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PubMed1988

Forearm bone loss in hemiplegia: a model for the study of immobilization osteoporosis.

Hemiplegia is associated with excessive bone loss in the paralyzed arm. The forearm bone mineral content was measured at a proximal cortical site and a distal trabecular site of both the normal and hemiplegic arms in 74 patients with hemiplegia. By comparing the ratios of bone mineral content in the two arms, the effect of immobilization could be quantitated independently of the large population variance in bone mineral content. Bone loss, estimated from this single comparison of bone mineral content in the normal and hemiplegic arms, at the trabecular and cortical sites was positively correlated with the duration of stroke and negatively correlated with reduction in forearm function. At the trabecular site females had a proportionately greater bone loss than males, indicating an interaction between gender and immobilization associated bone loss at this site. The regression line of excess bone loss in the hemiplegic limb against time had a negative slope of 1.3% and 1.5% a year of the starting value for the trabecular and cortical sites, respectively, over the 15 years studied. This study indicates that a reduction in function is associated with significant bone loss occurring over prolonged periods that may account, at least in part, for the significant osteoporosis seen in elderly people and in subjects with conditions resulting in reduced mobility such as arthritis, obstructive airways disease, and neurological disease.

Aged↗
PubMed2006

Unusual form of proprioceptive facilitation during recovery from hemiplegia.

Proprioceptive facilitation (PF) is a phenomenon occasionally seen during motor restoration following acute hemiplegia. At an early stage of recovery, a number of brief passive muscle stretches can facilitate voluntary contraction in the stretched muscles. Here we present a patient who during early recovery from a left hemispheric stroke causing right hemiplegia was able to develop maximum isometric arm force if, during this effort, large-amplitude passive stretches of the elbow were applied as conditioning stimuli. Based on clinical and positron emission tomography findings, possible physiological mechanisms of PF and the role of proprioception in stroke recovery are discussed.

Hemiplegia↗
PubMed1992

Abnormal cerebral hemodynamics during attacks of alternating hemiplegia.

Frequent episodes of bilateral weakness and apathy, followed later by hemiplegia of alternating sides were observed in a now 32-month-old girl. Transcranial Doppler ultrasonography showed reduced flow velocities in the middle cerebral artery of the affected side during a hemiplegic attack and increased flow velocities at different sites of the basilar artery during a bilateral episode. These abnormal cerebral hemodynamics appear to indicate that alternating hemiplegia and some forms of migraine have a similar pathophysiology.

Basilar Artery↗
PubMed1995

Alterations of bone mineral density of the femurs in hemiplegia.

We evaluated the bone mineral density (BMD) of the bilateral femurs in 112 patients with hemiplegia using dual-energy X-ray absorptiometry in order to elucidate the effect of disuse and immobilization. BMD of the paretic side was significantly reduced compared with that of the non-paretic side in hemiplegic patients (femoral neck 0.582 +/- 0.014 g/cm2 versus 0.623 +/- 0.014 g/cm2 and total femur 0.645 +/- 0.02 g/cm2 versus 0.702 +/- 0.017 g/cm2; mean +/- SEM, P < 0.01, respectively). Femoral BMD in both the paretic and nonparetic limb had significantly (P < 0.01) lower values than in age- and sex-matched controls, but the paretic side had a more significant reduction of BMD; femoral neck -20% versus -14% and total femur -24% versus -18%. In addition, patients with impaired activities of daily living (ADL), evaluated by a mobility score, had significantly decreased BMD ratios of paretic/nonparetic side than patients with improved ADL (femoral neck 91% versus 97%, P < 0.01 and total femur 89% versus 94%, P < 0.05). Our results indicated that BMD of both femurs of patients with hemiplegia was reduced, although the paretic side showed a greater BMD decrease. This decrease might be prevented or reduced by improvement of ADL.

Activities of Daily Living↗
PubMed2002

Determination of median nerve somatosensory evoked potentials in 27 patients with hemiplegia.

Twenty-seven in-patients with hemiplegia following brain injury were studied by using upper extremity median nerve somatosensory evoked patentials (SVEP), Brunnstrom assessment in hemiplegic hand and assessment of the patients' activities of daily lioing (ADL) (Barthel index). The upper extremity median nerve SEP on the affected and normal sides was determined. By using Kovindha standard, upper extremity median nerve SEP was graded in accordance with N20. The correlation between the differences of SEP N20 amplitude and the latencies on the both sides and the Barthel index scores was analyzed. A Spearman correlation analysis was made between the median nerve SEP N20 grades and Brunnstrom stages in hand or ADL on the affected side. The results showed that upper extremity median nerve SEP grades were positively correlated with those of the Brunnstrom stages in hand (r1 = 0.6925, P1 < 0.01). The correlation coefficient between SEP N20 grades and patients' ADL grades was r2 = 0.5015, P2 < 0.01. It was concluded that upper extremity median nerve SEP could be used as a sensitive electrophysiological predictor to clinically assess hemiplegic hand function. SEP N20 might play a role in predicting the ADL of the patients with hemiplegia to some extent, but could not be used as a sensitive predictor to directly observe and predict the ADL of the patients.

Adult↗
PubMed1997

Hemiconvulsion-hemiplegia-epilepsy syndrome. A clinical, electroencephalographic and neuroradiological study.

Six patients (4 boys and 2 girls) with hemiconvulsion-hemiplegia-epilepsy (HHE) syndrome are described. They had prolonged seizures, lasting from 30 min to 12 h, at ages 1-4 years. These took the form of hemiconvulsion in three of the children and generalized tonic-clonic seizures in the others, being preceded by hemifacial twitching or head and eye deviation in two. They were followed by hemiplegia, which cleared with time in five patients, apart from subtle pyramidal tract signs. One child had spastic quadriparesis, choreiform movements, contracture deformities and severe mental retardation following repeated status epilepticus. Subsequent epilepsy developed in five patients and was satisfactorily controlled with carbamazepine and/or phenobarbitone. Cerebral hemiatrophy was documented in all patients by cranial computed tomography and/or magnetic resonance imaging. Single photon emission computed tomography (done in 4 patients) showed ipsilateral hypoperfusion (of the damaged hemisphere). Electroencephalography showed ipsilateral slowing and low voltage of background activity. Epileptiform discharges were found on the ipsilateral side in two cases and the contralateral side (the undamaged hemisphere) in one.

Atrophy↗
PubMed1989

Hemiplegia and amputation: rehabilitation in the dual disability.

About 10% of all elderly dysvascular amputees have had cerebrovascular accidents at some time. This is an often overlooked but important fact which significantly impacts the outcomes of their rehabilitation, especially where prosthetic ambulation is attempted. This study reviews the rehabilitation outcomes of 46 patients with the dual disability of hemiplegia and amputation. The mean age of the patients was 63 years (range 49 to 84). Forty-one (89%) could participate in a trial of physical therapy, and 25 (54%) in a comprehensive rehabilitation program. Seventeen (37%) were fitted with a prosthesis, and 12 (26%) became independent ambulators. Eighteen (39%) achieved independence in their activities of daily living (ADL) and transfers. Patients were reviewed to establish those features predictive of a good outcome. The following factors were associated with regaining independent ambulation: the presence of a mild hemiparesis with residual hand function (p less than 0.001), a below-knee amputation (p less than 0.01), and a history of ambulation before the second disability (p = 0.05). The ADL independence was associated with a mild hemiparesis (p less than 0.001), and age less than 60 years (p less than 0.05). Incontinence of bowel or bladder was strongly predictive of failure to achieve independence in either ADL or ambulation (p less than 0.001). Of those patients who did achieve independent ambulation, 73% were still ambulating a mean of 16.5 months later. These findings should be considered when planning rehabilitation goals for patients with the dual disability of hemiplegia and amputation.

Activities of Daily Living↗
PubMed1986

gamma-Aminobutyric acid-induced potentiation of cortical hemiplegia.

A novel model of hemiplegia in young and aged rats is described. Osmotic minipumps were used to deliver a chronic (7 days), localized application of gamma-aminobutyric acid (GABA) (100 micrograms/microliter/h), to the somatomotor cortex of unrestrained rats. This resulted in an easily quantifiable, contralateral and reversible motor syndrome in both young and aged animals. In the young group, the motor deficit cleared over 5-day period, while in the aged animals it persisted for at least a 2-week period. Control animals treated with saline-filled minipumps did not develop a long-lasting motor deficit. The GABA-induced facilitation of hemiplegia due to small motor cortex lesions and the age effects on behavioral recovery of function are discussed. Cortical inhibitory mechanisms may play a role in debilitating syndromes such as stroke or post-epileptic paralysis.

Animals↗
PubMed1985

Changes in the recruitment pattern of single motor units in the blink reflex of patients with parkinsonism and hemiplegia.

