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PubMed1997

Treatment of apoplectic hemiplegia by digital acupoint pressure--a report of 42 cases.

Forty-two cases of apoplectic hemiplegia treated by digital acupoint pressure (DAP) therapy are briefly reported in this paper. This results were: basic cure in 10 cases (23.8%), marked effect in 17 cases (40.5%) and effect in 11 cases (26.2%). The total effective rate reached 90.5%. This therapy has several advantages, such as simple and convenient operation, low cost, reliable results and so on.

Acupressure↗
PubMedDate not supplied

[Importance of self-assessment of functional and communication abilities on the outcome of rehabilitation in patients with hemiplegia after cerebrovascular stroke].

INTRODUCTION: Cerebrovascular insult causes focal damage of the central nervous system structures consequently causing loss or disturbance of their functions. Motor deficit is often associated with personality alterations generally speaking, as well as changes in behavior and loss of numerous neuropsychological functions. Rehabilitation of such patients should be defined by all members of the team, including the patient himself and members of his family. MATERIAL AND METHODS: This is a case report on a male patient 49 years of age with rightsided paralysis accompanied by aphasia. Thirty days after cerebrovascular insult he was transferred from the Clinic of Neurology in Novi Sad to the Clinic of Medical Rehabilitation. Functional disability assessment was made using Barthel Index, whereas communication was assessed by Boston Diagnostic Aphasia Examination. The rehabilitation program included, apart from the usual team, the patient himself and members of his family. The patient became the center of the team and was informed about the disease. Personal assessment of the patient on his functional and communication abilities and their importance for further progress was used to set the objectives of the rehabilitation program. The rehabilitation program was performed by a speech therapist and a psychologist, including kinesis, work activities, occupational therapy, individual and group therapy. RESULTS: The outcome of the rehabilitation program in this patient was significantly better than expected. DISCUSSION AND CONCLUSION: This case report shows that being the center of the rehabilitation team the patient takes an active part in setting objectives of the rehabilitation program, whereas involvement of the family, knowledge on necessary medical issues about the disease, contribute to better motivation and better outcome of the rehabilitation program in patients with hemiplegia caused by cerebrovascular insult.

Aphasia↗
PubMed2000

A case of Adams-Oliver syndrome associated with acrania, microcephaly, hemiplegia, epilepsy, and mental retardation.

Adams-Oliver syndrome (AOS) is a rare congenital disorder, characterized by aplasia cutis congenita (ACC) of the scalp and variable degrees of terminal transverse limb defects. In this article, a newborn infant diagnosed as AOS for a large scalp defect, acrania, and finger malformations is presented. The patient was hospitalized and the scalp defect was successfully repaired with several surgical operations. During the hospitalization septicemia, meningitis, and convulsions developed, but they were successfully treated with appropriate antibiotics, antifungal, and anticonvulsive agents, He was discharged five months after admission to the hospital. Now, he is 3 years old, and has microcephaly, moderate mental retardation, left spastic hemiplegia, and epilepsy.

Abnormalities, Multiple↗
PubMed2001

Gait re-education based on the Bobath concept in two patients with hemiplegia following stroke.

BACKGROUND AND PURPOSE: This case report describes the use of gait re-education based on the Bobath concept to measure the changes that occurred in the gait of 2 patients with hemiplegia who were undergoing outpatient physical therapy. CASE DESCRIPTION: One patient ("NM"), a 65-year-old woman, was referred for physical therapy 6 weeks following a right cerebrovascular accident. She attended 30 therapy sessions over a 15-week period. The other patient ("SA"), a 71-year-old woman, was referred for physical therapy 7 weeks following a left cerebrovascular accident. She attended 28 therapy sessions over a 19-week period. Clinical indexes of impairment and disability and 3-dimensional gait data were obtained at the start of treatment and at discharge. Therapy was based on the Bobath concept. OUTCOMES: At discharge, NM demonstrated improvements in her hip and knee movements, reduced tone, and improved mobility. At discharge, SA demonstrated improved mobility. During gait, both patients demonstrated more normal movement patterns at the level of the pelvis, the knee, and the ankle in the sagittal plane. SA also demonstrated an improvement in hip extension. DISCUSSION: These cases demonstrate that recovery of more normal movement patterns and functional ability can be achieved following a cardiovascular accident and provide insight into the clinical decision making of experienced practitioners using Bobath's concept.

Activities of Daily Living↗
PubMed2001

[Epileptic seizures, hemiplegia and hyperglycemia: late discovery of a localized cortical dysplasia].

A 56-year-old woman was hospitalized with a right hemiplegia and aphasia evoking a cerebral infarction. In fact the neurologic deficits were of post-ictal origin, secondary to a partial epilepsy which began a few weeks before, at the same time as a polyuria-polydipsia syndrome revealing diabetes mellitus. This case illustrates the possibility for a partial epilepsy to occur in relation with a nonketotic hyperglycemia. If in most of those cases there is no underlying cortical lesion, in some observations the hyperglycemia is associated with an infarction. In our case the MRI revealed another type of lesion: a cortical dysplasia in form of a unilateral micropolygyria with a perisylvian distribution centered around the insula. The discovery of a cortical dysplasia at such an age is very unusual.

Cerebral Cortex↗
PubMedDate not supplied

[Alternating hemiplegia in young babies].

INTRODUCTION. This paper review the state of the art of alternating hemiplegia of childhood. This entity is a rare neurologic disorder of infancy characterize by transient hemiplegic spells shifting from one side to another, and occasionally affecting to both hemispheres at the same time. Usually start before 18 months, many cases exhibit neonatal symptoms related with the disorder. Early symptomatology include abnormal ocular movements, mainly nystagmus, and tonic or dystonic attacks generally beginning before 6 months of age. These symptoms are frequently misdiagnosis as epilepsy. Typical hemiplegic fits which disappeared when infant felt asleep appeared by 12 months of age. Diagnosis is on clinical basis after excluding any other causes of fluctuating and transitory hemiplegic attacks. Complementary investigations, such as electroencephalograms, TAC, MRI, angiographic MRI, CFS are strictly normal. Cerebral SPECT show controversial abnormalities in some studies. We perform SPECT study in a alert 12 months old girl during an interictal period resulting in a non significant asymmetry, with lesser perfusion in left frontal basal and anterior temporal gyrus. Nevertheless, we observed an striking hyperperfusion in middle occipital area. Treatment is symptomatic with flunarizine. Our patient experience a dramatic decrease in frequency, duration and severity of hemiplegic attacks.

Brain↗
PubMedDate not supplied

On pure motor hemiplegia (Fisher's syndrome).

The authors described three cases of so-called "lacunar strokes" with pure motor hemiplegia. Clinical diagnosis in all three cases was middle cerebral artery thrombosis. In cases 1 and 2 small post-malacic lacunes were found in the basal part of the pons. In case 3 the lesion was located in the pyramidal tract within the pons and medulla. In all cases advanced arteriosclerotic changes were observed. "Lacunar stroke" can result from a lesion of both the pons and the medulla. The clinical syndrome may be engendered also by selective lesion of the pyramidal tract.

Aged↗
PubMed1992

[Treatment of deformities of the locomotor system in hemiplegia].

In spastic hemiplegia mainly one side of the body is affected. In both the upper and the lower extremity the distal parts (hand and foot) are more severely involved than the proximal region. In cases of minor involvement the goal of treatment in the upper extremity is to achieve functional improvement by means of splinting and surgery. In cases of severe alterations cosmetic improvement without much functional gain is all that can be expected. Gait analysis has demonstrated that there are four basic patterns that can be related to the severity of involvement. In type I muscle imbalance exists without a contracture. In type II there is contracture of the muscles of the posterior compartment of the calf. In type III, in addition to the changes around the ankle joint, contractures around the knee are present, and in type IV also hip problems. Functional improvement can be achieved by means of splinting and surgery in all types. Basic principles of treatment have developed as a result of the application of gait analysis and dynamic electromyography. Specific examples of such treatment principles have recently been presented by Gage.

Child↗
PubMed1977

Acute hemiplegia and cortical blindness due to moya moya disease: report of a case in a child with Down's syndrome.

