Definition
Hemiparesis is a condition that is commonly caused by either stroke or cerebral palsy, although it can also be caused by multiple sclerosis, scle rosis, brain tumors, and other diseases of the nervous system or brain. 1
The word, 'hemi,' means, 'one side, while, 'paresis,' means, 'weakness.' Approximately eightypercent of people who experience a stroke stroke also also have some level of trouble moving one side of their body, or have weakness on one side. Hemiparesis is a condition that is commonly caused by either stroke or cerebral palsy,, although it can also be caused by multiple sclerosis, palsy sclerosis, brain tumors, tumors, and other diseases of the nervous system or brain or brain.. Hemiparesis is related to a condition called,'hemiplagia,' involving paralysis of one side of a person's body, instead of weakness. There are a number of reasons people develop hemiparesis, although the condition most commonly occurs as a secondary complication of another medical issue. The treatment options for hemiparesis differ depending on the reason why a person has developed the condition. 1
Etiology
!rain damage caused by head in"uries, in"uries, cancerous growths in a person's brain, or disease may also lead to the development development of muscle muscle weakness. weakness. #uscle weakness appears in the side of the person's body that corresponds to the area of the brain that has been in"ured. $amage to the person's spinal cord may cord may include damage caused by trauma, such as in"uries received through a fall, a car accident, or a wound wound received received in a fight or combat. combat. %ondition %onditionss including including multiple sclerosis, as well as some forms of cancer , may also cause lesions on a person's spinal cord that interfere with the functioning of their nerves. 1 The muscle weakness that is characteristic of hemiparesis may be caused by lesions lesions in a person's person's spinal cord which damages their nerves and innervates innervates their muscles, leading to weakness. $amage to the person's brain can lead to muscle weakness as well. &troke however, is the most common reason people develop
hemiparesis. At times, muscle weakness is one of the key symptoms of stroke, bringing people to the hospital in the first place.1
Forms of Hemiparesis
(eople who experience hemiparesis can have difficulty moving their legs and arms, walking, and might also have a loss of balance. $ue to this, performing everyday activities such as dressing, eating, grabbing ob"ects, or using the bathroom can be more difficult. )oss of abilities related to a stroke or hemiparesis depend upon the area of the person's brain that has been damaged. 1
*ightsided Hemiparesis +nvolves in"ury to the left side of the person's brain. The left side of a person's brain controls speaking and language. (eople who have this type of hemiparesis can also experience difficulty with talking and understanding what others say, as well as determining left from right.
)eftsided Hemiparesis +nvolves in"ury to the right side of the person's brain, which controls learning processes, certain types of behavior, and nonverbal communication. +n"ury to this area of a person's brain may also cause people to talk excessively, have short attention spans, as well as memory problems.
Ataxia +n"ury to the lower portion of a person's brain may affect their body's ability to coordinate movement. The result is referred to as, 'ataxia,' and might lead to difficulties with walking, balance, and posture.
(ure #otor Hemiparesis (ure motor hemiparesis is the most common type of hemiparesis. (eople who experience this type of hemiparesis have weakness in their leg, arm, and face. The condition may affect the person's body parts eually, or it may affect one body part more than others.
Ataxic Hemiparesis &yndrome Ataxic hemiparesis syndrome involves weakness or clumsiness on one side of a person's body. The person's leg is often more affected than their arm. The symptoms happen over a period of hours to days.
Diagnosis History: +ndividuals report weakness or paralysis on one side of the body, which
may include the arms, legs, facial muscles, tongue, and swallowing muscles. There may be defects in speech -aphasia or difficulty in swallowing -dysphagia./
Physical exam: #uscle weakness is evaluated during the physical and
neurological examination. +dentifying the pattern of muscle weakness or paralysis can help the physician identify where the damage has occurred in the nervous system. #uscle atrophy may be seen in the limbs or trunk of one side of the body. The face, an arm, a leg, or the entire side of the body may be affected. +ndividuals with hemiplegia may have difficulty walking or grasping ob"ects. A loss of ability to coordinate movement -ataxia may be evident and may manifest as problems with body posture, walking, and balance. 0xamination may also reveal a loss of sensation -sensory deficit./
Tests: #*+, %T scan, and cerebral angiogram are the most useful diagnostic tests
to confirm the cause of hemiplegia and the area of brain in"ury. / Hemiparesis Sign
Hemiparesis caused by a lesion of the pyramidal tract. This is the main neural pathway that carries the motor orders. +t is therefore a set of neurons involved in voluntary movement. /
The pyramidal pathway begins in the brain at an area of nerve cells of pyramidal shape and "oined with other nerve cells of the spinal cord. (yramidal tract neurons then transmit their orders to )# which carry them to the muscles. !efore reaching the spinal cord, brain stem, the pyramidal tract changes sides. This
explains that a lesion is locali2ed on the side opposite the affected limb3 left brain in"ury causes a right hemiplegia and vice versa. 4bserved with different depending on the location of the in"ury. •
5hen the lesion in the brain cortex, this causes a disproportionate hemiplegia3 the face and arms are predominantly affected.
•
5hen the lesion is located in the white matter of the brain, this causes a proportional hemiparesis3 arm and leg are affected similarly deficient.
