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PubMed2001

Percutaneous intramuscular neuromuscular electric stimulation for the treatment of shoulder subluxation and pain in patients with chronic hemiplegia: a pilot study.

OBJECTIVE: To investigate the feasibility of percutaneous intramuscular neuromuscular electric stimulation (perc-NMES) for treating shoulder subluxation and pain in patients with chronic hemiplegia. DESIGN: Before-after trial. SETTING: University-affiliated tertiary care hospital. PARTICIPANTS: A convenience sample of 8 neurologically stable subjects with chronic hemiplegia and shoulder subluxation. INTERVENTION: Six weeks of perc-NMES to the subluxated shoulder. MAIN OUTCOME MEASURES: Shoulder subluxation (radiograph), shoulder pain (Brief Pain Inventory), motor impairment (Fugl-Meyer score), shoulder pain-free external rotation (handheld goniometer), and disability (FIM instrument) were assessed before treatment (T1), after 6 weeks of neuromuscular stimulation (T2), and at 3-month follow-up (T3). A 1-way, repeated-measures analysis of variance using the generalized estimating equation approach was used to evaluate differences from T1 to T2 and from T1 to T3 for all outcome measures. RESULTS: Subluxation (p =.0117), pain (p =.0115), shoulder pain-free external rotation (p <.0001), and disability (p =.0044) improved significantly from T1 to T2. Subluxation (p =.0066), pain (p =.0136), motor impairment (p <.0001), shoulder pain-free external rotation (p =.0234), and disability (p =.0152) improved significantly from T1 to T3. CONCLUSIONS: Perc-NMES is feasible for treating shoulder dysfunction in hemiplegia and may reduce shoulder subluxation, reduce pain, improve range of motion, enhance motor recovery, and reduce disability in patients with chronic hemiplegia and shoulder subluxation. Further investigation is warranted.

Adult↗
PubMed1993

Congenital hemiplegia: morphology of cerebral lesions and pathogenetic aspects from MRI.

We have analyzed the MRI findings from the brains of 33 children with congenital hemiplegia. Referral of these children to our hospital was either because of neurological problems or a history of complicated birth. According to maturation-dependent pathophysiological mechanisms we have classified the lesions into the following five groups: 1. malformations/prenatal encephalo-clastic lesions, 2. periventricular leukomalacia or atrophy, 3. diencephalic lesions, 4. subcortical and cortical lesions, and 5. normal findings. Combination of lesions was not uncommon. The neuroradiologically most prominent and most expanded lesions determined the classification to the different groups. We detected malformations/encephalo-clastic lesions (Group 1) in 5 children; one of these children also presented additional lesions of Groups 2 and 3. Six children displayed periventricular leukomalacia (Group 2), and in one child in combination with diencephalic and subcortical lesions. Ten children exhibited diencephalic lesions (Group 3), in one case combined with periventricular leukomalacia. The MRI of seven children showed subcortical/cortical lesions (Group 4), in four cases extending into diencephalic structures. Two children had a combination of evenly matched periventricular, diencephalic and subcortical/cortical lesions, where it was impossible to define a principal lesion. Three children had normal MRI findings. Significantly, 8 of 33 children had bilateral lesions although presenting with hemiplegia. The large proportion of diencephalic lesions, not described in similar CT studies, and the small number of normal MRI findings show the value of MRI in evaluation of congenital hemiplegia. The ability to correlate, to some extent, neuroradiological findings of damage to developmental stage affords the conclusion that at least a third of the children in our series with congenital hemiplegia suffered prenatal damage.

Brain↗
PubMed2003

Does weight-shifting exercise improve postural symmetry in sitting in people with hemiplegia?

BACKGROUND: Weight-shifting exercise was empirically practised in correcting the biased posture of people with stroke-induced hemiplegia. OBJECTIVES: (1) Evaluate the loading symmetry at the buttock-seat interface as a reflection of a postural defect in sitting. (2) Investigate if weight-shifting exercises could correct the postural problem of people with hemiplegia. DESIGN: Control group design. PARTICIPANTS: 16 subjects with hemiplegia after stroke and 14 healthy individuals. PROCEDURES: Subjects were assessed for buttock-seat interface loading while in erect sitting using a seat pressure mapping system. Subjects with stroke then practised one session of weight-shifting exercise followed by a reassessment. RESULTS: The subjects with hemiplegia, particularly those with right hemisphere lesion, had more load borne at the buttock ipsilateral to the side of stroke lesion. The weight-shifting exercise did not produce an immediate improvement on the loading asymmetry. CONCLUSION: The exercise would require further investigation to clarify its benefits in treating postural problems after stroke.

Adult↗
PubMed1983

Acute hemiplegia of infancy and childhood in Addis Ababa: report on 50 followed up cases.

From 1978 to 1982, 50 consecutive cases of acute infantile and childhood hemiplegias were followed up at our Neurology clinic. Fifteen cases (30%) were below the age of two years and 34 cases under five years of age (68%). Our youngest patient was six months and the oldest 13 1/2 years. The male to female ratio was 1.3:1. An acute onset of hemiplegia was noted in 64% of cases. A right side hemiplegia was more common than a left (1.5:1). Idiopathic cases, where no clinical associations could be made, bacterial meningitis, head traumas, and encephalitis were the four leading causes of acute hemiplegias in our series. (A complete recovery was noted in 82% of cases without associated clinical causes.) Subsequent development of epilepsy was noted in 10% of cases at follow-up.

Acute Disease↗
PubMed1997

Reversible hemiplegia as a consequence of severe hyperkalemia and cocaine abuse in a hemodialysis patient.

Severe hyperkalemia may cause weakness that typically is ascending and symmetric. In an isolated case report, hemiplegia occurred after the development of hyperkalemia in a patient with a known central nervous system lesion. We describe a patient requiring long-term hemodialysis who had near-fatal hyperkalemia, hemiplegia, and rhabdomyolysis after abuse of crack cocaine. The hemiplegia resolved after normalization of serum potassium using emergency dialysis. No brain lesion could be identified during computed tomography or by electroencephalography, and the patient had no residual neurologic deficits. We conclude that this patient had hemiplegia secondary to cocaine-induced cerebral vasoconstriction because no structural lesion could be found and that the neurologic deficit was worsened by severe hyperkalemia, which probably resulted from cocaine-induced rhabdomyolysis. Hence, despite the absence of a structural lesion of the brain, severe hyperkalemia, typically associated with symmetric, ascending muscle weakness, may contribute to causing focal weakness in the condition of cocaine-induced vasoconstriction.

Adult↗
PubMed1980

Alternating hemiplegia in infants: report of five cases.

Five cases of alternating hemiplegia in infancy are reported. Special consideration is given to the associated ictal manifestations (tonic seizures, dystonic posturing and abnormal movements bouts of nystagmus and acute autonomic disturbances), some of which were noted in every case. Previously reported cases are reviewed critically, 14 of whom are considered to belong to the same syndrome as the five presented here. The nosology of the syndrome is discussed, and the differences between alternating hemiplegia and the common types of hemiplegia or basilar migraine are emphasized. Whatever its exact nature, alternating hemiplegia in infancy constitutes a well-defined and recognizable syndrome, with a guarded mental and neurological prognosis.

Child↗
PubMed1996

A twin study of congenital hemiplegia.

Twins were more than three times more common in a large sample of London children with congenital hemiplegia than in the general population. This over-representation of twins could largely be explained by their higher rate of preterm birth, though twin-specific risk factors, including the consequences of a co-twin's death in utero, may also have played a part. None of the 34 co-twins who survived infancy had hemiplegia or any other form of cerebral palsy. Among 155 siblings of singletons with congenital hemiplegia, no child had hemiplegia and only one had cerebral palsy. Perhaps it is chance rather then genetic liability or an adverse environment that primarily governs who does and does not become congenitally hemiplegic.

Adolescent↗
PubMed1984

Hypoxia in patients with acute hemiplegia.

