Editing Hemiparesis

{{short description|Weakness of one entire side of the body}}
{{Distinguish|Spastic hemiplegia}}
{{Infobox medical condition (new)
| name            = Hemiparesis
| synonyms        =
| field           = [[Neurology]]
| symptoms        = Loss of motor skills on one side of body
| complications   =
| onset           =
| duration        =
| types           =
| causes          = [[Stroke]], congenital conditions, trauma, tumors, traumatic brain injury
| risks           =
| diagnosis       =
| differential    =
| prevention      =
| treatment       =
| medication      =
| prognosis       =
| frequency       =
| deaths          =
}}
'''Hemiparesis''', also called unilateral [[paresis]], is the weakness of one entire side of the body (''[[wikt:hemi-#Prefix|hemi-]]'' means "half"). '''Hemiplegia''', in its most severe form, is the complete [[paralysis]] of one entire side of the body. Either hemiparesis or hemiplegia can result from a variety of medical causes, including congenital conditions, trauma, tumors, [[traumatic brain injury]] and stroke.<ref name="FactsInfo">[http://www.disabled-world.com/health/neurology/hemiparesis.php Detailed article about hemiparesis] {{Webarchive|url=https://web.archive.org/web/20220202003438/https://www.disabled-world.com/health/neurology/hemiparesis.php |date=2022-02-02 }} at Disabled-World.com</ref>

==Signs and symptoms==
Different types of hemiparesis can impair different bodily functions.  Some effects, such as weakness or partial paralysis of a limb on the affected side, are generally always to be expected. