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PubMedDate not supplied

[Motor function and functional capacity in hemiplegia with global aphasia after rehabilitation].

PURPOSE: The influence of global aphasia on the outcome rehabilitation of hemiplegia has been considered in very few case studies. Aim of this study is to evaluate motor function and functional capacities of patients whit hemiplegia and global aphasia after rehabilitation. PATIENTS AND METHODS: A consecutive sample of 54 first-stroke patients was assessed. The mean age of the patients was 64.9. Assessments were made using the Barthel Index, Fugl-Meyer Scale and Standard Language Examination of Basso. RESULTS: At admission 98.1% of the patients showed a complete paresis of the upper limb, while 72.2% provided a complete paresis of the lower limb. After rehabilitation 90.7% of the cases showed a complete paresis of the upper limb while 29.6% maintained the paresis of the lower limb. The lower limb had motriciy in flexor- and extensor synergies, while the upper limb only in flexor-synergies. At admission all patients showed severe or very severe disability. After rehabilitation disability was very severe in 9.2% of the patients, severe in 16.7%, moderate in 38.9% and light in 35.2%. At discharge 33.3% of the patients had a Berthel Index score above 70 while the mean score was 59.2/100. The higher self-sufficiency was detected in the personal hygiene (83% self-sufficient) and walking (61.1%); a lower degree of self-sufficiency was observed in eating, dressing and toileting (100% of the patients needed assistance). The patients aged less than 65 years showed a recovery in the functional capacities better than the level detected in patients older than 65 (p < 0.001). CONCLUSIONS: These results demonstrate that patients whit hemiplegia and global aphasia recovery better functional capacities than motor function after rehabilitation.

Aged↗
PubMed2002

Epilepsy in children with congenital hemiplegia: correlation between clinical, EEG and neuroimaging findings.

OBJECTIVES: the aim of this retrospective, multicentre study was to investigate the relationship between epilepsy, clinical, electroencephalographic (EEG) and neuroimaging findings in children with congenital hemiplegia (CH). PATIENTS AND METHODS: two hundred and three children with CH were assessed by history, neurological and developmental examination. Electroencephalogram (EEG) and CT/MRI brain imaging were performed in 150 of them (81/150 had an MRI and 69/150 had a CT scan). Patients were re-evaluated every six months for, at least, a two-year follow-up period (range 2-14 yrs). RESULTS: the EEG was abnormal in 76% of patients; epileptic seizures developed in 38.9% of them. The frequency of epilepsy paralleled the degree of EEG abnormality, approaching 85% in patients with severe EEG abnormalities and was also closely related to the extent of neuroimaging findings (up to 79% in patients with cerebral malformations). The prevalence of epilepsy in 12/62 patients (19.4%) with mild hemiplegia was significantly lower as compared to 67/141 (47.5%) of patients with moderate or severe hemiplegia. 36.7% of the children had their first seizure between the 1st and the 5th year of life, and 26.5% during the first year of life. CONCLUSIONS: epileptic seizures developed in more than one third of patients with CH, although EEG abnormalities were evident in the majority of them. The prevalence of epilepsy is closely related to the severity of hemiparesis, the extent of neuroimaging findings and the degree of EEG abnormalities. The absence of EEG abnormalities and/or normal (or minor) neuroimaging findings was negatively related to the occurrence of epilepsy.

Child↗
PubMedDate not supplied

[Disability and rehabilitation outcome in hemiplegia with global aphasia and neglect].