Sixteen patients with an early dense hemiplegia due to cerebrovascular accidents were shown to have a greater degree of hypoxia than 16 matched control patients. The patients with hemiplegia had a reflex compensatory fall in arterial carbon dioxide tensions (PaCO2) with possible reduction in cerebral blood flow. Oxygen treatment led to an increase in PaCO2 in the patients with hemiplegia, but the increase in oxygen tensions in these patients was significantly less than that in the control group, suggesting increased pulmonary shunting as the cause for the hypoxia. Oxygen treatment may improve cerebral blood flow and oxygenation and have a useful role in the early management of patients with a dense hemiplegia.

Aged↗
PubMed1996

Denial of hemiplegia: an investigation into the theories of causation.

A comprehensive study of denial of hemiplegia, with tests chosen to cover the varied proposed hypotheses, was undertaken. Twenty patients with denial of hemiplegia following acute CVA were studied. Their results were compared with those from two patient 'control' groups. A neurological examination and neuropsychological assessment were carried out in all patients and CT brain scan performed in 21 CVA cases. The findings are discussed in relation to previously proposed theories of causation concerning denial of hemiplegia which include personality factors, cognitive ability and the presence/absence of neurological deficits. CT scan analyses showed that patients with denial of hemiplegia have significantly more white matter involvement, particularly the corona radiata, than those with neglect and there was also a trend that patients with denial are more likely to have lesions in the caudate.

Acute Disease↗
PubMed1993

Hemiplegia due to posterior cerebral artery occlusion.

BACKGROUND: Hemiplegia is a rare manifestation of posterior cerebral artery occlusion. The acute clinical picture may be difficult to differentiate from occlusion of the middle cerebral artery. A mechanism for the hemiplegia has not been conclusively determined. CASE DESCRIPTION: We describe a patient with hemiplegia secondary to posterior cerebral artery occlusion by an embolized fragment of a prosthetic valve. Computed tomographic scan showed the foreign body just distal to the origin of the posterior cerebral artery with infarction of its vascular territory. These findings were later confirmed at autopsy. There was no radiological or autopsy evidence of involvement of the other cerebral arteries or their territories. CONCLUSIONS: The patient provides further evidence that occlusion of the posterior cerebral artery just distal to its junction with the posterior communicating artery may produce contralateral hemiplegia without oculomotor nerve nucleus involvement.

Adolescent↗
PubMed1997

Localization of lesion in denial of hemiplegia after acute stroke.

BACKGROUND AND PURPOSE: Previous studies of lesion localization in dental of hemiplegia have often been confounded by factors such as the cerebral etiology, which aspects of the disorder are denied, and whether delusions are present. Our investigation focuses on denial of hemiplegia, without concomitant delusions, after cerebrovascular accident (CVA). METHODS: The CT scans of 30 patients with denial of hemiplegia after acute stroke were compared with those from 10 CVA patients with hemiplegia and visuospatial neglect but no denial. Lesion sites were detailed using the templates of Damasio and Damasio and, for the deep structures, those of Talairach and Tournoux. RESULTS: Analysis of the CT scans demonstrated that 26 of 30 denial patients had unilateral right-sided lesions and that this group showed a significantly higher incidence of lesions in deep white matter and the basal ganglia. CONCLUSIONS: The results are discussed in relation to recent ideas regarding the role of the basal ganglia and subcortical circuits in movement and executive function.

Aged↗
PubMed1998

Increased workload enhances force output during pedaling exercise in persons with poststroke hemiplegia.

