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Diabetic Ketoacidosis

Overview

Diabetic ketoacidosis (DKA) is an acute, major, life-threatening complication of diabetes characterized by hyperglycemia, ketoacidosis, and ketonuria.It occurs when absolute or relative insulin deficiency inhibits the ability of glucose to enter cells for utilization as metabolic fuel, the result being that the liver rapidly breaks down fat into ketones to employ as a fuel source. The overproduction of ketones ensues, causing them to accumulate in the blood and urine and turn the blood acidic. DKA occurs mainly in patients with type 1 diabetes, but it is not uncommon in some patients with type 2 diabetes.

Signs and symptoms of diabetic ketoacidosis

The most common early symptoms of DKA are the insidious increase in polydipsia and polyuria. The following are other signs and symptoms of DKA:

  • Malaise, generalized weakness, and fatigability

  • Nausea and vomiting; may be associated with diffuse abdominal pain, decreased appetite, and anorexia

  • Rapid weight loss in patients newly diagnosed with type 1 diabetes

  • History of failure to comply with insulin therapy or missed insulin injections due to vomiting or psychological reasons or history of mechanical failure of insulin infusion pump

  • Decreased perspiration

  • Altered consciousness (eg, mild disorientation, confusion); frank coma is uncommon but may occur when the condition is neglected or with severe dehydration/acidosis

Signs and symptoms of DKA associated with possible intercurrent infection are as follows:

  • Fever

  • Coughing

  • Chills

  • Chest pain

  • Dyspnea

  • Arthralgia

Diagnosis and Tests

How is DKA diagnosed?

Healthcare providers diagnose diabetes-related ketoacidosis if you have the following four conditions:

  • Your blood glucose (sugar) level is above 250 mg/dL. It’s possible to have DKA if your blood sugar is lower than 250 mg/dL. This is euglycemic diabetes-related ketoacidosis (euDKA). It’s not as common.
  • Your blood pH is less than 7.3 (acidosis).
  • You have ketones in your pee and/or blood.
  • Your blood bicarbonate level is less than 18 mEq/L.

What tests are used to diagnose DKA?

In the hospital, healthcare providers may use the following tests to diagnose DKA:

  • Blood glucose test.
  • Ketone testing (through a urine or blood test).
  • Arterial blood gas (ABG).
  • Basic metabolic panel (BMP).
  • Blood pressure measurement.
  • Osmolality blood test.

You can take a few at-home tests to see if you could have DKA, including:

  • Urine ketone test: This measures the number of ketones in your pee. It’s usually a strip that’ll turn a certain color depending on the ketone levels in your pee. You can buy urine ketone tests at your local pharmacy without a prescription. Follow the instructions on the packaging to be sure you’re doing the test properly.
  • Blood ketone test: Some at-home blood glucose meters can check blood ketones as well as blood sugar levels with a drop of blood. Some meters just check ketones in your blood.
  • Blood sugar checks: High blood sugar (above 250 mg/dL) is a sign that you could have DKA. Checking your blood sugar with a blood glucose meter or using a continuous glucose monitor (CGM) are the only ways to know for sure if you have high blood sugar.

Treatment for diabetic ketoacidosis (DKA)

If you have diabetic ketoacidosis (DKA) you’ll need to be admitted to hospital for urgent treatment.

You’ll be given insulin, fluids and nutrients through a drip into your vein.

You’ll be monitored for complications, as DKA can sometimes affect your brain, heart or lungs.

Once your ketones are at a safe level and you can eat and drink normally you’ll be able to go home.

The doctors will talk to you about what caused DKA and give you advice on how to reduce the risk of it happening again.

Prevention

DKA is a serious condition, but you can take steps to help prevent it:

  • Check your blood sugar often, especially if you’re sick.
  • Keep your blood sugar levels in your target range as much as possible.
  • Take medicines as prescribed, even if you feel fine.
  • Talk to your doctor about how to adjust your insulin based on what you eat, how active you are, or if you’re sick.

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Paralysis and Paresis

Overview

Paralysis, paresis, and plegia are all terms related to loss of motor function,  A nervous system problem causes paralysis Even though both paralysis and paresis are related to muscle weakness, there is a significant difference in their severity and how they affect the human body. Plegia, or paralysis, is a complete paralysis of skeletal muscles. whereas paresis is partial or restricted weakness of the muscles. Understanding the differences between paralysis and paresis is essential for proper diagnosis and treatment. Homoeopathic remedies can help improve muscle strength, reduce pain, and support the body’s natural healing processes in addition to this lifestyle changes and physical therapy can also help treat paresis and paralysis.

difference between paralysis and paresis

Paralysis 

The term paralysis refers to a physical condition that causes a complete loss of muscle function in one or more areas of the body. It occurs when the brain or spinal cord is damaged, resulting in the inability of the affected muscles to move voluntarily. Paralysis can affect different parts of the body, including the arms, legs, face, and trunk. There are different paralysis types, such as:

  • Monoplegia: Paralysis in one limb or body part.
  • Hemiplegia: Paralysis on one side of the body.
  • Paraplegia: Paralysis from the waist down.
  • Quadriplegia: Paralysis from the neck down.

Paresis

Paresis, on the other hand, is a medical condition that causes partial loss of muscle function in one or more areas of the body. It occurs when there is damage to the nerves that control muscle movement. Unlike paralysis, paresis only affects the strength and control of the muscles and not their ability to move. There are different types of paresis, such as:

  • Hemiparesis: Weakness on one side of the body.
  • Paraparesis: Weakness in both legs
  • Quadriparesis. Quadriparesis is muscle weakness that affects all four limbs.
  • Bell’s palsy. Bell’s palsy is a condition that leads to temporary weakness in your facial muscles, which can cause facial drooping and pain.
  • Vocal cord paresis. Vocal cord paresis affects the movement of your vocal cords. The condition often leads to a soft voice or hoarseness, as well as feelings of breathlessness when speaking.
  • Gastroparesis. Gastroparesis is a condition where the emptying of the stomach is impaired due to muscle weakness. It’s associated with symptoms like nausea, vomiting, bloating, and feeling full quickly.
  • Todd’s paresis. Todd’s paresis is a type of paresis that occurs following a seizure. It’s often associated with paresis in one limb (monoparesis) or on one side of the body (hemiparesis).
  • Neurosyphilis. Neurosyphilis occurs when a syphilis infection attacks the nervous system. It can cause paresis as well as headaches, changes in behavior, and dementia.
  • Spastic paresis. Spastic paresis is a condition that causes muscle overactivity and spasticity. It’s due to nerve damage that often results from conditions like stroke, MS, and cerebral palsy. This can lead to pain as well as difficulty with activities like walking or getting dressed.