PURPOSE: Global aphasia and neglect are considered to be the neuropsychological disorders mostly affecting the hemiplegia outcome. The aim of this study is to examine which of the two disorders is making worse the recovery from hemiplegia. METHODS: The study was conduced on 45 patients suffering from hemiplegia: 15 subject with global aphasia, 15 with neglect and 15 without neuropsychological disorders (control group). All patients were subject to rehabilitation treatment. Before and after rehabilitation, the assessment of patients was made using neuropsychological tests, Fugl-Meyer scale and Functional Independence Measure (FIM). At admission, all patients were not self-sufficient. RESULTS: At the end of the rehabilitation period the recovery of motor function was poor in both groups. The damage on limbs motion was severe in 93.4% and marked in 6.6% of both patients with global aphasia and neglect. At discharge, the FIM motor score of patients with global aphasia (44.6 +/- 13) was higher than in those with neglect (37.2 +/- 10) and was not statistically different from control group (51.2 +/- 18) (p = 0.493). The FIM motor score of patients with neglect was significantly lower than control group (p = 0.036). In patients with global aphasia effectiveness was 35.5% and efficiency 0.40 while in patients with neglect effectiveness was 18% and efficiency 0.22. The final disability was lower in patients subject to global aphasia than neglect. CONCLUSIONS: The study showed that neglect limits the recovery from stroke more than global aphasia.e.

Activities of Daily Living↗
PubMed2003

Hemiplegia: an initial manifestation of Japanese encephalitis.

A 7-year-old boy from an area endemic to Japanese encephalitis (JE) manifested with acute febrile illness, left hemiplegia and preserved consciousness during the prodromal phase of illness. The child developed features of encephalitis 48 hours after the onset of hemiplegia. IgM MAC ELISA for JE virus revealed high titers in the serum and cerebrospinal fluid suggestive of JE. MRI of the brain showed asymmetrical bilateral thalamic hyperintense lesions on T2 weighted image, considered diagnostic of JE. Hemiplegia during the prodromal phase or as an initial symptom of JE is rather unusual.

Child↗
PubMed2003

[Clinical characteristics of alternating hemiplegia of childhood in 13 patients].

OBJECTIVE: To summarize the clinical characteristics of alternating hemiplegia of childhood (AHC). METHODS: The clinical data of 13 children with AHC were analyzed. Cranial MRI, EEG, analysis of serum amino acids and urinary organic acids, measurement of plasma lactate and pyruvate levels were done in all patients. Other laboratory examinations such as magnetic resonance angio-imaging (MRA), digital subtraction arteriography (DSA) and Video-EEG were also performed in some patients. RESULTS: Of the 13 patients, 12 were male, and 1 was female. The age of onset was from 2 days to 55 months (average 13.1 months). The initial symptoms were abnormal ocular movements (AOMs) consisting of ocular deviation, gaze or nystagmus in 2 cases, AOMs and dystonic posturing in 9 cases, hemiplegia in 2 cases. All patients had recurrent alternating hemiplegic episodes. The hemiplegic attacks lasted from a few minutes to 10 days. The occurrence of the attacks ranged from 8 times daily to one time every 2 months. In 10 patients the abnormal eye movements or dystonic posturing, at times, recurred intermittently during the hemiplegic attack. Choreoathetosis was present in 2 cases. Ataxia was present in 1 case; 7 patients also had the episodes of quadriplegia. During the episodes of quadriplegia, dysarthria or aphasia was present in 4 cases, dyspnea and dysphagia was present in 2 cases, respectively. Sleep could relieve both weakness and associated paroxysmal symptoms. Mental retardation was present in 9 cases, seizures in 3 cases. Except for EEG or Video-EEG was abnormal in 3 patients, other laboratory investigations were normal in all patients. Twelve patients received flunarizine therapy. Flunarizine reduced the severity, duration, or frequency of hemiplegic attacks in 8 patients. CONCLUSION: The results suggest that AHC is characterized by frequent episodes of alternating hemiplegia with extrapyramidal symptoms and mental retardation, flunarizine is effective in treating some AHC patients.

Anticonvulsants↗
PubMedDate not supplied

[Hemiconvulsion-hemiplegia syndrome: two case reports with findings from magnetic resonance imaging of the brain in diffusion-weighted sequences].

