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PubMed1977

Perceptuo-motor dysfunction in the child with hemiplegia.

Eighteen children with hemiplegia were examined by means of standard neurological and other, specialized, sub-tests to define the extent of their perceptuo-motor dysfunction. Particular attention was paid to auditory language function, praxis, visuo-spatial skills, body schema, tactile defensiveness and inattention. The side of the hemiplegia was not found to predispose to any specific dysfunction, with the exception of inattention which was seen only in those with left-sided hemiplegia. Children with a history of familial sinistrality had a higher incidence of speech problems, particularly in the area of auditory language and speech delay. The results are discussed in the light of therories of plasticity and cerebral organization.

Adolescent↗
PubMedDate not supplied

Blood gas tensions, acid-base status, heart rates, and venous profiles in exercising horses with laryngeal hemiplegia before and after corrective surgery.

The physiologic effects of exercise were studied in four horses with complete laryngeal hemiplegia. Right carotid arteries were surgically elevated to a subcutaneous position for percutaneous catheterization. Each horse was fitted with a device designed to obtain multiple arterial samples while the horse was exercised over a 1.6-km course. After each horse completed 10 test gallops, the laryngeal hemiplegia was treated using a laryngeal prothesis and ventriculectomy. The horses were then reconditioned, and the exercise test and sampling were repeated. Horses with laryngeal hemiplegia became acidotic, hypoxic, and hypercapnic compared to normal horses. Surgical treatment improved blood gas and acid-base status, but the values were not equivalent to those in normal horses similarly tested.

Acid-Base Equilibrium↗
PubMed1995

Putaminal haemorrhage leading to pure motor hemiplegia.

Pure motor hemiplegia (PMH) is commonly attributed to lacunar infarction of internal capsule or basis pontis. We report 7 patients of pure motor hemiplegia as a result of small or moderate size putaminal haemorrhage. All the patients had normal median somatosensory evoked potentials. Central Motor Conduction Time (CMCT) to upper limb was not recordable in all 3 patients with complete hemiplegia. Three of seven patients had complete and four had partial recovery. Anterioposterior extension of small or moderate size putaminal haemorrhage seems to spare the medially located sensory fibres in the internal capsule. On the basis of our results, lateral putaminal haemorrhage should be considered in the differential diagnosis of PMH.

Adult↗
PubMed1978

Alternating hemiplegia: complicated migraine of infancy.

Alternating hemiplegia in children is a rare form of "complicated" migraine. There are a number of similarities to seizure disorders and correct diagnosis may prove difficult. The clinical features of 6 patients with alternating hemiplegia are presented together with the results of electrophysiological, radiological, and biochemical studies. While there were a number of clinical similarities between the patients, extensive investigations failed to demonstrate significant abnormalities. Although a diagnosis of a seizure disorder was suggested at some time in all of the patients, in only 2 was it certain there was a fit. Headaches occurred in the eldest patient (although not always with a hemiplegic attach) while in the younger patients misery often accompanied their attacks. Intellectual status was impaired in 5 patients, although in 2 of these the cause was most likely to be perinatal difficulties. Response to various forms of treatment was generally not encouraging and concern is expressed that this alternating hemiplegia of childhood may carry an unfavourable prognosis.

Adolescent↗
PubMed2000

Illusory limb movements in anosognosia for hemiplegia.

To clarify the relation between anosognosia for hemiplegia and confabulation, 11 patients with acute right cerebral infarctions and left upper limb hemiparesis were assessed for anosognosia for hemiplegia, illusory limb movements (ILMs), hemispatial neglect, asomatognosia, and cognitive impairment. Five of 11 patients had unequivocal confabulation as evidenced by ILMs. The presence of ILMs was associated with the degree of anosognosia (p = 0.002), with hemispatial neglect (p<0.05), and with asomatognosia (p<0.01). The results confirm that a strong relation exists between anosognosia for hemiplegia and confabulations concerning the movement of the plegic limb. There is also a strong relation between ILMs and asomatognosia.

Aged↗
PubMedDate not supplied

Hypoglycemic hemiplegia: two cases and a clinical review.

Hypoglycemic hemiplegia mimics cerebrovascular disease. Two patients are reported who experienced multiple attacks of transient hemiplegia associated with hypoglycemia and who were initially diagnosed as having transient ischemic attacks. In both, angiography was normal and the attacks resolved with reduction of insulin dose. Recognition of hypoglycemia as the cause of transient hemiplegia is important, often obviating the need for cerebrovascular evaluation.

Cerebrovascular Disorders↗
PubMed1988

Pure motor hemiplegia secondary to a saccular basilar artery aneurysm.

