Hemiparesis Overview and Associated Conditions
Hemiparesis is a medical term that refers to weakness in one side of the body. “Hemi” means half and “paresis” means weakness. It is also associated with the medical term hemiplegia, which means paralysis of one side of the body. For individuals affected with hemiparesis, there is still movement of the affected side of the body but with less strength. One sided weakness can affect the arms, hands, legs and muscles of the face. This weakness impacts the ability to perform daily activities, self-care tasks and walking.
Other common impairments associated with hemiparesis include:
- Balance limitations
- Inability to walk or walking instability
- Limited control of hand function and grip strength
- Impaired coordination and control of precise movements
- Decreased overall independence
Hemiparesis can be the result of many types of conditions and injuries. Most causes of hemiparesis are due to injury to the brain, from loss of oxygen. The main cause of hemiparesis is due to a stroke, in which there is a loss of blood to a part of the brain. Other causes of hemiparesis include: trauma/falls, tumors, traumatic brain injuries, congenital defects, or birth injuries.
The brain is the powerhouse of the central nervous system and all of the bodies functions. The brain is connected to the spinal cord and peripheral nerves leave the spinal cord to innervate the rest of the body. The brain sends signals via nerves to the entire body, controlling all movement and sensations. If there is injury to one part of the brain, then it cannot properly send nerve signals and create movement. This disruption of brain function is why muscle strength is lost. There is no injury to the muscle, but the signal for activation has been lost or diminished.
The location in which the brain injury occurs will determine where the weakness will present. If there is injury to the left side of the brain (which controls speaking and language), it can result in weakness to the right side of the body and negatively affect communication. If there is injury to the right side of the brain, left sided weakness can result. For some brain injuries (though less likely), weakness will be on the same side of injury.
Throughout this book, this condition will be referred to as hemiparesis weakness of muscles on one side for consistency but similar conditions, effects are exhibited in partial paralysis, in paralysis can be identified more specifically and accurately by your health professionals based on an individuals specific cause and effects.
Hemiplegia or hemi·ple·gia/ (-ple´jah) paralysis of one side of the body.
Alternate (or crossed) paralysis of one side of the face and the opposite side of the body.
Cerebral hemiplegia that due to a brain lesion.
Facial hemiplegia paralysis of one side of the face.
Spastic hemiplegia hemiplegia with spasticity of the affected muscles and Increased tendon reflexes.
Spinal hemiplegia that due to a lesion of the spinal cord.
Stroke (Cerebral Vascular Accident)
A stroke is a sudden loss of neurologic function in the brain, caused by an interruption of blood flow to the brain. Strokes can be a result of ischemic or hemorrhagic infarcts. An ischemic stroke is one in which a clot blocks blood flow, depriving the brain of needed oxygen. Ischemic strokes are the most common type, accounting for approximately 80% of strokes. Hemorrhagic strokes happen when blood vessels rupture, leaking blood in and around the brain.
Stroke is the third leading cause of death and most common cause of disability in adults of the United States. As of this writing, It affects 700,000 individuals each year, with 500,000 new cases and 200,000 recurrent strokes. It is estimated that there are 5,400,000 stroke survivors, which accounts for 2.6 percent of the population in the United States. Men are more likely to suffer strokes than women, and African Americans, Mexican-Americans, and American Indians have a higher risk of stroke as compared to Caucasians. Stroke is the most common cause of chronic disability in the U.S. For survivors, 1/3 are functionally dependent after 1 year, meaning they need assistance with daily activities, walking, and/or speech. Approximately 26% of patients with stroke are in a nursing home institution.
After onset of stroke, there are many common clinical findings, including: changes in consciousness, impairment to the sensory and motor systems, as well as changes to the perceptual and language functions. Hemiparesis typically occurs on the side of the body that is opposite the site of brain injury. The brain functions in a manner that motor tasks and sensation crosses the medulla (middle of the brain) to control the opposite side of the body. The location and extent of brain injury, as well as acute management are huge determinants in the long term severity of neurologic deficits.
Motor function is the most commonly affected neurologic side effect of stroke. Motor function is the body’s ability to control movement. Weakness is found in 80-90% of all patients after stroke. Weakness is classified as the individual’s inability to generate the force necessary for controlling or initiating movement.
Typically after stroke, flaccid paralysis is present immediately. This is due to the effects of shock to the brain. Flaccid paralysis is the inability to elicit any movement. It is typically short-lived, lasting days or weeks. Flaccidity can persist in a small number of patients.