Causes of Paralysis and Paresis

Both paralysis and paresis can have different causes, ranging from traumatic injuries to medical conditions.

Some common causes of paralysis include:

  • Traumatic Injuries: Trauma to the brain or spinal cord can cause paralysis. This may occur due to accidents, falls, or sports injuries.
  • Strokes: A stroke occurs when the blood supply to the brain is disrupted, causing brain damage. This can lead to paralysis on one side of the body or in specific areas of the body.
  • Tumors: Tumors in the brain or spinal cord put pressure on nerves and cause paralysis.
  • Neurological Disorders: Certain neurological disorders, such as multiple sclerosis and Parkinson’s disease, can cause paralysis.
  • Infections: Some infections can also cause paralysis, such as Lyme disease, polio, and botulism.

Similarly, paresis can also be caused by various factors, such as:

  • Nerve Damage: Paresis occurs due to nerve damage caused by trauma or injury, autoimmune disorders, infections, or tumors.
  • Medications: Certain medications, such as those used to treat cancer, also cause paresis as a side effect.
  • Stroke: Paresis can occur due to a stroke, which is typically less severe than paralysis.
  • Spinal Cord Injuries: Injuries to the spinal cord are also one of the main causes of paresis.
  • Autoimmune Disorders: Some autoimmune disorders, such as Guillain-Barre syndrome, can cause paresis by attacking the nerves.

Symptoms of Paralysis and Paresis

The symptoms of paralysis and paresis differ depending on the location and extent of the damage to the nerves or muscles. In general, some common symptoms of paralysis include:

  • Inability to move the affected body part voluntarily
  • Loss of sensation in the affected area
  • Muscle stiffness or spasms
  • Difficulty breathing, speaking, or swallowing (in severe cases)

On the other hand, symptoms of paresis may include:

  • Weakness or reduction in muscle strength in the affected area
  • Difficulty performing tasks that require muscle strength or control
  • Fatigue or loss of endurance in the affected area
  • Muscle twitching or cramping

Treatment of Paresis and Paralysis

Learning to live with paralysis is challenging. It can cause dramatic changes to your life, activities and self-image. These changes can result in mental health issues and depression. Talk with your healthcare provider about getting physical and emotional support. Over time, and with rehabilitation, many people with paralysis learn to adapt. Many people lead independent, active lives with paralysis. People with quadriplegia need lifelong help from others, but their minds can stay active. Homoeopathy is a holistic system of medicine that focuses on treating the individual as a whole rather than just the symptoms. In the case of paresis and paralysis, homoeopathic remedies can help improve muscle strength, reduce pain, and support the body’s natural healing processes.

In addition to homoeopathic remedies, lifestyle changes and physical therapy can also help treat paresis and paralysis. Exercise, massage, and other physical therapy help improve muscle strength and control, reduce pain and stiffness, and promote overall healing and recovery.

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Monoplegia Paralysis

Overview

monoplegia

One of the functions of your nervous system is to move your body’s muscles. This includes movements that you control (voluntary) and those that you don’t (involuntary).Paralysis occurs when you’re unable to make voluntary muscle movements. When a part of the nervous system becomes damaged, it can disrupt the signaling activity to a muscle or muscle group. This can lead to muscle weakness (paresis) or paralysis in the affected area. Monoplegia is often caused by cerebral palsy. It can also be caused by an injury or trauma to the brain, spinal cord, or affected limb. therefore monoplegia is a form of paralysis that affects just one limb. most commonly an arm, even though it can also affect one of your legs. The main symptom of monoplegia is the inability to move one of your arms or legs. There’s currently no cure for paralysis, including monoplegia. Instead, treatment aims to address the symptoms while improving quality of life.

Causes  Of Monoplegia

Monoplegia is often caused by cerebral palsy. It can also be caused by an injury or trauma to the brain, spinal cord, or affected limb.

Other possible, though less common causes, include:

  • stroke
  • tumors affecting the brain or spinal cord
  • peripheral nerve compression, due to conditions like a herniated disc, bone spurs, or a tumor
  • nerve inflammation (neuritis)
  • peripheral neuropathy
  • a motor neuron disease that affects a single limb, such as monomelic amyotrophy
  • autoimmune neurological diseases such as multiple sclerosis or Guillain-Barre syndrome (GBS)
  • Epilepsy
  • Aneurysm
  • Lumbar radiculopathy

Symptoms of monoplegia paralysis

  • Decreased sensation
  • Muscle stiffness or spasms
  • Feelings of numbness or tingling
  • Loss of muscle tone or muscle floppiness
  • Curling of the fingers or toes on the affected limb

Diagnosis of monoplegia

Diagnosis of monoplegia involves the following steps:

  • Medical History: A detailed medical history of the patient will be taken to gather information about any underlying diseases that may have caused the monoplegia. For example, if there is rapid onset of symptoms, it is suggestive of stroke. Therefore, the medical history will help the doctors to decide on investigations that need to be performed to clinch the diagnosis.
  • Physical Examination: A thorough physical exam will be done to assess the condition and help to identify the underlying cause. For example, if there is back pain or radicular pain (pain radiating down the spinal cord), it may be due to compression of the nerves, possibly by a tumor. The physical exam will also detect any motor weakness or loss of sensation in the affected limb.
  • Computed Tomography (CT) Scan: This imaging technique involves a combination of X-rays and computer technology to produce cross-sectional images (‘slices’) of internal body structures. CT scanning can be used for the diagnosis of stroke and its complications such as hemorrhage or bleeding.
  • Magnetic Resonance Imaging (MRI): This imaging technique uses a magnetic field combined with radio waves and a computer to produce very detailed and accurate images of the internal structures. MRI is the imaging modality of choice for diagnosis of acute ischemic stroke. MRI can also detect brachial neuritis caused by varicella-zoster virus (VZV).
  • Electromyography (EMG): This technique assesses muscle function. Electrical sensors are attached to the affected limb and the electrical activities of the nerves that innervate the muscles are measured. For example, conditions such as brachial plexopathy can be diagnosed by performing nerve conduction studies using EMG.