Pure motor hemiplegia is the most commonly encountered lacunar syndrome and is classically associated with small infarctions in the contralateral internal capsule or basis pontis. Pure motor hemiplegia has also been observed secondary to a wide variety of other vascular and nonvascular focal central nervous system processes. We describe a patient with pure motor hemiplegia associated with a saccular basilar artery aneurysm causing a lacunar infarction of the cerebral peduncle.

Aged↗
PubMed2006

Acute childhood hemiplegia associated with chickenpox and elevated anticardiolipin antibody.

Chickenpox is a common infection of childhood. Central nervous system complications, such as cerebellar ataxia and meningoencephalitis, are estimated to occur in less than 1% of cases of chickenpox. Although transverse myelitis and hemiplegia have also, although rarely, been reported, hemiplegia associated with chickenpox and elevated anticardiolipin antibody has not been reported in the literature. We report the case of a 2.5-year-old boy who developed a right hemiplegia 3 weeks after the onset of a primary varicella infection. The serum level of anticardiolipin antibody IgG was markedly elevated. Brain magnetic resonance imaging (MRI) revealed an infarction involving the left globus pallidus, caudate nucleus, and posterior leg of the internal capsule. Laboratory studies ruled out all known causes of stroke. Neurologic signs and symptoms slowly improved with supportive treatment. Varicella infection should be considered one of the possible causes of acute ischemic strokes in children. Usually, two or more risk factors are detected in children with ischemic strokes, and we suggest that all possible causes of strokes be investigated in children with ischemic strokes.

Antibodies↗
PubMed2006

Bilateral training does not facilitate performance of copying tasks in poststroke hemiplegia.

OBJECTIVE: Previous studies in rehabilitation in poststroke hemiplegia have suggested that brief periods of bilateral training improve subsequent unilateral performance of the paretic upper limb. The bilateral training protocol involved task-specific practice using both upper limbs simultaneously and homologously (such that they mirrored each other). This study aimed to determine the generalizability of the bilateral training phenomenon by replicating the work with different tasks, measures, and a different experimenter. METHODS: Five single-case experiments were performed using a within-participant multiple-baseline design. Participants with post-stroke hemiplegia underwent 25 to 40 daily training sessions involving repetitive practice of 3 copying tasks. Pen movements were recorded on a digitizing pad. During the baseline phase, participants performed tasks unilaterally with their hemiplegic limb. Bilateral therapy was then applied in a staggered fashion to each task in turn. Quality of movement was measured in terms of temporal performance (jerkiness, speed, task duration), spatial performance (accuracy of copy), and arm posture (pen tilt). RESULTS: Movement quality of the hemiplegic limb was not improved during or subsequent to regular bilateral training. CONCLUSIONS: The training phenomenon observed in previous work was not replicated when participants with hemiplegia practiced copying tasks bilaterally.

Adult↗
PubMed2004

Percutaneous neuromuscular electrical stimulation (P-NMES) for treating shoulder pain in chronic hemiplegia. Effects on shoulder pain and quality of life.

OBJECTIVE: To evaluate the effect of percutaneous neuromuscular electrical stimulation (P-NMES) of the shoulder muscles on shoulder pain intensity and health-related quality of life in chronic hemiplegia. DESIGN: Prospective, open label design. SETTING: The outpatient services of a large teaching rehabilitation hospital in The Netherlands. SUBJECTS: Fifteen stroke survivors with chronic (> six months) hemiplegia and a therapy-resistant painful shoulder with subluxation. All patients suffered from clinically relevant shoulder pain, as assessed by a score of at least 4 out of 10 on a numerical rating scale. Shoulder subluxation was indicated by at least 1/2 fingerbreadth of glenohumeral separation on palpation. INTERVENTION: Six hours of P-NMES per day for a total of six weeks. MAIN OUTCOME MEASURES: Shoulder pain (Brief Pain Inventory), shoulder subluxation (clinical and radiographic), shoulder pain-free external rotation (hand-held goniometer), motor impairment (Fugl-Meyer Motor test) and quality of life (SF-36) were assessed before treatment, after six weeks of intramuscular stimulation, at three months and six months follow-up. RESULTS: A significant reduction in pain was found on the Brief Pain Inventory. Pain reduction was still present at six months follow-up. All domains, in particular bodily pain, of the SF-36 showed improvement in the short term. After six months of follow-up, bodily pain was still strongly and significantly reduced, whereas social functioning and role physical demonstrated a nonsignificant improvement of more than 10% compared with baseline. CONCLUSION: This pilot suggests that P-NMES potentially reduces shoulder pain in chronic hemiplegia. To establish the clinical value of P-NMES in treating hemiplegic shoulder pain a randomized controlled trial is needed.