INTRODUCTION: Hemiconvulsion-hemiplegia (HH) syndrome is characterised by prolonged hemiclonic seizures followed by, very often permanent, hemiplegia. We report the cases of two patients with HH syndrome; in addition, the paper also includes a discussion of the value of neuroimaging in its diagnosis, including the use of magnetic resonance imaging (MRI) of the brain in diffusion-weighted sequences, and its clinical-radiological progression. CASE REPORTS: Case 1: a 16-month-old female who was admitted to hospital owing to right-side hemiclonic seizures, with a febrile condition, that lasted at least 30 minutes, and persistent hemiparesis on the right-hand side of the body. Results of an initial computerised tomography (CT) brain scan were normal. Brain MRI at 3 days: T2 weighted sequences were normal; diffusion-weighted sequences showed lowered diffusion in the temporoparietooccipital region in the left hemisphere. Brain CT scan at 6 months: hemiatrophy on the left-hand side of the brain. Paresis of the right hand continues at the age of 4 years and 8 months; no further seizures have occurred and the patient's psychic development is normal. Case 2: a female aged 2 years and 6 months who was admitted to the Paediatric Intensive Care Unit owing to right-side hemiclonic seizures, with a feverish condition, lasting between 35-40 minutes, with persistent hemiplegia on the right-hand side of the body. The patient had a history of psychomotor retardation secondary to chromosome pathology; findings from a brain CT scan were normal. CT scan at 48 hours after the episode: edema in the left hemisphere of the brain. Brain MRI at 7 days following hospital admission: extensive involvement of the left hemisphere of the brain could be seen in T2 weighted sequences and in diffusion-weighted sequences. CT scan at 3 months: hemiatrophy on the left-hand side of the brain. Hemiparesis persists at the age of 5 years and 4 months; the patient has had no further seizures and attends specialised schooling. CONCLUSION: Although rare in our environment, HH syndrome can be seen in the context of hemiclonic febrile conditions. MRI of the brain in diffusion-weighted sequences may be the only means of proving the initial brain lesion.

Child, Preschool↗
PubMed2005

[Single photon emission computed tomography findings in a case of alternating hemiplegia of childhood in relation to migraine].

Single photon emission computed tomography (SPECT) was performed 3 times during attacks and performed 4 times during postictal periods on a case of alternating hemiplegia of childhood. Hyperperfusion of the corresponding hemisphere to hemiparesis was suggested by asymmetric increase RI uptake during the ictal scans, whereas interictal scans showed symmetric topography of cerebral blood flow. Manifestations except hemiplegia included loss of consciousness and vomiting. These manifestations and ictal SPECT findings are the same evidence as hemiplegic migraine. It suggests that these two disorders have a similar pathophysiology. There are two interesting findings regarding this patient. The first finding is magnetic resonance imaging showed progressive cerebellar atrophy. Second finding is interictal SPECT showed a progressive decrease of cerebral perfusion, especially in cerebellar hemispheres. These two findings suggest alternating hemiplegia of childhood may be a chronic progressive disorder.

Atrophy↗
PubMed2005

[Alternating hemiplegia of childhood (AHC)].

BACKGROUND: Alternating hemiplegia of childhood (AHC) is a rare neurological disease of unknown aetiology characterized by recurrent paroxysmal attacks of side-alternating hemiplegias of variable duration associated with other paroxysmal dysfunctions. Paroxysmal attacks start in infants but neurological deficits become progressive with the age. METHODS AND RESULTS: During the last 20 years 8 patients (5 boys, 3 girls) with AHC were followed. Mean age at the time of diagnosis was 2.75 years, age range 2-5 years; mean follow up period 13.9 years (range 1 month-20 years) The diagnosis was based on clinical history and neurological findings, completed by neurophysiological and neuroimaging methods (SPECT, PET), and results of psychological and biochemical findings. Paroxysmal phenomena (occulo-motor, tonic, choreo-athetotic, autonomic) appearing at the age of 4.1 +/- 2.2 months and followed by repeated attacks of hemiplegia (age onset 16.3 +/- 13.0 months) were the first symptoms. Progressive neurological impairment covering spasticity, dyskinetic syndrome, cerebellar ataxia and intellectual deficit was present in all cases, epileptic seizures in 7 out of 8 patients. On ictal SPECT/PET examination hypoperfusion/glucose hypometabolism were demonstrated above affected hemispheres including basal ganglia, both thalami and cerebellar hemispheres. Improvement of hemiparesis was illustrated by nocturnal videomonitoring. CONCLUSIONS: AHC is a chronic disease with progressive neurological deficit. A flunarizine therapy has a favorable effect on frequency and severity of paroxysmal attacks, but does not prevent a progressive neurological impairment.