Spasticity comes about in about 90% of cases and happens in the side opposite the brain lesion. Spasticity is high tone in muscles. It results in tight/stiff muscles and limits voluntary movement. Whether muscle tone is flaccid or spastic, muscle weakness typically prevails.
Other Types of Brain Injury
Another way to acquire hemiparesis is with a head injury, as a result of trauma or fall. The mechanism of injury is the same as a stroke. With a head trauma, blood is pooled in one portion of the brain, injuring nervous tissue function. It is estimated that 1.5 to 2 million people incur a traumatic brain injury each year. Motor vehicle accidents and falls account for most injuries. Forces on the brain include acceleration, deceleration and rotational strain to the brain tissue against the bony skull. Depending on the area of damage, different areas of muscle strength will be affected. Spinal cord injuries due to trauma or tumors, can also damage neurologic structures, causing paralysis or weakness. Tumors can press on brain structures, causing hemiparesis or hemiplegia. Congenital conditions or birth accidents (like cerebral palsy) can also cause hemiparesis.
Common Problem Areas
For individuals that are affected with weakness in the upper body, it is common to develop shoulder subluxation. Because of decreased muscle tone in the muscles of the shoulder, the humerus (top bone in the arm) can begin to pull down, out of the shoulder socket. This subluxation can be painful, or it can happen without any discomfort. Upper arm slings, taping, as well as electric stimulation of the muscle can all help prevent or correct for subluxation.
For individuals affected with leg weakness, it is common to develop a “foot drop.” A foot drop is a result of inability to control the anterior tibialis muscle, which lies over the front of the lower leg, next to the shin. This weakness leads to an inability to clear the foot when walking. The toe drags and causes a huge risk for falling. To compensate for this weakness, ankle foot orthoses can be worn. This brace supports the foot and ankle, providing rigidity and preventing the toe from dragging. Foot drop care , rehabilitation is addressed in much more needed detail in its own section later in this book.
Inability to fully open the hand is common for people that develop spasticity in their upper body. Because of the high muscle tone in the arm and hand, it is common to lose the ability to fully open the hand. It is essential that the patient pay attention to range of motion in the hand. If spasticity begins, the patient should always hold a small ball in their palm, to keep the hand open and prevent contracture in the palm.
Other Possible Side Effects
Besides loss of muscle strength, there are other unpleasant side effects of brain injury including:
Sensation loss: Sensation is commonly impaired on the affected side. This can create a changing sensation for light touch or sharp touch and temperature sensation. A change in sensation can lead to neglect for the affected side. Unilateral neglect is a situation in which the affected individual has little awareness of the hemiplegic side of the body, resulting in potential injury to that side. Personally, I” have cut myself on my foot during a footdrop dragging incident and didn’t realize it was cut until removing my shoe later in the day. Be careful here.
Pain: Pain is an unfortunate side effect for some individuals after a brain injury. Some experience constant, burning pain with stabbing, sharp pains. Sometimes light pressure or loud noises can elicit painful responses. Pain is also common at joint structures or in muscles with increased muscle tone.
Depending on the severity a neurologist may prescribe medication for management of the pain or discomfort. Myself, I’ve learned to deal with this with meditation practices and I’ve learned I start each day with a 15 minute meditation practice and the end my day with a 10 minute meditation practice. In the early years after my injury, I had limited medication prescribed for pain but back in often make a person drowsy I find as many others meditation helps.
There are also guided meditations and relaxation exercises available on audio and will be references in the appendix.
Vision changes: Visual changes can occur after a stroke, depending on what part of the brain structure is affected. One part of the field of vision can be lost, or patients can have visual neglect, difficulty with depth perception and spatial relationships.
Cognitive impairments: If the cognitive processing area of the brain has been injured, it can cause changes in memory and cognition. Memory problems are often very disruptive for people with brain injury. It can be very frustrating for us not being able to recall quickly. I know it can be embarrassing and causes some very awkward moments. If the injured can use humor better, it puts most everyone at ease.
More tips and training, improvement offered later in this book in care and tips sections. The importance of concentration and focus in improving cognitive processes and physical movement really requires his own section and a chapter will be devoted to this topic with exercises later in the book.