Monoplegia vs Hemiplegia

Monoplegia and hemiplegia are both types of paralysis. but how do they vary from each other?

Monoplegia is paralysis that affects a single limb of the upper or lower part of the body. so, for instance, if you had monoplegia and could not move your right arm, you would still be able to move your right leg. hemiplegia is paralysis that affects one side of the body. either/or the right side or the left side of the body can be affected.

If you had hemiplegia on your right side you would not be able to move your right arm and right leg. the muscles on the right side of your face might further be affected. spell the two conditions are dissimilar hemiplegia and monoplegia share many of the same potential causes. this can include things like injury, stroke, and cerebral palsy.

Treatment for Monoplegia

There’s currently no cure for paralysis, including monoplegia. Instead, treatment aims to address the symptoms while improving quality of life.

Treating the underlying cause of monoplegia is important.

Some of the potential treatment options for monoplegia include:

  • Physical therapy: PT can be used to help maintain or build strength, flexibility, and mobility in the affected limb. Stretches, exercises, or massage may be used to help stimulate muscles and nerves.
  • Occupational therapy: Occupational therapy teaches different techniques to make it easier to perform everyday tasks like getting dressed, bathing, or cooking.
  • Assistive devices: These devices can make day-to-day activities easier. A few examples include walkers, wheelchairs, specialized grips and handles, and voice-activated devices.
  • Medications: Medications may help reduce some of the symptoms associated with monoplegia. Examples include pain medications to alleviate discomfort and muscle relaxants for muscle stiffness or spasms.
  • Surgery: If monoplegia is due to a tumor or nerve compression, surgery may be needed.

Conclusion

Monoplegia can affect the upper or lower body, either one arm or one leg. Symptoms can appear suddenly or progress gradually over time. Monoplegia is often caused by cerebral palsy. But it can also be the result of an injury or trauma to the brain, spinal cord, or the affected limb. Although monoplegia can sometimes improve over time, it may be permanent in some individuals. Treatment options typically focus on alleviating symptoms and improving quality of life.

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Paraplegia

Overview

paraplegia

Paraplegia is a type of paralysis characterized by the loss of motor, sensory, and limb function in the lower half of the body. It is a result of severe damage to the spinal cord and the nervous system or a result of an accident or a chronic condition. Paraplegia mainly affects the trunk, legs, and the pelvic region. You might have trouble moving your legs, feet, and stomach muscles. A doctor may prescribe physical or occupational therapy to help with pain and muscle issues. Physical therapy can also help a person preserve their strength and range of motion. Devices to support mobility, such as a wheelchair or a mobility scooter, are usually necessary. A doctor might also suggest some medications. For example, taking muscle-relaxing medications can help with pain or spasms. Taking blood-thinning medications will reduce the risk of blood clots. In some cases, surgery might be necessary. Surgery can help with swelling and removing lesions. There are currently no treatments to prevent or reverse paraplegia. However, it is possible to treat some of the symptoms and complications that occur. It is also possible for some people to regain partial or complete control over affected areas with time.

Types of Paraplegia

The type of Paraplegia depends on the symptoms and severity of the condition. Some common types of Paraplegia are mentioned below.

Complete Paraplegia

Complete Paraplegia is the total loss of motor and sensory function in the lower body due to spinal cord injury or disease. It can often lead to loss of bladder or bowel control.

Partial Paraplegia

Partial paralysis involves limited muscle function and sensation loss due to nerve damage or injury. Unlike complete paralysis, some movement and feeling remain, though they may be impaired.

Traumatic Paraplegia

Traumatic Paraplegia occurs when a severe injury, like a spinal cord trauma resulting from accidents, falls, or sports-related incidents, leads to paralysis of the lower body. This condition disrupts nerve signals between the brain and lower limbs, causing loss of sensation and movement control.

Non-Traumatic Paraplegia

Non-traumatic Paraplegia refers to lower body paralysis not caused by physical injuries. It can result from conditions like spinal tumors, infections, autoimmune diseases, or congenital abnormalities. Nerve signal disruption causes loss of sensation and motor function. Treatment involves addressing the underlying cause and rehabilitation and assistive measures to improve daily living and mobility.

Spastic Paraplegia

Spastic Paraplegia is a neurological disorder characterized by muscle stiffness and weakness, predominantly affecting the legs. It often stems from genetic mutations impacting nerve cells that control movement. This condition leads to difficulty in walking and coordination. Management includes therapies to alleviate symptoms and enhance functional abilities.

Congenital Paraplegia

Congenital Paraplegia is a rare condition present at birth, involving partial or complete paralysis of the lower body. It can result from genetic mutations, prenatal factors, or developmental issues affecting the spinal cord. Medical intervention and therapies support affected individuals in managing mobility challenges and maximizing their independence and quality of life.

Causes

People with paraplegia usually have an injury to the brain or spinal cord that prevents signaling to the lower body. The loss of signaling causes paralysis of the lower body.

According to the National Spinal Cord Injury Statistical Center, since 38.3% of spinal injuries have been the result of a vehicle accident, and 31.6% have been from falls. Some other common causes include violent crimes and sporting accidents.

Some chronic conditions can also lead to paraplegia. Conditions that might cause paraplegia include:

  • tumors or lesions of the spine or brain
  • neurological conditions, such as strokeTrusted Source or cerebral palsyTrusted Source
  • autoimmune conditions, such as multiple sclerosis

Symptoms

There are many symptoms that can occur in paraplegia. Sometimes, these symptoms will change over time, or even from day to day.