Aged↗
PubMed1991

The pathogenesis of anosognosia for hemiplegia.

We compared patients with unawareness of hemiplegia lasting more than 1 month after right hemisphere stroke with other patients with right hemisphere stroke who became aware of hemiplegia within a few days after onset. Patients with persistent unawareness invariably had severe left hemisensory loss and usually had severe left spatial neglect. They were almost always apathetic; their thought lacked direction, clarity, and flexibility, and they had at least moderate impairment of intellect and memory. Their right hemisphere strokes were large and always affected the central gyri or their thalamic connections and capsular pathways. In addition, there was evidence of at least mild left hemisphere damage, most commonly caused by age-associated atrophy. The pathogenesis of anosognosia for hemiplegia may involve failure to discover paralysis because proprioceptive mechanisms that ordinarily inform an individual about the position and movement of limbs are damaged, and the patient, because of additional cognitive defects, lacks the capacity to make the necessary observations and inferences to diagnose the paralysis. We discuss the implications of this "discovery" theory and contrast it with other explanations of anosognosia.

Affect↗
PubMed2001

Benign nocturnal alternating hemiplegia of childhood: six patients and long-term follow-up.

Benign familial nocturnal alternating hemiplegia of childhood refers to recurrent attacks of hemiplegia arising from sleep, described in young children without neurologic or mental impairment. It is probably migraine related. The authors report two unrelated patients with nocturnal attacks starting at 22 and 31 months, followed by daytime episodes in one. The authors confirm the benign course of this disorder. It is distinct from the classic malignant form of alternating hemiplegia of childhood.

Child↗
PubMed1991

Motor function and activities of daily living assessments: a study of three tests for persons with hemiplegia.

The relationship between upper extremity motor function and independence in basic activities of daily living in subjects with hemiplegia was explored. The Barthel Index (Mahoney & Barthel, 1965) and the Fugl-Meyer Test (Fugl-Meyer, Jääskö, Leyman, Olsson, & Steglind, 1975) were selected as the standard instruments for the evaluation of activities of daily living and upper extremity motor function, respectively, because their validity and reliability have been demonstrated many times. The Functional Test for the Hemiplegic/Paretic Upper Extremity (Wilson, Baker, & Craddock, 1984a, 1984b) was also used for the evaluation of upper extremity motor function. The results obtained in 18 subjects with hemiplegia indicate that the scores on the Barthel Index are poorly correlated with both the Fugl-Meyer Test and the Functional Test for the Hemiplegic/Paretic Upper Extremity scores. It is suggested that variables other than motor function, such as the learning of compensatory techniques and perceptual-cognitive status, are responsible for this discrepancy because they can influence activities of daily living performance in persons with hemiplegia. The high correlation between the scores on the Fugl-Meyer Test and the Functional Test for the Hemiplegic/Paretic Upper Extremity indicates that either test may be used for the assessment of upper extremity motor function.

Activities of Daily Living↗
PubMed1994

Effects of continuous passive motion on the edematous hands of two persons with flaccid hemiplegia.

OBJECTIVES: This study evaluated the effect of the use of a continuous passive motion device for the edematous hands of two persons with flaccid hemiplegia. METHOD: The subjects were both 1 month post-cerebrovascular accident with left-sided hemiplegia. Each subject's routine therapy program was maintained throughout this ABA design study. During the first week, baseline data were gathered, during the second week the intervention was provided (2 hr of continuous passive motion device use), and during the third week data were gathered with treatment withdrawn. Edema was measured with a hand volumeter and finger circumference. RESULTS: The continuous passive motion device had an effect in reducing edema in the hands of the two subjects. CONCLUSION: The continuous passive motion device is a readily available tool that could enhance the treatment of edematous hands of persons with flaccid hemiplegia by offering a contribution to already established treatment protocols. Further research is needed, however, to establish guidelines for use.

Aged↗
PubMed1996

A comparison of performance in added-purpose occupations and rote exercise for dynamic standing balance in persons with hemiplegia.