Child, Preschool↗
PubMed2005

[Clinical observation on hemiplegia early rehabilitation effects of different acupuncture programs].

OBJECTIVE: To observe early rehabilitation of two different acupuncture programs for hemiplegia due to stroke. METHODS: Seventy cases of early hemiplegia due to stroke were randomly divided into a treatment group and a control group. The treatment group were treated by acupuncture at acupoints of both the healthy and affected sides, twice each day, respectively, and the control group by acupuncture at the affected side, once daily. Their therapeutic effects were evaluated by the brief Fugl-Meyer movement scale and the modified Barthel indexes. RESULTS: The patients with over grade IV for FMA accounted for 68.6% and the good rate for ADL was 74.3% in the treatment group, and 31.4% and 42.8% in the control group, respectively, the therapeutic effect of the treatment group being better than that of the control group (P<0.01 or P<0.05). CONCLUSION: The acupuncture program in which acupoints at both the healthy and affected sides are applied alternately is more beneficial to recovery of motor function and activity daily living (ADL) of the patient with hemiplegia due to stroke.

Activities of Daily Living↗
PubMed2005

[Clinical study on scalp acupuncture combined with sports therapy for rehabilitation of poststroke hemiplegia].

OBJECTIVE: To probe into effect of scalp acupuncture combined with sports therapy on movement function of limbs in the patient of poststroke hemiplegia. METHODS: One hundred and twenty cases of poststroke hemiplegia were randomly divided into an observation group and a control group, 60 cases in each group. The observation group were treated by scalp acupuncture and the control group by simple sports therapy. The movement function of limbs were assessed by Fugl-Meyer rating method and Barthel index. RESULTS: The movement function of limbs and ability of daily life after treatment in the observation group improved very significantly as compared with the control group (P < 0.01). CONCLUSION: Scalp acupuncture combined with sports therapy can promote recovery of the movement function of limbs in the patient of poststroke hemiplegia.

Acupuncture Therapy↗
PubMed2006

[Observation on therapeutic effect of blood-letting therapy on apoplectic hemiplegia numbness syndrome].

OBJECTIVE: To observe therapeutic effect of blood-letting therapy on apoplectic hemiplegia numbness syndrome and search for clinically effective therapy. METHODS: Ninety and five cases of apoplectic hemiplegia were randomly divided into a treatment group of 55 cases and a control group of 40 cases in order of visiting. The treatment group were treated with tapping Huatuo Jiaji (EX-B2) on the back by plum-blossom needle combined with blood-letting on twelve Well-points or Shixuan (EX-UE 11), once every day, 6 times constituting one course; the control group were treated with routine acupuncture at points of the four limbs, once daily, 12 times constituting one course. After they were treated for 4 courses, their therapeutic effects were observed. RESULTS: The total effective rate was 94.5% in the treatment group and 77.5% in the control group with a significant difference between the two groups (P < 0.01). CONCLUSION: Blood-letting therapy is an effective therapy for post-apoplectic hemiplegia numbness syndrome.

Acupuncture Therapy↗
PubMed2006

[Observation on clinical therapeutic effect of scalp acupuncture combined with body acupuncture on apoplectic hemiplegia].