Symptoms might include:

  • a loss of sensation in the lower body
  • impaired mobility
  • weight gain
  • depression
  • phantom bouts of pain or sensation in the lower body
  • chronic pain
  • sexual dysfunction
  • difficulty with bladder and bowel function
  • secondary infections, such as bedsores and skin problems
  • autonomic dysreflexia

Diagnosis

To diagnose paraplegia, a doctor will assess the person’s symptoms and medical history. They may also ask about recent accidents and whether or not the person has any family history of certain conditions.

It is important that they establish the cause of paraplegia to determine the most suitable treatment options.

Diagnosing paraplegia will usually involve medical imaging. These tests help doctors assess the damage and identify the cause of paralysis. For example, they might use an MRI scan, a CT scan, or an X-ray.

To test nerve functioning, the doctor may use electromyography. This test measures the body’s responses to the stimulation of the muscle.

Treatment Options for Paraplegia

There are several options for treating and managing Paraplegia. Depending on the condition and the severity, rehabilitation, assistive devices, medications, surgery, adaptive strategies, psychotherapy, and experimental therapies are options.

Physical Therapy

Physical therapy is pivotal in treating Paraplegia by enhancing muscle strength, flexibility, coordination, and overall mobility in the affected areas. Therapists employ exercises and techniques tailored to the individual’s needs and abilities. This helps improve range of motion, prevent muscle atrophy, manage spasticity, and develop adaptive strategies for daily activities. To maximize functional independence and enhance the quality of life for people with paraplegia, regular physical therapy sessions are a necessity.

Occupational Therapy

Occupational therapy is essential in paraplegia treatment, concentrating on developing practical skills for independent living. Therapists teach techniques for tasks such as self-care, home management, and work-related activities. They recommend adaptive equipment and strategies to enhance the individual’s ability to navigate daily life, fostering self-sufficiency and improving overall well-being despite the challenges posed by Paraplegia.

Medications

Medications are used to manage various aspects of Paraplegia. Muscle relaxants can help alleviate spasticity and muscle stiffness. Pain relievers address discomfort. Antidepressants and anti-anxiety drugs assist with emotional well-being. Blood-thinning medications reduce the risk of deep vein thrombosis—bladder and bowel control medications aid in managing urinary and fecal functions. To enhance mobility and quality of life for individuals with paraplegia, medication plans are tailored to their individual needs. These plans are usually combined with other treatments, such as physical therapy. It is best to consult a medical professional before starting any medication or treatment.

Assistive Devices

Assistive devices are crucial for paraplegia management. Wheelchairs provide mobility, while braces and orthotics support weakened muscles and aid stability. Adaptive tools like reachers, dressing aids, and modified utensils enhance independence in daily tasks. These devices empower individuals to navigate their environment and maintain a more fulfilling life despite mobility challenges.

Surgical Interventions

Surgical interventions address Paraplegia by relieving spinal cord compression, repairing fractures, or correcting deformities. Procedures like decompression surgeries remove pressure on the cord, while stabilization surgeries ensure spinal stability. Surgical options are tailored to the underlying cause and aim to alleviate symptoms, enhance function, and improve overall quality of life.

Rehabilitation Centers

Rehabilitation centers play a vital role in paraplegia treatment, offering comprehensive programs to improve physical, functional, and emotional well-being. Skilled professionals, including physical and occupational therapists, work to enhance mobility, independence, and adaptive skills. These centers provide tailored exercise regimens, mobility training, assistive technology guidance, and psychological support. By focusing on holistic rehabilitation, individuals with Paraplegia can regain self-confidence and maximize their potential for a fulfilling life.

Common Risk Factors for Paraplegia

Various factors contribute to the likelihood of developing paraplegia, ranging from traumatic incidents to medical conditions and genetic predispositions.

  • Traumatic incidents like automobile accidents, falls, and sports injuries leading to spinal cord damage
  • Medical conditions such as spinal tumors, infections, and degenerative disorders
  • Engaging in activities with a higher potential for spinal injuries, such as extreme sports
  • Certain congenital conditions or genetic predispositions increasing the risk of developing paraplegia

Conclusion

Paraplegia is a type of paralysis that affects the lower half of your body. It affects your ability to walk, stand, and do other actions that require control of your legs, feet, pelvic muscles, and stomach.

Paraplegia is generally the result of an injury, but it can also be caused by conditions that damage your spinal cord or brain. There is no cure for paraplegia, but with comprehensive rehabilitation, adaptive strategies, and advancements in assistive technologies, many individuals can significantly improve mobility, independence, and overall quality of life.

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Hemiplegia vs Hemiparesis

 

Overview

hemi

Hemiparesis or hemiplegia are the medical terms, for paralysis of one half of the body. Hemiplegia is a symptom of brain or spinal cord damage where as Hemiparesis refers to weakness in one leg, arm, or side of the face. Hemiplegia describes severe or complete unilateral loss of strength or paralysis. Both may result from a stroke and other conditions. Hemiparesis and hemiplegia may have the same cause, but depending on the severity and location of brain and spinal damage, you may develop one or the other.

Hemiparesis and hemiplegia are both inherently unpredictable, with symptoms that may change over time. Prompt intervention, including extensive physical therapy, can substantially improve the chances of a full recovery. Psychotherapy is also important, since the overwhelming nature of these injuries can interfere with a patient’s ability and willingness to stick with treatment.

Every patient is different, but there is no way to conclusively predict the prognosis of these disorders. Some people spontaneously recover, even with no treatment. Others make little progress, even with extensive treatment. In general, however, the more aggressively a patient works to recover some functionality, the more likely a full or partial recovery becomes.

Hemiparesis and Hemiplegia Causes

There are a number of conditions that can cause hemiparesis or hemiplegia. Examples of hemiparesis and hemiplegia causes include strokes, brain injuries, spinal cord injuries, infections, and a handful of other conditions affecting the central nervous system.