BACKGROUND AND PURPOSE: A principle of poststroke rehabilitation is that effort should be avoided since it leads to increased spasticity and produces widespread associated abnormal reactions. Although weakness also contributes to movement dysfunction after a stroke, it has been feared that heightened activity levels during strength training will further exacerbate the abnormal tone imbalance present in spastic hemiplegia. The purpose of this study was to test this hypothesis by quantifying the effects of increased workload on motor performance during different speeds of pedaling exercise in persons with poststroke hemiplegia. METHODS: Twelve healthy elderly subjects and 15 subjects with poststroke hemiplegia of greater than 6 months since onset were tested. The experimental protocol consisted of having subjects pedal at 12 randomly ordered workload and cadence combinations (45-J, 90-J, 135-J, and 180-J workloads at 25, 40, and 55 rpm). Pedal reaction forces were measured and used to calculate work done by each leg, including net positive and negative components. An electromyogram was recorded from seven leg muscles. RESULTS: The main finding was that net mechanical work done by the plegic leg increased as workload increased in 75 of 81 instances without increasing the percentage of inappropriate muscle activity. CONCLUSIONS: This study provides evidence that persons with hemiplegia increase force output by their plegic limb when pedaling against higher workloads without exacerbation of impaired motor control. Therefore, exertional pedaling exercise is a beneficial intervention for achieving gains in muscular force output without worsening motor control impairments.

Aged↗
PubMed2006

Hemiconvulsion-hemiplegia-epilepsy syndrome as a presenting feature of L-2-hydroxyglutaric aciduria.

L-2-hydroxyglutaric aciduria was diagnosed in a 9-month-old female infant after a complex febrile convulsion with subsequent transient left-sided hemiplegia. The symptoms were consistent with acute hemiconvulsion-hemiplegia-epilepsy syndrome. Magnetic resonance imaging (MRI) of the brain revealed distinct white-matter abnormalities in the bifrontal and bioccipital periventricular area and increased signal intensity in the lenticular, caudate, and dentate nuclei, consistent with L-2-hydroxyglutaric aciduria. Increased concentrations of L-2-hydroxyglutaric acid were detected in the urine, plasma, and cerebrospinal fluid. The patient was homozyous for the p.Lys81Glu (c.241A>G) missense mutation in the L-2-HGA gene, confirming the diagnosis of L-2-hydroxyglutaric aciduria. Acute hemiconvulsion-hemiplegia-epilepsy syndrome has not been reported as a presenting feature in L-2-hydroxyglutaric aciduria. In patients with prolonged or complicated febrile seizures such as hemiconvulsion-hemiplegia-epilepsy syndrome, L-2-hydroxyglutaric aciduria should be included in the differential diagnosis, especially in children with concomitant macrocephaly.

Epilepsy↗
PubMed1977

Coxsackie A9 focal encephalitis associated with acute infantile hemiplegia and porencephaly.

The factors underlying acute infantile hemiplegia are seldom identified. Coxsackie A9 focal encephalitis was documented for the first time in a 3-month-old infant with fever, hemiconvulsions, and hemiplegia followed by a static motor deficit and epilepsy. It has been suggested that the acute infantile hemiplegia associated with encephalitis results from an arteritis or venous sinus thrombosis with subsequent cerebral infarction. However, this was not observed in our patient. Rather, a series of brain scans, computerized tomograms, and a cerebral angiogram clearly documented the evolution of a focal necrotizing encephaloclastic process resulting in a porencephalic cyst. Serial cerebrospinal fluid viral cultures were necessary to isolate the etiologic agent (tcoxsackie A9). The infant did not have a neutralizing antibody response to the infecting viral agent despite an apparently intact immune system, which possibly may be explained by the developed of immune tolerance or an insufficient amount of infecting viral antigen. This emphasizes that serologic studies alone may not be adequate to document an acute central nervous system viral infection. This patient also typifies the poor prognosis in infants presenting with acute hemiplegia, fever, and convulsions in the absence of cerebrovascular occlusion.

Acute Disease↗
PubMedDate not supplied

Caring for patients with hemiplegia in an arm following a stroke.

The patient's arm affected by hemiplegia is a common problem following a stroke. The term hemiplegia is a limited physiological description of the effects of a stroke on a patient's limb. Any nurse involved in the care of stroke patients must possess essential knowledge on the pathophysiology of hemiplegia and its subsequent treatment and care management programmes. This article reviews the stroke literature for patients with arms affected by hemiplegia. It describes common complications that may arise and subsequent preventive care management strategies that need to be considered. Finally it discusses why success in rehabilitation and recovery programmes need to be considered from the patient's perspective and measured in the context of the patient's experiences and feelings of well-being.