OBJECTIVES: Adding purpose to daily occupations to promote performance is a basic premise of occupational therapy. This study investigated the hypothesis that in persons with hemiplegia, two added-purpose occupations would elicit more exercise repetitions than a rote exercise. METHOD: In a counterbalanced order, 21 subjects with hemiplegia, aged 51 to 78 years, experienced all three conditions of a dynamic standing balance exercise that involved bending down, reaching, standing up, and extending the arm. One condition of added purpose involved the use of materials (small balls and target); a second added-purpose condition involved the subjects' imagination of the small balls. The third condition was the rote exercise without added purpose. RESULTS: A one-way analysis of variance for related measures indicated that the subjects performed significantly differently in each of the three conditions (p < .001). A Tukey multiple comparison test revealed that the subjects did significantly more exercise repetitions in the added-materials condition and in the imagery-based condition than in the rote exercise condition (p < .05). CONCLUSION: This study demonstrates how added purpose can enhance motor performance in persons with hemiplegia. Purpose may be effectively added to an exercise through the use of materials or imagery.

Aged↗
PubMedDate not supplied

Abnormalities in the uninvolved lower limb in children with spastic hemiplegia: the effect of actual and functional leg-length discrepancy.

We assessed the pattern of gait in children with spastic hemiplegia and a leg-length discrepancy, particularly in relation to the uninvolved limb. The kinematics of the uninvolved limbs were compared with the pattern in normal children. The uninvolved limbs in children with hemiplegia and a significant leg-length discrepancy were compared with the uninvolved limb in those children who did not have a leg-length discrepancy. We found that the involved and uninvolved legs in patients with hemiplegia had characteristic patterns that were significantly different from normal. The kinematics of the involved leg were not affected by the presence of a leg-length discrepancy. The abnormal pattern in the uninvolved limb was more exaggerated in children with a leg-length discrepancy. The abnormal sagittal plane kinematics in the uninvolved lower limb in hemiplegic children appears to be related to the presence of an actual or functional leg-length discrepancy and have not previously been described. Our findings suggest that attention be paid to the functional and actual leg-length discrepancy that exists in these children, and early consideration be given to epiphysiodesis of the uninvolved limb.

Adolescent↗
PubMed2000

[Alternating hemiplegia of childhoood and oculomotor anomalies].

BACKGROUND: Alternating hemiplegia of childhood is a syndrome which begins in the first year of life. It is characterized by repeated attacks of uni-or bilateral hemiplegia or hemiparesia. In most cases paroxysmal manifestations are observed: movements or dystonia++ attacks, episodic nystagmus, abnormal eye movements and disturbance of the neurovegetative system, predominantly in the first year of life. ANALYSIS: In half of the cases, neurological anomalies begin during the neonatal period with a non characteristic aspect. Typical attacks take place after one year of life, sometimes associated with partial epilepsy. In a quarter of cases, the oculomotor anomalies have been known since early life. The diagnosis is made prior to one year on the basis of associated oculomotor anomalies and other symptoms without EEG arguments for epilepsy. Paroxysmal nystagmus is always found. One eye is affect in most cases, generally with horizontal and seldom with vertical movements of large variable pendular amplitude. One eye with nystagmus and the other with mydriasis is sometimes reported. Most attacks last from 30 sec to 3 min. Paroxysmal strabismus described in half of the cases seems to be generally unilateral internuclear transitory ophthalmoplegia. Finally, ocular deviations on the hemiparetic side are described. They are generally unique or sometimes associated with head deviation. Spontaneous blinking is reduced. CONCLUSION: Alternating hemiplegia of childhood is a non-epileptic sporadic, paroxysmal manifestation of unknown pathogenesis. Prognosis is poor. The presence of oculomotor signs suggests the diagnosis.

Diagnosis, Differential↗
PubMed2001

[Anesthetic management for gastrojejunostomy in a patient with hemiplegia and recurrent laryngeal nerve palsy].

A 70-year-old man who had undergone a low anterior resection for primary rectal cancer 9 years before complained of anorexia, hemiplegia, and recurrent laryngeal nerve palsy. The anorexia was caused by duodenal stenosis due to swollen lymph nodes, the hemiplegia was caused by a metastatic brain tumor, and the recurrent laryngeal nerve palsy was caused by metastases of the cancer to the mediastinal space. Metastases were also found in the bilateral lungs, liver, ureter, and cervical vertebra. In choosing the anesthesia for the gastrojejunostomy to improve the malnutrition of this patient, we decided, on the basis of the patient's full stomach, malnutrition, hypovolemia, hemiplegia, cerebral compression, recurrent laryngeal nerve palsy, renal dysfunction, and respiratory dysfunction, to use thoracic epidural anesthesia rather than spinal anesthesia or general anesthesia. Thoracic epidural anesthesia could provide sufficient analgesia, and the operation was uneventful. In anesthetic management of an end-stage patient undergoing a palliative operation like this, we should consider the purpose of the operation, its complications, and further complications which may be induced by anesthesia in order to plan out an anesthetic regimen unlikely to lead to harmful events in perioperative period.

Aged↗