Overview

Hemiplegia (hemi = half; plegia = paralysis), as the name suggests, literally means paralysis of half of the body, is a type of paralysis of the muscles of the lower face, arm, and leg on one side of the body. hemiplegia is further classified as right or left hemiplegia. Hemiplegia is usually caused by brain damage localized to the cerebral hemisphere opposite the affected side. The most common cause of hemiplegia is stroke, other causes of hemiplegia include trauma eg. spinal cord injury; brain tumours; and brain infections.  hemiplegia can be temporary or permanent. Some causes of hemiplegia are treatable or even reversible with immediate medical care.

Hemiplegia may appear soon after birth (i.e., up to approximately two years of life), where it is known as congenital hemiplegia, or hemiplegic cerebral palsy. On the other hand, acquired hemiplegia presents later in life as a result of injury or other pathology. People living with hemiplegia usually undergo a combination of rehabilitation therapy, which typically involves physical therapists, mental health professionals, and rehabilitation therapists.

A person with hemiplegia can experience up to full paralysis on one side of their body and may have trouble speaking or breathing.

IMPORTANT: Hemiplegia is a key sign of a stroke, which is a life-threatening medical emergency. To recognize the symptoms of a stroke, remember to think FAST:

• F is for face. Ask the person to smile. Look for a droop on one or both sides of their face, which is a sign of paralysis (facial hemiplegia) or muscle weakness.
• A is for arm. A person having a stroke often has muscle weakness or paralysis on one side. Ask them to raise their arms. If they have new one-sided weakness or paralysis, one arm will stay higher while the other will sag and drop downward, or won’t raise up at all.
• S is for speech. Strokes often cause a person to lose their ability to speak. They might slur their speech or have trouble choosing the right words.
• T is for time. Time is critical, so don’t wait to get help! If possible, look at your watch or a clock and remember when symptoms start. Telling a healthcare provider about when the symptoms started can help them know what treatment options are best.

Conditions that cause hemiplegia

There are dozens of conditions and circumstances that can cause hemiplegia. Some of the most common causes include:

• Strokes or transient ischemic attacks (TIAs).
• Aneurysms and hemorrhages inside of your brain.
• Concussions and traumatic brain injuries (TBIs).
• Spinal cord injuries.
• Injuries you experience during birth or very early childhood, causing conditions like hemiplegic cerebral palsy.
• Congenital conditions (which you have when you’re born) such as alternating hemiplegia of childhood.
• Facial paralysis conditions like Bell’s palsy.
• Seizures and epilepsy.
• Bleeding in between your brain and its outer layers (subdural hematomas or subarachnoid hemorrhages) or between your skull and your brain’s outer membrane (epidural hematomas).
• Brain tumors (including cancers).
• Nervous system diseases, especially autoimmune and inflammatory conditions, such as multiple sclerosis or progressive multifocal leukoencephalopathy (PML).
• Infections that affect your nervous system, like encephalitis, meningitis or Ramsay Hunt syndrome.
• Migraine headaches (when these involve hemiplegia, they’re known as hemiplegic migraines).

Hemiplegia symptoms

Hemiplegia can affect either the left or right side of your body. Whichever side of your brain is affected causes symptoms on the opposite side of your body.

People can have different symptoms from hemiplegia depending on its severity. Symptoms can include:

• muscle weakness or stiffness on one side
• muscle spasticity or permanently contracted muscle
• Loss of motor function
• trouble walking
• poor balance
• trouble grabbing objects
• speech associated trouble.

Children with hemiplegia may also take longer to reach developmental milestones than their peers. They may also use only one hand when playing or keep one hand in a fist.

If hemiplegia is caused by a brain injury, the brain damage can cause symptoms that aren’t specific to hemiplegia, such as:

• memory problems
• trouble concentrating
• speech issues
• behavior changes
• seizures

Diagnosis

Hemiplegia is often diagnosed after reviewing the individual’s past medical history and performing a detailed neurological examination assessing sensory and motor functions.

Additional tests can be conducted in order to determine the underlying cause of hemiplegia. Blood tests, including a

Complete blood count (CBC)

Erythrocyte sedimentation rate (ESR)

Coagulation tests (e.g., PT, aPTT) can help eliminate various underlying causes, such as infections or malignancies.

Imaging, including magnetic resonance imaging (MRI)

Computerized tomography (CT) scans of the head, are necessary in order to exclude most pathologies, including strokes, aneurysms, brain tumors, multiple sclerosis, and injuries.

Lastly, electroencephalography (EEG), which measures the electrical activity of the brain, can be used for diagnostic purposes (e.g., reveal the part(s) of the brain from which seizures originate).

Types of hemiplegia

The following are movement disorders that can cause hemiplegia symptoms.

Facial hemiplegia

People with facial hemiplegia experience paralyzed muscles on one side of their face. Facial hemiplegia may also be coupled with a slight hemiplegia elsewhere in the body.

Spinal hemiplegia

Spinal hemiplegia is also referred to as Brown-Sequard syndromeTrusted Source. It involves damage on one side of the spinal cord that results in paralysis on the same side of the body as the injury. It also causes loss of pain and temperature sensation on the opposite side of the body.

