatment method that can be implemented with the goal of helping to regain motor function in the affected limb is constraint-induced movement therapy.
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.
Commonly called braces, orthotics range from 'off the shelf' to custom fabricated solutions, but their main goal is alike, to supplement diminished or missing muscle function and joint laxity.