What is Hemiplegia? Hemiplegia Rehabilitation and Treatment

by Abbas Jahangir · June 15, 2024

Stroke, defined in medicine as Cerebrovascular Incident (CVO), is defined as the occlusion or rupture of one or more of the vessels feeding the brain, resulting in certain areas of the brain being deprived of oxygen and resulting in brain damage. The effects of stroke vary depending on the area of the brain where the damage occurs. While in some cases it only causes minimal muscle loss, some conditions require urgent intervention and may even result in loss of life. (2)

What is Hemiplegia?

Hemiplegia is defined as loss of neurological and physical function in a certain part of the body due to stroke. (1) This condition, which is confused with stroke by the public, is actually a condition that occurs as a result of stroke. The majority of strokes result in neurological conditions with decreased muscle strength, and hemiplegia is the most common nervous system symptom in this neurological condition.

What are the symptoms of hemiplegia?

The findings observed in the hemiplegic patient vary depending on the region of the brain where the damage occurs, but the most common symptoms can be listed as follows:

Generally, at the beginning of the disease, excessive contraction, defined as spasticity, is observed in the muscles in the affected part of the body. In hemiplegia affecting the arms, spasticity usually occurs with flexion contraction in the form of bending at the elbow, while extension contraction, which can be explained as the desire to move towards the opposite direction of the knee joint, is observed in the legs. This state of the disease is often described as spastic hemiplegia.
Long-term continuation of spasticity results in the muscle stiffening due to excessive contraction, and this condition is defined as rigidity.
In some cases, involuntary muscle movements called dyskinesia occur as a result of the muscle remaining contracted for a long time.
Tremor symptoms develop due to excessive muscle contraction and uncontrollable tremors occur in the relevant muscle.
Another finding that can be observed at almost every stage of the disease is loss of coordination during complex actions such as walking and speaking, and this condition is defined in medicine as ataxia.
In some cases, the muscle in which hemiplegia occurs completely loses its strength and paralysis occurs in the relevant muscle.
In some cases, although the patient has the muscle competence to perform a certain movement, he cannot make the motor planning to perform that movement. This condition is defined as apraxia in medicine. (5)

In addition to all these findings, the hemiplegic patient may also show symptoms such as mental, psychological and psychosocial dysfunction. Since the disease usually occurs in later ages, these symptoms are often overlooked, especially in slowly progressing hemiplegia cases caused by tumors and similar conditions.

What are the causes of hemiplegia?

Since hemiplegia is a condition that occurs as a result of stroke, conditions that cause stroke can also be listed as causes of hemiplegia. In addition to unchangeable risk factors such as age, gender, family history of stroke and genetic predisposition due to race, many systemic diseases can also cause problems such as occlusion or rupture in the brain vessels, thus causing stroke. The main reasons that increase the risk of stroke and cause hemiplegia are:

Age:75% of patients with a history of stroke in the world are over the age of 65. Therefore, age is identified as the most important risk factor for stroke. The risk of developing stroke doubles for every 10 years after the age of 55, even in healthy individuals. Therefore, routine neurological checks are recommended for every individual in their 50s, even if they do not have any systemic disease or family-based genetic predisposition.
Heart Diseases:Heart disease can cause problems such as hardening, narrowing and blockage in the structure of the brain vessels, as well as in all vessels of the body. This situation causes circulatory disorders in the brain vessels, and the risk of stroke increases as a result of the brain cells not being adequately nourished. Among heart diseases, the factor that most increases the risk of hemorrhagic stroke and is treatable is a type of rhythm disorder called atrial fibrillation. Atrial fibrillation increases the risk of stroke by approximately 5 times, and 1 in 4 strokes in individuals over 80 years of age develops due to rhythm disturbance. Considering that approximately 70% of strokes caused by atrial fibrillation can be prevented with the use of oral blood thinners, it is extremely important for neurological health for people diagnosed with heart disease to continue their routine cardiological check-ups. (6)
Diabetes:Diabetes Mellitus (DM) increases the risk of blockages in the arteries and susceptibility to other risk factors such as hypertension, obesity, hyperlipidemia. In this case, the risk of stroke increases 1.8 times in men and 2.2 times in women. (6)
Hypertension: The development of a clot in the brain vessels and the resulting decrease or complete cessation of blood flow to the brain is defined as ischemic stroke. In the presence of hypertension, the risk of ischemic stroke increases 4 times. Approximately 60% of strokes develop due to hypertension, and it is observed that the risk of stroke decreases by approximately 40% with correctly applied antihypertensive treatment. (6)
Smoking:Smoking addiction is a harmful habit that greatly affects the body’s entire vascular structure, circulatory system, lung tissue, blood oxygen saturation, in short, the functioning of all body cells. It increases the risk of stroke approximately 2 times. However, when you quit smoking, the risk of stroke decreases rapidly and it is possible to return to normal within 2-4 years. (6)
Nutrition Containing Animal Food:A person’s lifestyle and eating habits have an impact on stroke and related complications, as in all diseases. It can be said that a plant-based diet particularly supports the vascular structure and also prevents serious illnesses such as stroke by reducing the risk of obesity and diabetes.
Insufficient Physical Activity:The rate of physical activity decreasing with age greatly increases the frequency of various diseases such as stroke. Regular exercise supports the person both physically and spiritually and reduces the incidence of vascular diseases such as CVD as well as serious psychiatric disorders such as Alzheimer’s.