Both hemiparesis and hemiplegia are nervous system disorders, not caused by injury to the affected side of the body. For example, an injury to the spinal cord or brain interferes with the body’s ability to send or receive signals to the region of the body affected by the injury. So, while the left or right side of the body haven’t been damaged directly, the spinal cord injury may cause hemiparesis or hemiplegia.

The most common cause of both injuries is a stroke. Strokes interfere with blood flow to the brain. If a region of the brain that affects movement or perception is affected, hemiparesis or hemiplegia may develop. The affected region is usually the opposite of the side of the brain affected, so an injury to the right side of the brain will affect the left side of the body.

Some other causes of hemiparesis and hemiplegia include:

  • Brain infections such as meningitis or encephalitis
  • Brain cancer or lesions
  • Damage to the neurons due to a degenerative disorder such as Parkinson’s
  • Traumatic injuries, such as a blow to the head during a car accident
  • Congenital disorders such as cerebral palsy

Rarely, psychological conditions can manifest as hemiparesis or hemiplegia. When this occurs, doctors must treat the psychological issue, not the physical symptoms.

Right Hemiplegia vs Left Hemiplegia

Left hemiplegia is the paralysis of limbs on the left side of the body, while right hemiplegia indicates paralysis on the right side of the body. Like hemiparesis, right or left hemiplegia may be caused by damage to the nervous system.

One common cause of left or right hemiplegia is an incomplete spinal cord injury. In an incomplete SCI, only part of the spinal cord is severed, so there may still be some function below the injury site. For example, an incomplete spinal cord injury in the cervical spinal cord might paralyze the left side of the body while leaving the right side functional — though this isn’t guaranteed because the specific nerves severed may alter the effects of the injury.

Right Hemiparesis vs Left Hemiparesis

As the name implies, right hemiparesis is weakness on the right side of the body, while left hemiparesis is weakness on the left side of the body. What causes this weakness in one side of the body and not the other varies, but damage to the nervous system from injury, infection, or degenerative conditions can result in hemiparesis.

In the case of degenerative conditions such as multiple sclerosis or amyotrophic lateral sclerosis (ALS), hemiparesis may progress into hemiplegia with time.

Did you ever thought why is only one side of the body affected?

Your spinal cord and brain have a left side and a right side. The halves are identical. Each half controls the movements on one side of the body.

An injury to one side of the spinal cord or brain may result in weakness or paralysis on the side of the body that half controls.

If you have multiple strokes on both sides of the brain, you may experience hemiparesis or hemiplegia on both sides of the body.

Symptoms of Hemiplegia & Hemiparesis

Hemiplegia is more severe than hemiparesis. It involves a complete loss of strength or paralysis (inability to move) on one side of the body. It may affect your arm, face, or leg only, or all of them.

Although the paralysis may not be extensive (whole body), it could affect your ability to:

  • breath
  • swallow
  • speak
  • control your bladder
  • control your bowel
  • move one side of your body

It’s common for hemiparesis to unevenly affect one side of the body. The disorder is on a continuum, with symptoms ranging from minor and sporadic to extensive and severe. signs include:

  •  Difficulties with motor skills, particularly standing.
  • Weakness in large areas on one side of the body. For example, a patient might be unable to lift his or her arms.
  • Pusher syndrome: a common byproduct of traumatic brain injuries, pusher syndrome causes a person with hemiparesis to shift their weight to the affected side, thereby undermining motor skills and making walking difficult and potentially painful. Doctors use a scale to assess the severity of pusher syndrome. This scale can help doctors make accurate prognostications, in addition to identifying the cause of symptoms.
  • Strain on the unaffected side of the body, which may overcompensate for injuries on the hemiparetic side.
  • Unusual sensations or tingling on the affected side.

Importantly, doctors will look for injuries on the affected side to rule out other causes, such as pinched nerves, muscle strains, or loss of blood flow.

Diagnosing hemiparesis and hemiplegia

A doctor will most likely use a number of diagnostic procedures and imaging tests to diagnose hemiparesis and hemiplegia.

These might include:

  • X-ray
  • magnetic resonance imaging (MRI)
  • computerized tomography (CT) scan
  • electromyography (EMG)
  • myelography (imaging test of your spinal cord)

Treatment for Hemiparesis and Hemiplegia

Though hemiparesis and hemiplegia produce different symptoms, they are substantially similar in cause and treatment. To treat either condition, a doctor will first look at what caused the symptoms. When an infection, growth, or other medical issue causes symptoms, a doctor may first address these symptoms. When a stroke is the culprit, the stroke itself cannot be reversed, but a number of treatments may help restore some or all functioning:

  • Physical, occupational, or exercise therapy to restore functioning and help the brain work around the injury.
  • Assistive devices such as walkers or wheelchairs.
  • Occupational therapy to support independence.
  • Psychotherapy to address the psychological impact of a severe injury.
  • Alternative treatments such as acupuncture and dietary changes.

Conclusion

Though the symptoms are different, the two conditions are essentially different versions of the same underlying problem. Mild to moderate nerve or brain damage will produce hemiparesis, while moderate to severe nerve or brain damage will result in hemiplegia. Moreover, the same injury can produce both symptoms at different times. This is especially true when nerves are compressed or the spinal cord is swollen, since changes in swelling or compression can also produce changes in symptoms.

People living with hemiplegia  and hemiparesis usually undergo a combination of rehabilitation therapy, which typically involves physical therapists, mental health professionals, and rehabilitation .

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Is hemiplegia permanent?

Overview

brain

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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Is hemiparesis a stroke ?

Overview

hemi

Hemiparesis is the medical term for weakness on one side of the body. It is an early sign of stroke and transient ischemic attacks (TIAs). If you experience sudden hemiparesis in a limb or your face for an unknown reason, you should immediately go to the nearest emergency room (ER). Having this symptom unexpectedly can be an early sign of a stroke. You should also seek immediate medical help if you have any other signs of stroke, including balance issues, vision changes, face and arm drooping and speech difficulties. Hemiparesis is a common after-effect of stroke that causes weakness on one side of the body. This one-sided weakness can limit your movement and affect all basic activities, such as dressing, eating, and walking. People often confuse hemiparesis and hemiplegia. Both conditions occur as the result of a stroke.

