Hemiplegia

A left side injury of the brain will cause a right hemiplegia and injury to the right side a left hemiplegia.  This may happen before, during or soon after birth, when it is known as congenital hemiplegia, or later in childhood as a result of injury or illness, in which case it is called acquired hemiplegia.

Effect:
- a varying degree of weakness, stiffness (spasticity) and lack of control in the affected side of the body, rather like the effects of a stroke. In one child this may be very obvious (he or she may have little use of one hand, may limp or have poor balance); in another child it will be so slight that it only shows when attempting specific physical activities.

What can be done to help?
Hemiplegia cannot be cured, but a lot can be done to minimise its effects … the immature brain is very flexible, and some of the functions of the damaged area can be taken over by undamaged parts of the brain in a process known as neuroplasticity. An adult, whose brain pathways are already organised, has much less neuroplasticity and so after a stroke may lose very specific functions, depending on which part of the brain was affected.
The aim will be to improve the child’s participation in everyday activities e.g. play, feeding, dressing, school life. The therapists will work to develop the child’s skills, assessing posture and providing muscle stretching, and possibly strengthening activities. This will help prevent possible secondary consequences of the condition such as pain or the development of contractures (abnormal shortening of the muscles).
Physiotherapists work on balance, weightbearing on the affected side, and developing sensitivity in the affected hand.

Occupational therapy uses play, adaptive and work activities to develop children's motor, cognitive, perceptual and self care skills.
Splints, or orthoses, can help to manage walking patterns in children with hemiplegia.
Orthopaedic surgery
 can correct some of the physical effects of neurological damage, in children with hemiplegia.
Botulinum Toxin injections can be used to treat hemiplegia as part of a movement therapy programme.

Hemiplegia is caused by injury to the brain, it is not just motor pathways and motor development that may be affected.  Some people do have additional diagnoses. Some of these are medical in nature, such as epilepsy, visual impairment or speech difficulties. Many children have less obvious additional challenges, such as perceptual problems, specific learning difficulties or emotional and behavioural problems (Hemihelp, 2014).

“If you can’t do one thing because of your disability find another dream and go for it. Be strong and realise everyone has their weaknesses and just play on your strengths” (Danielle, age 31).

How can Osteopathy help?

Case study

I saw a 33 year old male patient who presented with chronic left wrist pain. 

The cause of his pain was a musculoskeletal / repetitive strain injury. 

He also had congenital right hemiplegia. 

I focused on the individual symptoms that affected him, taking his condition into consideration. He was solely relying on his left hand during his everyday activities.  The osteopathic treatments consisted of soft tissue and muscle energy techniques, as well as gentle to firm joint manipulation. My aim was to improve the range of movement in his restricted thoracic joints.  I used a wide range of non-invasive manual techniques, such as deep tissue massage, joint articulation, trigger point therapy, myofascial release. Medical acupuncture and electrostimulation were particularly beneficial when treating his tight forearm muscles. 

I also recommended the patient to follow specific postural advice, stretching, and an exercise programme.  

It took several months of continuing weekly treatments for the chronic wrist symptoms to eventually resolve. 

Despite his disability, the patient is healthy and physically active and he is now able to continue enjoying his everyday activities. He participates regularly in sports such as horse riding, swimming and rowing.


References:

Hemihelp, 2014. Available online from <http://www.hemihelp.org.uk/hemiplegia/what_is_hemiplegia>. Accessed 28/02/2016.
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