The recruitment pattern of single motor units (SMUs) was studied in the early (R1) and late (R2) blink reflex components in normal subjects (15), patients with parkinsonism (10) and with hemiplegia due to hemispheral lesions (5). Reflexes were evoked by constant current stimuli applied to the supraorbital nerve. SMU discharges were recorded in the preseptal part of the lower eyelid using a bipolar needle electrode. Thresholds of R1 and R2, latencies at the thresholds and the number of discharges in R2 were determined. In parkinsonism, the recruitment of SMUs in R1 was impaired, suggesting that the malfunction of the basal ganglia in this disorder is associated with a reduced excitability of neurons in the pontine brain-stem. In hemiplegia, the recruitment in both R1 and R2 could be impaired. The orderly function of neurones in the pontine and medullary pathways of these components appears to require facilitatory hemispheral influences. Signs of disinhibition occasionally found in R1 may point to an imbalance between facilitatory and inhibitory hemispheral influences upon the pontine pathway.

Adult↗
PubMed1984

Pure motor hemiplegia and lower cranial nerve palsies in a primary medullary tumor with review of the literature.

A case is described of pure motor hemiplegia and lower cranial nerve palsies in a primary medullary tumor. The literature is reviewed to support the contention that this is a case of primary medullary glioma and to show the uniqueness of the presentation of pure motor hemiplegia with a tumor in this location. A discussion of the problems of brainstem tumor is presented; surgical exploration is recommended if indicated, followed by radiation therapy.

Brain Neoplasms↗
PubMedDate not supplied

Short latency somatosensory evoked potentials and 99mTc-HMPAO SPECT in a case of flunarizine-effective alternating hemiplegia in infancy.

Short latency somatosensory evoked potentials (SSEPs) and 99mTc-hexamethylpropylene amine oxime single photon emission computed tomography (99mTc-HMPAO SPECT) were examined in a patient with alternating hemiplegia in infancy (AHI) before and after flunarizine treatment. The low amplitude and elongation of the latency time at the C'4 level of the interictal SSEPs before treatment were ameliorated by flunarizine administration. The cerebral hypoperfusion in the right hemisphere observed on 99mTc-HMPAO SPECT before treatment improved, as seen by normal and symmetrical imaging, after flunarizine treatment. These observations suggest that AHI is caused by a functional disturbance in the cerebral area contralateral to the hemiplegia, and that SSEPs and 99mTc-HMPAO SPECT are useful for evaluating functional disturbance in the contralateral motoneurons and the effect of flunarizine treatment in AHI patients.

Evoked Potentials, Somatosensory↗
PubMedDate not supplied

Sequential 123I-IMP-SPECT in acute infantile hemiplegia.

Sequential 123I-N-isopropyl-p-iodoamphetamine (IMP) single-photon emission computed tomography (SPECT) was performed in 2 patients with acute infantile hemiplegia. In both patients, low uptake of IMP was detected in the targeted abnormal hemisphere. The 123I-IMP-SPECT findings indicative of a pathologic condition persisted even when the clinical findings and electroencephalographic abnormalities improved. Because of its sensitivity, noninvasiveness, and accurate reflection of the cerebral blood flow distribution, 123I-IMP-SPECT is useful in the examination of acute infantile hemiplegia and in the evaluation of prognosis.

Acute Disease↗
PubMedDate not supplied

Varicella with delayed hemiplegia.

We report 4 children who developed acute hemiplegia 7 weeks to 4 months after varicella infection. In 2 patients, carotid angiography demonstrated segmental narrowing and occlusion of the middle cerebral artery. Their clinical and angiographic features were similar to those associated with contralateral hemiplegia after herpes zoster ophthalmicus, the pathogenesis of which comprises cerebral angiitis due to varicella zoster viral infection. We believe that our patients had the same pathogenesis. In a survey of infectious diseases in our region, the frequency of varicella with delayed hemiparesis was roughly 1:6,500 varicella patients.

Cerebral Angiography↗
PubMedDate not supplied

Ictal 99mTc-HMPAO SPECT in alternating hemiplegia.

99mTc-hexamethylpropylenamine oxime (99mTc-HMPAO) single-photon emission computed tomography (SPECT) was performed in a patient with alternating hemiplegia during 2 episodes of the disease. The regional cerebral blood flow patterns correlated with the clinical manifestations during both episodes. Hyperperfusion of the contralateral hemisphere was suggested by asymmetric 99mTc-HMPAO uptake, whereas symmetric 123I-N-isopropyl-p-iodoamphetamine uptake was detected during the interictal period. The results suggested that alternating hemiplegia in infants represents an atypical manifestation of epilepsy, despite the lack of paroxysmal electroencephalographic abnormalities during the episodes. 99mTc-HMPAO SPECT appears to be a useful method for detecting transient regional cerebral blood flow alterations during paroxysmal events because the tracer is rapidly available for emergencies and retains a fixed distribution for 5-8 hours, sufficient time to allow for SPECT acquisition.