Symptoms of hemiparesis

Common signs and symptoms of hemiparesis may include:

  • difficulty walking and standing
  • loss of balance and coordination
  • numbness or tingling on one side of the body
  • weakness in one arm or leg
  • weakness in one side of the face that causes drooping of an eyelid or corner of the mouth
  • numbness or weakness in the tongue that interferes with speech and swallowing
  • asymmetry in one side of the body (e.g. lifting both arms and having one of them not come all the way up)

Diagnosis

Complete blood count. This includes a check for your level of platelets, which are cells that help clot blood. A lab will also measure electrolyte levels in your blood to see how well your kidneys are working.

Clotting time. A pair of tests called PT (prothrombin time) and PTT (partial thromboplastin time) can check how quickly your blood clots. If it takes too long, it could be a sign of bleeding problems.

Computerized tomography (CT). Your doctor takes several X-rays from different angles and puts them together to show if there’s any bleeding in your brain or damage to brain cells. They may put dye in your vein first to look for an aneurysm, a thin or weak spot on an artery.

Magnetic resonance imaging (MRI). This uses powerful magnets and radio waves to make a detailed picture of your brain. It’s sharper than a CT scan and can show injuries earlier than a traditional CT.

Carotid ultrasound. This uses sound waves to find fatty deposits that may have narrowed or blocked the arteries that carry blood to your brain.

Echocardiogram. Sometimes a clot forms in another part of the body (often the heart) and travels to the brain. This imaging test of the heart can look for clots in the heart or enlarged parts of the heart.

Angiograms of your head and neck. Your doctor will put dye in your blood so they can see your blood vessels with X-rays. This can help find a blockage or aneurysm.

Hemiparesis treatment may include medical and nonmedical techniques:

  • Electrical stimulation. As part of this method, small electrical pads are placed on the weak muscles of the side that has hemiparesis. An electrical charge is sent to the body that helps the muscles contract. Some of these machines can be used at home once you learn how to use them.
  • Cortical stimulation. This is a bit similar to electrical stimulation, except that the electric current is sent to the tough membrane covering the brain (called the dura). While your brain is subjected to this current, you have to do rehabilitation exercises.
  • mCIT. Modified, constraint-induced therapy is a treatment method that forces you into using the weak side of the body. With regular practice, nerve function may improve in the region. mCIT works well when used with other therapies.

Treating Right Sided hemiparesis

A physical therapist can recommend the appropriate device. Braces, canes, walkers and wheelchairs can increase strength and movement. An ankle-foot orthosis brace can help control your ankle and foot. Repeated practice and regular activity will help increase control and flexibility and re-establish nerve circuitry.

 Possible complications or risks of not treating hemiparesis

The risks of not treating it can be high. In the worst cases, it can result in permanent brain damage, paralysis, loss of abilities or even death.

Conclusion/Takeover

A stroke happens when the flow of blood to part of your brain gets cut off. This means your brain can’t get oxygen, and without that, brain cells can be damaged in minutes. That’s why it’s important to get to the emergency room right away if you think you’re having a stroke. You might need a clot-busting drug within the first 3 hours.

The F-A-S-T test is an easy way to remember them:

  • Face: Smile. Does one side of your face sag?
  • Arms: Raise both and see if one droops.
  • Speech: Say a common phrase: Does it sound strange or slurred?
  • Time: Call Ambulance service right away if you notice any of these symptoms. Note what time they started.

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Blepharoplasty

Overview

ble

The eye is an important component of facial aesthetics, blepharoplasty often means removing excess skin, muscle and underlying fatty tissue. Blepharoplasty play a vital positive role in facial harmony and the perception of aging. Blepharoplasty is one of the most commonly performed facial cosmetic procedures. Symptoms such as tired-looking eyes, excess skin, droopy eyelids, or circles around the eyes may benefit from blepharoplasty. You might be a good candidate for this procedure if your vision is affected by sagging skin. Some people may complain that their vision when looking upwards is blocked by the hanging skin.

people who have blepharoplasty say they feel more self-confident and feel they look younger and more rested. For some people, surgery results may last a lifetime. For others, droopy eyelids can recur. Bruising and swelling generally lessen slowly in about 10 to 14 days. Scars from the surgical cuts may take months to fade.

Causes

Blepharoplasty might be an  ideal option for:

  • Baggy or droopy upper eyelids
  • Excess skin of the upper eyelids that partially blocks peripheral vision
  • Excess skin on the lower eyelids
  • Bags under the eyes

Blepharoplasty can be done at the same time as another procedure, such as a brow lift, face-lift or skin resurfacing.

Symptoms

Patient with below symptoms may require blepharoplasty

  • Tired-looking eyes
  • Excess skin
  • Droopy eyelids
  • Circles around the eyes

Risks involved

All surgery has risks, including reaction to anesthesia and blood clots. Besides those, rare risks of eyelid surgery include:

  • Infection and bleeding
  • Dry, irritated eyes
  • Difficulty closing the eyes or other eyelid problems
  • Noticeable scarring
  • Injury to eye muscles
  • Skin discoloration
  • Temporarily blurred vision or, rarely, loss of eyesight
  • The need for follow-up surgery.

Treatment

eye

Depending on your goals and the recommendation of your surgeon, blepharoplasty can involve your upper eyelids, lower eyelids or both.

Upper blepharoplasty

During an upper blepharoplasty, your surgeon will make cuts (incisions) in the natural crease of your upper eyelid. These incisions will be hidden when your eyes are open. Your surgeon will remove excess skin and protruding fat, and then they’ll close the incisions.

Lower blepharoplasty

During a lower blepharoplasty, your surgeon will make an incision just below your lower eyelash line. They’ll remove excess skin in your lower eyelid through this incision. They may also use an incision hidden inside your lower eyelid (transconjunctival incision) to correct lower eyelid issues and redistribute or remove excess fat.