Activities of Daily Living↗
PubMed2005

Multilevel orthopaedic surgery in group IV spastic hemiplegia.

Most children with spastic hemiplegia have high levels of function and independence but fixed deformities and gait abnormalities are common. The classification proposed by Winters et al is widely used to interpret hemiplegic gait patterns and plan intervention. However, this classification is based on sagittal kinematics and fails to consider important abnormalities in the transverse plane. Using three-dimensional gait analysis, we studied the incidence of transverse-plane deformity and gait abnormality in 17 children with group IV hemiplegia according to Winters et al before and after multilevel orthopaedic surgery. We found that internal rotation of the hip and pelvic retraction were consistent abnormalities of gait in group-IV hemiplegia. A programme of multilevel surgery resulted in predictable improvement in gait and posture, including pelvic retraction. In group IV hemiplegia pelvic retraction appeared in part to be a compensating mechanism to control foot progression in the presence of medial femoral torsion. Correction of this torsion can improve gait symmetry and function.

Adolescent↗
PubMed2004

Functional gait changes in patients with chronic lower extremity hemiplegia treated with a technology to induce movement (TIM)-type system.

BACKGROUND AND PURPOSE: The purpose of this study was to examine changes in gait and ankle motor performance in a group of patients with chronic lower extremity hemiplegia associated with treatment using a surface electromyography (SEMG)-based technology to induce movement (TIM)-type system. PARTICIPANTS: Thirteen adult (average age, 44.8 years) volunteer participants with chronic lower extremity hemiplegia (average, 9.2 years) participated in this study. METHOD: A single cohort, repeated measure design was used with each participant assessed initially and after a 6-week intervention of twice weekly SEMG-TIM-type treatments. Patients were assessed by measures of functional gait (free walking velocity and the Tinetti test of gait and balance) and by measures of ankle motor performance (number of standing heel lifts, standing toe lifts, or seated toe taps performed in 1 minute). RESULTS: Patients with chronic lower extremity hemiplegia demonstrated a statistically significant improvement (p < .05) in all measures of functional gait and ankle motor performance. DISCUSSION AND CONCLUSION: Patients with chronic lower extremity hemiplegia demonstrated improvement in measures of functional gait and ankle motor performance after treatment with an SEMG-based TIM-type system. This study should be replicated in randomized controlled, larger, and multicentered clinical studies.

Adult↗
PubMed2000

The effect of intravenous verapamil on cerebral hemodynamics in a migraine patient with hemiplegia.

OBJECTIVE: To describe the use of intravenous verapamil in a migraine patient with hemiplegia to reverse the symptomatology and hemodynamics of the middle cerebral artery as determined by transcranial Doppler. CASE SUMMARY: A 31-year-old white woman was admitted with an acute exacerbation of migraine with hemiplegia. A transcranial Doppler showed an increased flow velocity through the middle cerebral artery consistent with a migrainous process. The patient was treated with verapamil 5 mg iv and the hemiplegia gradually resolved. A transcranial Doppler indicated that the flow velocity through the middle cerebral artery was decreased after verapamil administration, indicating reversal of the vasospasm. DISCUSSION: Transcranial Doppler has not been previously used to determine the effect of intravenous verapamil on the migrainous process. Intravenous verapamil reversed the altered hemodynamics of the middle cerebral artery as determined by transcranial Doppler. This finding correlated with the gradual resolution of hemiplegia. Whether both subjective and objective findings in this patient can be attributed to the reversal of the cerebral artery hemodynamics is not known. CONCLUSIONS: Intravenous verapamil appears to reverse the vasospasm that may be associated with a migrainous process. Whether this effect is solely responsible for clinical improvement is not known. Verapamil may be a consideration for the treatment of intractable migraine, especially when there is evidence of spasm of the major cerebral arteries.

Adult↗