Speech impairments: Aphasia is a medical term that refers to a disruption in speech or the ability to understand verbal communication. Some individuals have difficulty speaking and difficulty expressing themselves verbally. In other individuals, there is difficulty understanding what others are trying to say. After excellent work with a speech therapists in a hospital; clarity of speech improved immensely. I have to note that there should be verbal communication exercised ongoing as not all of us are conversationalists or have families around daily to practice in common communication. As an engineer living alone for years when my daughter was not around, much time was spent not communicating verbally. Even coworkers, relatives and friends out of town all seemed to move to texting or email rather than phone calls. That in itself caused as need for practice, but when tired the effects of slurring letters, words worsened. At first , only early in the morning or late at night when I showed general tiredness, did my speech suffer. But as I aged, I needed to be more focused on speaking clearly. When interacting with store clerks or others unfamiliar with me, I often had to repeat things two, sometimes three times. All this is just to alert the need for communicating regularly even if about simply talking sports or the weather. If not , them out loud reading of somethings every morning or a few times per week even need. to be done to keep limber, in practice. If alone even sing or try to anyway.
Tips and Notes for Improving speech and communication
.The exercises that the speech therapist would of in a hospital or out patient care setting should be continued in the home exercises as in front of a mirror. In general, mirrors are extremely helpful in recovery in the home as being able to watch movements with face, arms or legs is so beneficial.
Communication can be improved between the injured or affected and family members by speaking short sentences and keeping concepts singular say not complicated. Speaking slowly does help yes but speaking exaggerated slowly especially out in public is kind of embarrassing so short sentences probably a better way. When speaking to the injured or affected person please speaking in normal tone of voice. Sometimes people try to exaggerate the slowness as if there is speaking to a little child and that is simply the wrong thing for good communication.
Sometimes during the early healing and even years after during speech, words may come out to in the incorrect order may seem disconnected at times as part of the healing process. Inappropriate language that may be used at times even when the injured person never used that kind of language before. I can tell you personally that brain training is available from some of the most respected sites online these days and I;ll give you references, recommendation in the appendix , can help immensely. A word of caution though with the training is that a small amount a day may be better even in segments , possibly in the morning, midday or night would be better than long sessions since fatigue can set in so easily.
Sleep disturbances: Sleep problems can occur following a stroke or other brain injury. Sleep evaluations, supplemental oxygen and pharmaceutical interventions can help regulate sleep. A way that some, including me, have benefited here is from relaxation audio, guided meditation, and with physician’s approval even brainwave entrainment to induce deep peaceful sleep.
Depression: Unfortunately for many people with hemiparesis, depression is a common side effect. Due to personal loss of independence and strength, feelings of sadness can quickly lead to depression. It has been common for people that have hemiparesis to be on long term antidepressant medications. Myself, avoiding medications is best if natural cure is available and in this case I feel the best course is continued relationships with friends, family and a strong faith.
Care after Brain Injury
After the onset of injury, the first course of treatment will be at the hospital. Imaging studies will examine the brain to look for trauma or dysfunction. A CT (computerized tomography) scan examines the brain structures. This imaging study will reveal an area of injury/dysfunction due to stroke or other brain injury. Other imaging studies that are typically performed include MRI (magnetic resonance imaging) and sometimes X-rays (radiographs) if there is suspicion of any fracture. The individual will receive care from nursing staff and physicians to ensure vital signs are stable and there is no risk of further injury or damage.
The main physician that will oversee the plan of care is the neurologist. Neurologists are physicians that specialize in the systems of the brain and nervous system. The neurologist will examine the function of the nervous system, identifying the area of damage to the brain and classifying extent of physical ramifications. Other physicians may be brought into the plan of care such as a cardiologist to oversee the monitoring of heart function, as well as a trauma doctor in case of injury. A physiatrist is a physician that specializes in rehabilitation. A physiatrist will oversee the care and progression during rehabilitation.
While in the hospital and at extended care, the patient will be cared for by nurses, nurse assistants, respiratory therapists, phlebotomists, nutritionists, case workers, psychologists, and (of course) physical, occupational and speech therapists. The three types of rehabilitation therapists have some overlapping roles, but three distinct specialties. The physical therapist specializes in functional movement training. The occupational therapist specializes in self-care training. The speech therapist specializes in speech and swallowing. Working with all three specialties is essential for rehabilitation progression.
During the recovery process, individuals are typically seen in a hospital setting, rehabilitation setting, home health setting and eventually outpatient clinic settings. The patient and family meet with a large number of healthcare providers for a comprehensive rehabilitation journey. Functional independence and safety are the main factors in determining where a patient will be placed after hospitalization.