[″ + plege, a stroke]
Paralysis of one side of the body, usually resulting from damage to the corticospinal tracts of the central nervous system.
SYN: SEE: hemiamyosthenia; SEE: hemiparalysis; SEE: hemiparesis
SEE: Benedikt's syndrome; SEE: paralysis; SEE: thalamic syndrome
The most common cause of hemiplegia is stroke caused by thrombosis, brain hemorrhage, or cerebral embolism. Tumors and spinal cord injuries are responsible for hemiplegia in a smaller number of patients.
The patient will be unable to move the arm and/or leg or facial muscles on one side of the body. Usually the paralysis is more complete in the proximal muscles, e.g., at the shoulder or hip muscles, than it is in the more distal muscles of the hands or feet. If the nondominant parietal lobe of the brain is injured, e.g., after an occlusion of the middle cerebral artery on that side, the patient may neglect the paralyzed side of the body. He or she may deny neurological deficits on that side and may be unable to see or feel stimuli presented to the affected hemibody or visual field.
SEE: visual anosognosia
Depending upon which part of the central nervous system is affected, the patient may also have other neurological deficits, e.g., visual field disturbances, aphasia, dysphagia, vertigo, sensory changes and/or personality changes, which may impact rehabilitation. Assistance is provided with active range-of-motion exercises to unaffected limbs and passive exercises to affected limbs. Correct body positioning and alignment of extremities are maintained, and measures are taken to prevent foot drop, contractures, and pressure ulcers. The patient is assessed for dysphagia, and a nutritional plan developed to provide adequate calories and fluids. Active participation in rehabilitation through physical therapy and occupational therapy is encouraged. The patient is taught to use the unaffected limbs to move and exercise the affected limbs to maintain joint mobility and prevent contractures and to maintain muscle tone and strength. The patient is protected from injury through the use of supportive devices to prevent subluxation or dislocation of affected joints. The patient and the family are taught how to use assistive devices, e.g., slings, splints, walkers, and the goals and processes involved in rehabilitation are explained. Accurate information, realistic reassurance, and emotional support are provided to assist with coping. Both patient and family may benefit from referral to local support groups and the National Stroke Association (800-787-6537; www.stroke.org).
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