There will be a stitch in each of your upper lids that’ll remain for about a week. The lower lids don’t require stitches if the incisions are made on the inside of your lids. It’s common for swelling and bruising to occur in your upper and lower lids. Expect to stay home from work and limit your activities for several days after surgery to allow your eyelids to heal.

Although the surgery is typically painless, you may have some swelling and bruising. Most people feel comfortable going out in public after 10 to 14 days. But it can take a few months to heal completely.

Recovery

During your blepharoplasty recovery, you can use cold compresses and antibiotic ointment to ease any swelling. Your surgeon will give you specific instructions that may include:

  • How to care for your eyes.
  • Medications to aid healing and reduce the potential for infection.
  • Specific concerns to look for at the surgical site.
  • When to follow up with your surgeon.

Some people experience dry eyes after surgery, but the condition rarely lasts more than two weeks. If you have dry eyes for more than two weeks, contact your healthcare provider.

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Foot drop syndrome

Overview

Foot drop also known as drop foot, is a general term for difficulty lifting the front part of the foot. If you have foot drop, the front of your foot might drag on the ground when you walk. Foot drop can be unilateral (affecting one foot) or bilateral (affecting both feet)at the same time. It can strike at any age. In general, foot drop stems from weakness or paralysis of the muscles that lift the foot. Sometimes foot drop is temporary, but it can be permanent. If you have foot drop, Fortunately, there are several treatment options, which may include a combination of orthotics, physical therapy, and surgical procedures. However, it’s important to seek early treatment to improve the chances of recovery.

Causes

  • multiple sclerosis
  • amyotrophic lateral sclerosis (ALS), commonly known as Lou Gehrig’s disease
  • muscular dystrophy
  • spinal muscular atrophy
  • stroke
  • Charcot-Marie-Tooth disease (CMT), a neurological disorder
  • Parkinson’s disease
  • poliomyelitis, also known as polio

Foot drop can also be caused by injuries to the nerves that control the muscles that lift the foot. The affected nerves may be in the knee or in the lower spine.

Other causes include hip or knee replacement surgery and diabetes. Nerve damage in the eye, which can result in pain when moving the eye or even vision loss, can also cause difficulties with walking.

Other causes of foot drop include nerve compression or a herniated disc.

Symptoms

  • decreased muscle mass
  • frequent trips or falls
  • limpness of the foot
  • loss of sensation in the leg or foot
  • changes in gait, such as raising your leg higher or swinging your leg to the side when walking

Risk factors

The peroneal nerve controls the muscles that lift the foot. This nerve runs near the surface of the skin on the side of the knee closest to the hand. Activities that compress this nerve can increase the risk of foot drop. Examples include:

  • Leg crossing. People who habitually cross their legs can compress the peroneal nerve on their uppermost leg.
  • Prolonged kneeling. Occupations that involve prolonged squatting or kneeling — such as picking strawberries or laying floor tile — can result in foot drop.
  • Wearing a leg cast. Plaster casts that enclose the ankle and end just below the knee can exert pressure on the peroneal nerve.

Treatment

Treatment depends on the specific cause of foot drop. The most common treatment is to support the foot with lightweight leg braces and shoe inserts, called ankle-foot orthotics. Exercise therapy to strengthen the muscles and maintain joint motion also helps to improve gait. Devices that electrically stimulate the peroneal nerve during footfall are appropriate for a small number of individuals with foot drop. In cases with permanent loss of movement, surgery that fuses the foot and ankle joint or that transfers tendons from stronger leg muscles is occasionally performed.

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Pressure sores

Overview

You may know pressure sores by their more common name i.e, bedsores, pressure ulcers and decubitus (‘lying down’) ulcers. Bedsores can arise over hours or days. Pressure sores are areas of damage to the skin and the underlying tissue caused by constant pressure or friction. This type of skin damage can develop quickly to anyone with reduced mobility, such as older people or those confined to a bed or chair.

It affects the skin over bony areas such as the heels, elbows, the back of the head and the tailbone (coccyx) is particularly at risk. The lack of enough blood flow can cause the affected tissue to die if left untreated. Pressure sores can be difficult to treat and can lead to serious complications. Pressure sores are graded to four levels, If found early, there’s a good chance these sores will heal in a few days, with little fuss or pain. Without treatment, they can get worse. Most sores heal with treatment, but some never heal completely. You can take steps to put a stop to bedsores and help them heal.

Warning signs of pressure sores

Daily checks are needed to look for early warning signs including:

  • red, purple or blue torn or swollen skin, especially over bony areas
  • signs of infection, such as skin warmth, swelling, cracks, calluses, and wrinkles.

 Pressure Sores Diagnosis   

  • When did the sore appear?
  • Does it hurt?
  • How often do you change positions?
  • Have you ever had a pressure sore before?

 

Pressure Sores Stages/Grades and their  Symptoms

pressure sore

There are four stages of pressure sores from mild to severe:

Stage I

This is the mildest stage. These pressure sores only affect the upper layer of your skin.

Symptoms: Pain, burning, or itching are common symptoms. The spot may also feel different from the surrounding skin: firmer or softer, warmer or cooler.

You may notice a red area on your skin. If you have darker skin, the discolored area may be harder to see. The spot doesn’t get lighter when you press on it or even 10-30 minutes after you stop pressing. This means less blood is getting to the area.

Stage II

This happens when the sore digs deeper below the surface of your skin.

Symptoms: Your skin is broken, has an open wound, or looks like a pus-filled blister. The skin around it may be discolored.

The area is swollen, warm, and/or red. The sore may ooze clear fluid or pus. And it’s painful.

 Stage III

These sores have gone through the second layer of skin into the fat tissue.

Symptoms: The sore looks like a crater and may have a bad odor. It may show signs of infection: red edges, pus, odor, heat, and/or drainage. The tissue in or around the sore is black if it has died.

Stage IV

These sores are the most serious. Some may even go so deep they affect your muscles, ligaments, and bones.

Symptoms: The sore is deep and big. Skin has turned black and shows signs of infection—red edges, pus, odor, heat, and/or drainage. You may be able to see tendons, muscles, and bone.