We are reporting what we believe to be the first case of moya moya disease (hemiplegia associated with supraclinoid carotid stenosis and multiple cerebral telangiectasia) in a child with Down's syndrome. On cerebral angiography, multiple collateral vessels and rete mirabile (anastomosis of meningeal vessels with internal cerebral vessels) were noted, in addition to the supraclinoid carotid stenosis. Computerized tomography revealed nonobstructive hydrocephalus and findings consistent with multiple vascular insults or infarcts. It is not clear whether moya moya disease represents a true disease entity (congenital arterial dysplasia) or is a syndrome caused by nonspecific vascular reaction. Since abnormal vascular morphology has previously been described in children with trisomy 21, we suggest that the presence of these two disease entities may not be coincidental. It may represent a genetic predisposition in Down's syndrome toward vascular abnormalities, with variable expressivity which manifested itself in this case by abnormalities in the cerebral circulation.

Blindness↗
PubMed1992

[Acute childhood hemiplegia ].

Stroke in children has been considered to be the most important cause of acute infantile hemiplegia. The author studied 32 patients with childhood stroke. Of the patients 20 had ischemic stroke, and 12 had hemorrhagic stroke. There is an increase of ischemic stroke cases without known predisposing factors in spring. The possibility of nasopharyngeal infection of ischemic stroke in childhood is emphasized.

Acute Disease↗
PubMed1992

Associated movement in hemiplegia: the effects of force exerted, limb usage and inhibitory training.

The intensity of associated movement or motor overflow in the contralateral limb during a unimanual task was evaluated in postacute traumatic brain injured (TBI) young adults with left side hemiplegia and age-matched controls. Both groups demonstrated increased overflow with increasing active limb force, although the trend was for greater overflow to occur in the TBI group, particularly when the spastic limb was active. Following three successive days of inhibitory training with electromyographic feedback, TBI subjects were able to significantly reduce the amount of overflow in the contralateral limb, greater inhibition occurring in the noninvolved limb during spastic limb movement. The results are discussed in terms of a dual model of inhibitory control and the role of such processes in uncoupling the limbs for independent limb usage.

Adult↗
PubMedDate not supplied

[Acute infantile hemiplegia caused by Coxsackie B virus].

INTRODUCTION: Acute infantile hemiplegia (AIH) is a syndrome that appears, typically, in infants without any underlying neurological damage. It can be due to a number of causes, in which viral infections play an important role. We report a case of AIH caused by Coxsackie B virus. CASE REPORT: A 20-month-old female who visited because of fever, vomiting and progressive left hemiparesis. Clinical exploration did not reveal any alteration in the level of consciousness and the only striking feature was the left hemiparesis, with weak deep muscle reflexes. Of the complementary examinations carried out, the most important were: LCR with 80 leukocytes/mm3 (predominance of mononuclear cells), EEG with a persistent focus in the right temporal region (which had become normal at four days) and a positive Coxsackie B virus serology. Progression was completely normal. CONCLUSIONS: AIH is produced as a complication of focal encephalitis which gives rise to a vasculitic phenomenon. Among the infectious causes, one important aetiological agent is the herpes simplex virus. Enterovirus, however, are infrequent. Therefore, until the exact aetiology has been established, it appears wise to begin empirical therapy with acyclovir. When the germs involved in this entity are enterovirus, prognosis is good, although there are reports of cases involving neurological sequelae in the literature.

Coxsackievirus Infections↗
PubMed1992

Factitious hemiplegia and Munchausen's syndrome.

We report a case of a thirty-year-old woman suffering from chronic factitious disorder with hemiplegia. Such a pathomimia is very uncommon in Munchausen's syndrome. Indeed, most often, the clinical picture is characterised by acute abdominal pain, fainting, haemoptysis, precordialgia, hematemesis or dermatological lesions.

Adult↗
PubMed2004

Noradrenergic modulation of hemiplegia: facilitation and maintenance of recovery.