OBJECTIVE: To search for the best method for increasing clinical therapeutic effect on apoplectic hemiplegia. METHODS: One hundred and twenty cases of apoplectic hemiplegia were randomly divided into three groups in order of visiting. Group A (n = 33) were treated by scalp acupuncture combined with consciousness-restoring resuscitation method, group B (n = 60) by scalp acupuncture combined with traditional acupuncture, and group C (n = 27) by traditional acupuncture. The clinical therapeutic effects were evaluated according to the scores of manner, speech, motor function of limbs, and so on. RESULTS: Three cases were basically cured, 20 were markedly effective, 7 were effective, with a total effective rate of 90.9% in the group A; and the corresponding figures were 7, 28, 21 cases and 93.3%, respectively in group B with no significant difference between the group A and B (P > 0.05); and 7 cases were markedly effective, 11 effective with a total effective rate of 66. 7% in the group C with a significant difference as compared with the group A and B (P < 0.05, P < 0.001). CONCLUSION: Scalp acupuncture combined with consciousness-restoring resuscitation method and scalp acupuncture combined with traditional acupuncture have a similar therapeutic effect on apoplectic hemiplegia, which is superior to that of traditional acupuncture.

Acupuncture Therapy↗
PubMed2006

[Analysis on relative factors of influencing limb functional recovery in the patient of hemiplegia].

OBJECTIVE: To investigate relative factors of influencing limb functional recovery in the patient of hemiplegia. METHODS: In 312 stroke patients with hemiplegia who were treated by a comprehensive rehabilitation program, 10 factors of possibly influencing limb functional recovery in the patient of hemiplegia were selected to make retrospective analysis and study on 48 cases with no improvement of limb function after treatment. RESULTS: Functional recovery of hemiplegic limbs was not correlated with gender and location of brain lesion, but was correlated with the age and courses of disease, types of stroke, aphasis, psychic disturbance as well as complications (P < 0.05), with the closest relation to the focus character and cognitive disturbance (P < 0.01). CONCLUSION: In establishing therapeutic project and evaluating prognosis, above relative factors should be considered.

Acupuncture Therapy↗
PubMed2006

[Effects study of standardized tertiary rehabilitation on promoting of the neurological functions in stroke patients with hemiplegia].

OBJECTIVE: To investigate the effects of standardized tertiary rehabilitation (STR) on promotion of the neurological functions in stroke patients with hemiplegia. METHODS: A large-sample, multi-center, randomized, controlled prospective study was conducted nationwide. 1209 stroke patients with hemiplegia, aged 40 - 80, within 11 d +/- 5 d after the onset, stabilized in vital life signs in the past one week, of 20 hospitals affiliated to medical colleges or of hospitals at the provincial level in mainland China were randomly allocated to one of the 2 baseline data-matched groups: control group (n = 599, 446 with cerebral infarction and 153 with cerebral hemorrhage) receiving routine intervention of internal medicine, and STR group (n = 610, 455 with cerebral infarction and 155 with cerebral hemorrhage), receiving routine intervention and STR including physical therapy and occupational therapy (OT) in addition. Evaluation was conducted by the time of enrollment, and by the ends of the first, third, and sixth months by the national clinical neurological function defects (CNFD) scoring. RESULTS: There were no significant differences in the baseline indexes between these 2 groups. The scores of CNFD at enrollment of the patients with cerebral infarction in the STR group was 21.55, not significantly different from that of the patients with cerebral infarction in the control group (22.16), however, the scores of these patients with cerebral infarction in the STR group by the ends of the first, third, and sixth months were 16.32, and 11.48, and 8.63 respectively, all significantly lower than those of the corresponding patients in the control group (18.95, 15.57, and 13.78 respectively, all P < 0.01). The CNFD score at enrollment of the patients with cerebral hemorrhage in the STR group was 23.27, not significantly different from that of the corresponding patients in the control group (24.36), however, the scores of the patients with cerebral hemorrhage in the STR group by the ends of the first, third, and sixth months were 17.61, 11.20, and 7.95 respectively, all significantly lower than those of the corresponding patients in the control group (20.36, 15.01, and 13.57 respectively, all P < 0.01). By the end of the sixth month, the CNFD score of the cerebral infarction and hemorrhage patients in the STR group were improved by 12.79 and 15.23, both higher than the corresponding patients in the control group (8.30 and 10.65 respectively). The trend of decrease of CNFD score moved faster in the STR group than in the control group, especially at the early stage. CONCLUSION: STR significantly helps improved the neurological function in the patients with cerebral stroke accompanied with hemiplegia.