Other stages

In addition to the four main stages for bed sores, there are two others:

Unstageable is when you can’t see the bottom of the sore because it’s covered in a layer of dead skin. Your doctor can only stage it once it’s cleaned out.

Suspected deep tissue injury is when the surface of the skin looks like a stage I or II sore, but underneath the surface, it’s a stage III or IV sore.

Risk factors for pressure sores

A pressure sore is caused by constant pressure applied to the skin over a period of time. The skin of older people tends to be thinner and more delicate, which means an older person has an increased risk of developing a pressure sore during a prolonged stay in bed.

Other risk factors for pressure sores include:

  • immobility and paralysis – for example due to a stroke or a severe head injury
  • being restricted to either sitting or lying down
  • impaired sensation or impaired ability to respond to pain or discomfort. For example, people with diabetes who experience nerve damage are at increased risk of pressure sores
  • urinary and faecal incontinence – skin exposed to urine or faeces is more susceptible to irritation and damage
  • malnutrition – can lead to skin thinning and poor blood supply, meaning that skin is more fragile
  • obesity – being overweight in combination with, for example, immobility or being restricted to sitting or lying down can place extra pressure on capillaries. This then reduces blood flow to the skin
  • circulation disorders – leading to reduced blood flow to the skin in some areas
  • smoking – reduces blood flow to the skin and, in combination with reduced mobility, can lead to pressure sores. The healing of pressure sores is also a slower process for people who smoke.

If you use a wheelchair you’re most likely to develop a pressure sore on the parts of the body where they rest against the chair. These may include the tailbone or buttocks, shoulder blades, spine and the backs of arms or legs.

If you’re bedridden, pressure sores can occur in a number of areas, including:

  • back or sides of the head
  • rims of the ears
  • shoulders or shoulder blades
  • hipbones
  • lower back or tailbone
  • backs or sides of the knees
  • heels, ankles and toes.

Treatment for pressure sores

There are a variety of treatments available to manage pressure sores and promote healing, depending on the severity of the pressure sore. These include:

  • regular position changes
  • special mattresses and beds that reduce pressure
  • being aware of the importance of maintaining healthy diet and nutrition
  • dressings to keep the sore moist and the surrounding skin dry. There is no advantage of one type of dressing over another.
  • saline gauze dressing may be used if ointments or other dressings (for example foam dressings) are unavailable.
  • light packing of any empty skin spaces with dressings to help prevent infection
  • regular cleaning with appropriate solutions, depending on the stage of the sore
  • there is no advantage of one particular type of antiseptic (e.g. iodine) or antibiotic treatment over another
  • specific drugs and chemicals applied to the area, if an infection persists
  • surgery to remove the damaged tissue that involves thorough debridement of the wound, the removal of underlying or exposed bone, and filling the empty space
  • operations to close the wound, using skin grafts if necessary
  • continuing supportive lifestyle habits such as eating a healthy and nutritious diet, as suggested by the nutritional staff.

Preventing pressure sores

If you are confined to a bed or chair for any period of time, it’s important to be aware of the risk of pressure sores. To prevent skin damage, you or your carer need to relieve the pressure, reduce the time that pressure is applied and improve skin quality. Pressure offloading surfaces such as mattresses and wheelchair cushions may help in providing pressure relief by evenly distributing the pressure.

Pressure injury monitoring devices that measure the skin moisture content, body motion and the pressure in-between may be used to prevent pressure sores and injuries. An example of a devices is pressure-sensing mats placed on beds or wheelchairs.

Develop a plan that your, your carer and any other caregivers can follow. This plan will include position changes, supportive devices, daily skin care, a nutritious diet and lifestyle changes.

A routine nursing assessment may be required if you’re at high risk of pressure sores. As visual skin assessment may sometimes be unreliable, early detection of pressure sores using some bedside technologies may help facilitate preventive interventions.

Pressure from medical devices such as oxygen tubing, catheters, cervical collars, casts and restraints should be minimised or removed.

Position changes to prevent pressure sores

If you use a wheelchair shift position within your chair about every 15 minutes. If you spend most of their time in bed change position at least once every two hours, even during the night and avoid lying directly on your hipbones.

Pillows may be used as soft buffers between your skin and the bed or chair. The head-of-bed elevation should be maintained at/or below 30 degrees. Or depending on the your medical condition, the bed should at least be elevated to the lowest degree to prevent injury. When lying on your side, a 30 degrees position should be used.

Daily skin care to prevent pressure sores

Ways to prevent pressure injuries include:

  • Checking the skin at least daily for redness or signs of discolouration.
  • Keeping the skin at the right moisture level, as damage is more likely to occur if skin is either too dry or too moist.
  • Using moisturising products to keep skin supple and prevent dryness.
  • Never massaging bony areas because the skin is too delicate.

Diet and lifestyle changes to avoid pressure sores

Changes to avoid pressure sores include:

  • Make sure you eat a healthy and nutritious diet. This includes a balanced diet (proteins, fats and carbohydrates) and fluids/water. And if necessary,you’re your doctor about vitamin and nutritional supplements (e.g. zinc, antioxidants).
  • Low body weight or being overweight can cause pressure sores, so make sure you maintain heathy body weight
  • If you’re malnourished or at risk of malnutrition, protein, fluid and energy intake should be increased.
  • Be aware of using good hygiene practices.
  • Maintain activity levels, where appropriate.
  • Make sure you quit smoking.

 Tips for skin care

Consider these suggestions for skin care:

  • Keep skin clean and dry. Wash the skin with a gentle cleanser and pat dry. Do this cleansing routine regularly to limit the skin’s exposure to moisture, urine and stool.
  • Protect the skin. Use moisture barrier creams to protect the skin from urine and stool. Change bedding and clothing frequently if needed. Watch for buttons on the clothing and wrinkles in the bedding that can irritate your skin.
  • Inspect the skin daily. Look closely at your skin daily for warning signs of a bedsore.

Further for any queries in regards to the  medical assistance please feel free to email us on query@gtsmeditour.com or you can whatsapp us on +91 9880149003.

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