Cerebrovascular Circulation↗
PubMed2005

Children with spastic hemiplegia are equally able as controls in maintaining a precise percentage of maximum force without visually monitoring their performance.

In this study the hypothesis was tested that children with spastic hemiplegia rely more on externally guided visual feedback when trying to keep force constant with their affected hand (AH) as compared to their non-affected hand (NAH) and as compared to controls. An isometric force task in which a cursor had to be moved to a visually specified target that disappeared half way the task, was performed by 19 children with cerebral palsy (CP), spastic hemiplegia, aged between 5 and 16 years and an aged matched control group. It was found that the absolute deterioration of performance after withdrawal of target visualization did differ between AH, NAH and controls. The absolute error was smaller and the variability was larger in the hemiplegic hand. However, the normalized force error and co-efficient of variation increased similarly between groups. Furthermore, power spectrum density analysis of the force signal showed that both hands in both groups had a similar loss in the energy in the 2-3 Hz range when target visualization was removed. These results suggest that CP children are equally able to produce stable force without visually monitoring their performance than children without CP, provided they are allowed to operate within their own force range.

Adolescent↗
PubMed2000

Influencing factors and ambulation outcome in patients with dual disabilities of hemiplegia and amputation.

OBJECTIVE: To determine the ambulatory outcome and predictive factors of successful ambulation training in patients with both hemiplegia and lower extremity amputation. DESIGN: A retrospective study. SETTING: A rehabilitation center of a university hospital. PATIENTS: Twenty-three patients with dual disabilities consecutively admitted to the rehabilitation center from 1984 to 1994. MAIN OUTCOME MEASURES: Ambulatory outcome was measured using physical therapists' and physicians' notes at discharge or the last available clinical visit. Ambulation ability was graded as community and noncommunity ambulation, which included indoor ambulation and nonambulation. Several clinical features were reviewed to assess their association with ambulation outcome. RESULTS: About two thirds of the 23 patients could be trained to be ambulatory: 10 (43.8%) achieved community ambulation and 5 (21.7%) achieved indoor ambulation. Of the clinical factors, only mental status showed a statistically significant association with good ambulation outcome (p<.05). When odds ratios were considered, several factors, including mild motor involvement, transtibial amputation, amputation before cerebrovascular accident, age younger than 60 years, and the presence of ipsilateral hemiplegia and amputation, showed trends toward association with increased ambulation achievement, although these associations were not statistically significant. CONCLUSION: Impaired mental status seemed to be the most influential negative predictive factor of achieving community ambulation. If subjects with dual disabilities are properly selected, satisfactory results of ambulation training will be obtained.

Aged↗
PubMed2003

Intrathecal baclofen in subjects with spastic hemiplegia: assessment of the antispastic effect during gait.

OBJECTIVE: To determine whether leg muscle stiffness is measurably reduced after intrathecal baclofen (ITB) in subjects with spastic hemiplegia. DESIGN: Nonrandomized trial. SETTING: Inpatient multidisciplinary rehabilitation unit in France. PARTICIPANTS: Seven consecutive subjects with spastic hemiplegia having Ashworth Scale scores for their quadriceps and triceps greater than 2. INTERVENTION: Subjects were given ITB by lumbar puncture after a dose-selecting test period. MAIN OUTCOME MEASURES: Triceps and quadriceps Ashworth scores, gait analysis at preferred and maximal speed measured by a motion analysis system with 2 forceplates, and electromyographic recording of leg muscles before and 4 hours after ITB. The slopes of the moment-angle curves were measured on the hemiplegic side at the onset of ankle and knee flexion to assess muscle stiffness during walking. Pre- and post-ITB spatiotemporal, kinetic, and kinematic data were compared by using a nonparametric test (Wilcoxon signed-rank test). RESULTS: Ashworth scores of the quadriceps and triceps of all subjects decreased significantly after ITB. Maximal walking speed increased significantly, with a significant increase in stride length, but the preferred walking speed was unchanged. Minimal knee extension and maximal ankle flexion were the only kinematic data significantly different (increased) after ITB. The slope of the ankle moment-angle curve decreased significantly after ITB at preferred gait speed; it also decreased at maximal gait speed in all but 1 subject. Of the 4 available moment-angle curves, 3 showed decreased knee extensor muscle stiffness. The duration of the bursts of spastic muscles decreased after ITB. CONCLUSION: Acute ITB improved walking and reduced muscle stiffness at both the ankles and knees on the spastic hemiplegic side of our subjects. Electromyographic findings suggest that some of the post-ITB reduction in muscle stiffness might be attributed to decreased spasticity.

Adult↗