Contralateral hemiplegia

This refers to paralysis on the opposite side of the body that brain damage occurs in.

Spastic hemiplegia

This is a type of cerebral palsy that predominately affects one side of the body. The muscles on the affected side are constantly contracted or spastic.

Alternating hemiplegia of childhood

Alternating hemiplegia of childhood usually affects children younger than 18 months old. It causes recurring episodes of hemiplegia that affect one or both sides of the body.

Hemiplegia symptoms

Hemiplegia can affect either the left or right side of your body. Whichever side of your brain is affected causes symptoms on the opposite side of your body.

People can have different symptoms from hemiplegia depending on its severity. Symptoms can include:

• muscle weakness or stiffness on one side
• muscle spasticity or permanently contracted muscle
• poor fine motor skills
• trouble walking
• poor balance
• trouble grabbing objects

Children with hemiplegia may also take longer to reach developmental milestones than their peers. They may also use only one hand when playing or keep one hand in a fist.

If hemiplegia is caused by a brain injury, the brain damage can cause symptoms that aren’t specific to hemiplegia, such as:

• memory problems
• trouble concentrating
• speech issues
• behavior changes
• seizures

Treatment

Treatment of hemiplegia involves a multidisciplinary approach. Healthcare professionals including physicians, physical therapists, occupational therapists, and psychologists must all contribute in order to assist affected individuals in regaining their functionality. Treatment typically aims at improving sensation and motor abilities so that individuals can perform their daily activities with as much independence as possible; as well as treating any underlying pathology causing the hemiplegia.

Physiotherapy

Working with a physiotherapist allows people with hemiplegia to develop their balance ability, build strength, and coordinate movement. A physiotherapist can also help stretch out tight and spastic muscles.

When hemiplegia isn’t temporary, healthcare providers often recommend rehabilitation in addition to other treatments. Rehabilitation can take place in a hospital (inpatient rehabilitation), clinic or office (outpatient rehabilitation), or at home. Rehabilitation generally includes:

• Physical therapy: Focused on leg function, standing, walking and balance.
• Occupational therapy: Focused on arm/hand function and other activities of daily life.
• Prescription of equipment, to enhance safety and the ability to function inside and outside of your home.
• Managing symptoms associated with hemiplegia, such as spasticity and depression.
• Guidance and resources to address the consequences of hemiplegia, for example, returning to work or applying for disability benefits.

Modified constraint-induced movement therapy (MCIMT)

Modified constraint-induced movement therapy involves restraining the side of your body unaffected by hemiplegia. This treatment option forces your weaker side to compensate and aims to improve your muscle control and mobility.

One small studyTrusted Source published in 2018 concluded that including mCIMT in stroke rehabilitation may be more effective than traditional therapies alone.

Assistive devices

Some physical therapists may recommend the use of a brace, cane, wheelchair, or walker. Using an assistive deviceTrusted Source may help improve muscular control and mobility.

It’s a good idea to consult a healthcare professional to find which device is best for you. They may also recommend modifications you can make to your home such as raised toilet seats, ramps, and grab bars.

Mental imagery

Imagining moving the paralyzed half of your body may help activate the parts of the brain responsible for movement. Mental imagery is often paired with other therapies and is rarely used by itself.

One meta-analysis looking at the results of 23 studies found that mental imagery may be an effective treatment option for regaining strength when combined with physical therapy.

Electrical stimulation

A medical professional can help stimulate muscular movement by using electrical pads. The electricity allows muscles that you can’t move consciously to contract. Electrical stimulation aims to reduce imbalances in the affected side of the brain and improve brain plasticityTrusted Source

Hemiplegia is Preventive when you..

• Pursue a healthy lifestyle (stop smoking, drink in moderation)
• Eat a balanced diet
• Attend scheduled check-up appointments
• Avoid exposure to extremes of temperature
• Try to avoid emotional stress
• Avoid physical fatigue
• Protect yourself against respiratory system infections

Conclusion

Hemiplegia is a severe paralysis on one side of your body caused by brain damage. It’s a non-progressive disorder and doesn’t get worse once it develops. With a proper treatment plan, it’s possible to improve the symptoms of hemiplegia.

If you’re living with hemiplegia, you can make the following changes to your lifestyle to aid your rehabilitation:

• Stay active to the best of your ability.
• Modify your home with assistive devices like ramps, grab bars, and handrails.
• Wear flat and supportive shoes.
• Follow your doctor’s recommendation for assistive devices.

Remember to think FAST

• F is for face. Ask the person to smile. Look for a droop on one or both sides of their face, which is a sign of paralysis (facial hemiplegia) or muscle weakness.
• A is for arm. A person having a stroke often has muscle weakness or paralysis on one side. Ask them to raise their arms. If they have new one-sided weakness or paralysis, one arm will stay higher while the other will sag and drop downward, or won’t raise up at all.
• S is for speech. Strokes often cause a person to lose their ability to speak. They might slur their speech or have trouble choosing the right words.
• T is for time. Time is critical, so don’t wait to get help! If possible, look at your watch or a clock and remember when symptoms start. Telling a healthcare provider about when the symptoms started can help them know what treatment options are best.

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