This review presents data from laboratory studies and clinical trials indicating the efficacy of the "Noradrenergic Strategy" for enhancing recovery after cortical injury. Short-term acute treatment combining Physical Therapy (PT) with drugs increasing noradrenaline (NA) levels enhances recovery of hemiplegia in both laboratory studies and clinical trials which also report improved aphasia recovery. Importantly these effects endure even when treatment is initiated months after stroke onset. The hypothesized mechanisms included modulation of neuronal processes underlying "spontaneous" recovery since drugs reducing NA levels slow spontaneous recovery. The effect of some drugs change with time after sensorimotor cortex (SMCx) injury. Drugs reducing NA levels, including clonidine and prazosin, and GABA receptor agonists at doses having little effect early after injury, when administered to animals or stroke patients after "complete recovery" transiently reinstate the original symptoms. Reinstatement by prazosin remains unchanged after repeated testing for over six months in rat, and the deficits can be as severe as the first days after injury. This suggests "completed" recovery is an inaccurate label for an enduring "fragile" state. This transient reinstatement of symptoms may be useful for distinguishing causal from corollary relationships between symptoms and physiological processes proposed as mechanisms for recovery of function.

Animals↗
PubMed2004

[Effects of standardized three-stage rehabilitation on recovery of neurological function in stroke patients with hemiplegia].

OBJECTIVE: To explore the effects of standardized three stages' rehabilitation on the neurological function in stroke patients with hemiplegia. METHODS: All 52 patients firstly are brought into two blocks: primary cerebral infarction and primary cerebral hemorrhage then are divided into treated group and controlled group randomly. Patients in the treated group are given Standardized Three Stages' Rehabilitation, while those in the controlled group are only given normal internal medicine treatments that are the same as the treated group but without Standardized Three Stages' Rehabilitation. All patients would be assessed with the scale of Clinical Neurological Function Defects (CNFD) at the entering time, the end of 1st month, 3rd month and 6th month respectively after stroke. RESULTS: The scores of the treated group are lower than those of the controlled group (P < 0.001) at every stage, the margins between every stage's scores in the treated group are greater than those in the controlled group (P < 0.001). The scores of the treated group's patients are about 51%, 34%, 18% and 8% of total scores at the entering time, the end of 1st month, 3rd month and 6th month after stroke differently, but that of the controlled group are about 58%, 54%, 42% and 37% of total scores differently. The margins between the scores of entering time and that of the end of 1st month, 3rd month and 6th month in the treated group are 17%, 33% and 43% of total scores respectively, but that of the controlled group are about 5%, 16% and 21% of total scores differently. CONCLUSION: Standardized three stages' rehabilitation could promote stroke patients' motor function of every stage obviously.

Adult↗
PubMed1992

The source of shoulder pain in hemiplegia.

Shoulder pain is a common problem in hemiplegia. This preliminary study attempted to identify pain-producing structures by evaluating the results of injecting 1% lidocaine into several sites in the shoulder area. Sixty-seven patients with shoulder problems were identified, examined, and characterized. The amount of pain was related most to loss of motion; it was unrelated to subluxation, spasticity, strength, or sensation. Of 28 patients who received a subacromial injection, approximately one-half obtained moderate or marked relief of pain and improved range of motion, suggesting that the subacromial area of the shoulder is a location of pain-producing structure in a significant number of cases.

Age Factors↗
PubMedDate not supplied

The effect of physiotherapeutic ultrasound on muscle spasticity in patients with hemiplegia: a pilot study.

BACKGROUND: Spasticity is one part of the upper motor neuron syndrome. Untreated spasticity not only causes loss of motor control that results in functional disability, but can easily lead to joint contractures as well. Physical therapy plays an important role in the management of patients with spasticity. Among the modalities, Therapeutic ultrasound has become an important modality for treatment of various conditions including spasticity. OBJECTIVES: The aim of this study is to determine the effect of ultrasound on spasticity. METHODS: In this before-after study, four adult patients (mean age: 57.5 +/- 14.43) with first ever stroke and resulting in hemiplegia participated in the study. The outcome measures were the Ashworth Scale for the assessment of spasticity, ankle passive and active range of motion, and the Hmax: Mmax ratio. RESULTS: The mean of Ashworth scores, Hmax:Mmax ratio, and passive range of motion in ankle joint improved after treatment with ultrasound, but it was not statistically significant (p > 0.05). CONCLUSIONS: The study did not show a significant decrease in spasticity after ultrasound therapy. A study with a large number of patients and a control group would clarify the effects of ultrasound on spasticity.

Adolescent↗