A brainstem lesion, it causes a paralysis of one side of the body and involvement of the face on the other side. /
Hemiparesis Symptoms
+n some cases the lesions, arm and leg are affected, in others only the arm or only the face./ Hemiparesis is partial and that movements are still possible, there is a decrease in muscle strength and mobility impaired, as manifested by clumsiness, trouble walking accompanied by a great tiredness and falls of one side. 6 4n the face, the damage to the muscles can result in a drooping eyelid or an asymmetric smile./
Pathophysiology
+ncreasement of tissue volume of brain typically resulted from brain tumor, a hematoma or cerebral edema cause an increased +%( -+ntracranial (ressure.5hen +%( increases exceed the brain7s compensatory capibilities, compliance decrease and ceberal perfusion pressure deteriorate. (aresis -muscle weakness in the arms and legs is a comprehensive damage on cortical pyramidal neurons . Hemiparase happened suggests that abnormalities or lesions along the pyramidal tract. These lesions may be caused by reduced blood supply, tissue damage by trauma or infection, or direct and indirect suppression by mass hematomas, abscesses, and tumors. This will then lead to a disturbance in the corticospinal tract that is responsible to the muscles upper and lower limbs.
8
A lesion of the cortex is associated with cortical dysfunction3 a right hemiparesis is associated with aphasia and a left hemiparesis with neglect,
dressing apraxia etc. Cortical sensory loss3 -6point discrimination, graphasthesia, and stereognosis 3 there is no point in testing for cortical sensory loss if the patient cannot feel touch or pain or the basic modalities of sensation. 8 To make another important point, "oint position sense loss or loss of two point discrimination does not mean the lesion must be in the hemispheres3 peripheral neuropathies can cause loss of all or any modalities, as can spinal cord lesions3 it is the dissociation between, on the one hand, the ability to feel primary modalities like touch and pain, and on the other hand, the inability to synthesise this information to decide if there are two pins or one, or a key in ones hand, that defines cortical sensory loss.9
+T0*A) %A(&:)0 )0&+4 : The typical features of an internal capsule lesion are3 arm and leg affected eually, often uiet severely weak. There should be no cortical fallout such as aphasia, and if the patient has sufficient sensation to enable testing there should be no cortical sensory loss present. Hemianopia may occur if the retrolentiform area is involved, but this is rare. 9
!*A+&T0#: )ike the spinal cord, lesions of the brainstem cause lower motor neurone disturbance on the level where the lesion is and long tract signs below the lesion. +n the case of the brainstem, naturally, the hemiparesis is on the opposite side to the lesion, as is the sensory loss, "ust like a lesion of the cerebral hemisphere. 9
Rehabitilitation
+ndividuals who suffer from hemiplegia may reuire various rehabilitation services, including physical therapy, occupational therapy, speech therapy, and orthotic management. *ehabilitation services should occur at a freuency of 6 to / timesa week for ; weeks. 6
4ccupational therapy focuses on regaining the ability to perform activities of daily living. +ndividuals learn to perform tasks while sitting down on a kitchen stool. !y instructing individuals in tasks such as these, occupational therapists also engage in balance retraining. +ndividuals also learn dressing and bathing techniues. 4ccupational therapists may order euipment to assist individuals.
4ccupational therapists also promote the return of upper extremity and hand function through a variety of activities. 4ften the upper arm separates -subluxes from the shoulder girdle because of a loss of muscle tone. 4ccupational therapy may use neuromuscular electrical stimulation -#0&, in which electrodes provide external stimulation to the muscles to counteract this symptom. #ore freuently, individuals wear a hemisling that helps support the arm to prevent subluxation. 4ccupational therapists may stretch the upper extremities and teach selfstretching techniues so that the arm can regain maximum potential. +ndividuals also learn strengthening exercises and practice tasks that reuire the affected hand to bear weight, thus sending nerve impulses to the brain so that damaged neural paths can begin to heal. +ndividuals engage in tasks that reuire both hands, such as holding a cup with the hemiplegic hand while pouring a drink using the good hand. As function returns, individuals may engage in fine motor tasks such as handwriting. 6
4ccupational therapists also are instrumental in helping an individual perform activities of daily living, such as housecleaning, gardening, and practicing arts and crafts. They also help individuals learn how to adapt to driving and provide on road training, which may be an important consideration in returning to work.
(hysical therapy focuses on stretching and strengthening the hemiplegic side. Therapists may passively stretch the affected side. +ndividuals and their family members learn to perform a stretching and strengthening program for the legs. (hysical therapy also focuses on transfer training. The therapist teaches the individual to bear weight evenly when sitting and standing so that the individual is aware of the hemiplegic side. +ndividuals also learn mobility techniues such as walking and climbing stairs while using a pyramid cane or 9pronged cane.
4rthotic management may also be reuired for individuals to regain function. 4ccupational therapists may make an individual a night splint, which positions the thumb and fingers so that the hand forms the letter =%.= This position places the hand in a functional position, allowing for full use of the hand if strength returns. An orthotist, who customfits braces and splints, may make an individual a leg splint to promote better control of the ankle and knee during ambulation.
&peech therapy may be reuired to strengthen the muscles of the face for improved speech and swallowing. +ndividuals learn to move the facial muscles in a balanced manner, both by manual assistance and visual cueing through the use of a mirror. +ndividuals perform tongue exercises to allow for better speech and eating. Activities such as sustained vocal expressions help individuals learn to speak with greater clarity. +ndividuals begin eating semimoist, pureed food, which is easier to swallow, and progress to eating food rich in taste, smell, and texture to assist in the swallowing reflex. +ndividuals also learn to achieve sucking control and saliva production.
>ocational therapists may help an individual with hemiplegia identify vocational strengths and develop resumes that highlight those strengths.
Reference
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