Adult↗
PubMed1991

Shoulder subluxation in hemiplegia: effects of three different supports.

Shoulder subluxation in hemiplegia is a difficult problem to manage and it may be associated with pain and other complications. Measurements taken from x-rays have been used to obtain objective measures of shoulder subluxation, but have not been used to compare the effects of different shoulder supports. This study used x-ray measurements to evaluate different shoulder supports for subluxation in hemiplegia and to see if there was a significant difference between the Harris hemisling and the Bobath sling. The Harris hemisling gave good vertical correction of subluxation and compared closely to the uninvolved shoulder. The Bobath sling did not correct the subluxation as well, and the mean difference between the two slings was significant. The arm trough or lap board was less effective and tended to overcorrect. The Harris hemisling and arm trough or lap board had horizontal measurements similar to the uninvolved shoulders. The Bobath sling, however, distracted the glenohumeral joint horizontally and was more variable. The mean horizontal difference between the Harris hemisling and the Bobath sling was significant. These results support the effectiveness and specificity of shoulder support to decrease subluxation after hemiplegia.

Aged↗
PubMed1990

[Alternating hemiplegia in infancy: clinical features, clinical course and treatment based on three cases].

Alternating hemiplegia is an infrequent form of complicated migraine. Clinical course has similarities with seizure disorders and correct diagnosis may be difficult. We report three patients whose onset in early childhood was with general impairment, transient hemiplegia, ocular movements and vasomotor symptoms. Clinical course of alternating hemiplegia is characterized by progressive neurologic deterioration. Intermittent motor impairment is alternating in side and later during the episodic attacks headache is present. Laboratory, electrophysiologic and neuroradiologic procedures are not demonstrative. In this report we show the findings in three patients in relation to the symptoms they presented, the utility of paraclinical investigations and their response to flunarizine treatment.

Age Factors↗
PubMed1986

[Etiological diagnosis errors corrected by x-ray computed tomography in acute hemiplegia].

Correlations between the clinical diagnosis on admission and the aetiological diagnosis revealed by computerized tomography (CT) were studied in 248 cases of acute hemiplegia. In 15% of the cases, hemiplegia was not due to a cerebral vascular accident. This mechanism was overestimated in 9% of the cases and missed in 14%. Ischaemia was overestimated in 15% of the cases and haemorrhage in 45%. With regard to transient deficit, CT scans showed that ischaemia was responsible for only 72% of acute hemiplegias, 28% of them being due to haematoma, tumour or subdural haematoma. In many cases where subdural haematoma or tumour was suspected on clinical grounds, CT confirmed that the suspicion was founded.

Acute Disease↗
PubMed1987

Rehabilitation in dual disability of hemiplegia and upper extremity amputation: two case reports.

Dual disability involving amputation and hemiplegia is relatively rare. The vast majority of these cases involve lower extremity amputations. In this report two patients sustained a right-sided hemiplegia complicating an old left upper extremity amputation. Through the comprehensive rehabilitation program these two patients were able to make gains, especially in some activities of daily living and in lower extremity functions. Since some of the upper extremity activities, such as dressing or bathing, could not be accomplished, it appears that patients with upper extremity amputation who have a contralateral hemiplegia have a poorer prognosis for achieving functional independence than patients with lower extremity amputation and similar neurologic loss.

Amputation, Surgical↗