What are the Hemiplegia Diagnosis Methods?

The diagnosis of hemiplegia is usually made by clinical examination. A patient with a history of stroke may experience spasticity and associated contractions in some parts of the body, as well as signs of deterioration in sensory-motor functions and perception. In addition, uncontrollable muscle movements, tremors in the muscles of the affected area, inability to perform complex events such as walking and speaking, muscle stiffness and related body pain develop. Many such findings indicate the presence of post-stroke hemiplegia.

How to Plan the Hemiplegia Recovery Process?

After the patient with a stroke history is stabilized with emergency medical interventions, a detailed neurological examination is performed and each muscle mass is evaluated in detail. Taking into account all findings such as spasticity, rigidity, tremor, loss of sensation, the body parts that develop hemiplegia are identified. A treatment program is created accordingly. Physical therapy and rehabilitation interventions constitute the first step of the recovery process in hemiplegic patients. The aim of physical therapy is to ensure and maintain normal joint movements and to maximize muscle strength and coordination in order to preserve muscle functions.

At this stage, the patient must cooperate with a physiotherapist who is an expert in his field, and the exercises he will do both in the clinic and at home should be planned specifically for the patient by the physiotherapist.

How is Hemiplegia Rehabilitation Provided?

The primary treatment option for all types of hemiplegia is to increase muscle strength to the highest possible level through physiotherapy applications. During these applications, the patient should be evaluated in terms of spiritual, mental and psychosocial aspects as well as physically and neurologically, and physical therapy applications and rehabilitation care should not be considered separately from each other.

During the acute rehabilitation phase, passive range of motion exercises are applied to all joints of the patient. Appropriate physical therapy interventions are planned for hemiplegic muscles along with exercises to strengthen the healthy side extremity. In the acute phase, hemiplegic muscles are strengthened and muscle loss is prevented with passive, active-assisted, active, active-resistant and progressive-resistant exercises in accordance with the condition of the muscles. During this period, the aim is for the patient to gain in-bed sitting skills.

The next phase of rehabilitation is called the chronic rehabilitation phase, and in this period, the aim is for the patient to regain daily living activities while continuing the acute phase exercises. First of all, the patient is asked to do exercises such as turning over or sitting up in bed with the help of a rope. The physical therapy phase of the patient is planned according to the clinical condition and, if clinically appropriate, the parallel bar phase consisting of knee locking, weight bearing, weight transfer, balance and gait training is started.

In order to make an appropriate treatment plan for the patient, it should be known how the patient evaluates the current disease, to what extent he can continue his daily life activities, whether he receives home care and treatment support, to what extent he adapts to the planned exercises, and what his expectations are from the treatment. Handling this entire process holistically, with expert physiotherapists and experienced rehabilitation centers, is one of the critical points for correct hemiplegia treatment. For the correct treatment of hemiplegia, one of the common consequences of stroke, you can consult neurologists who are experts in their field and choose experienced rehabilitation centers.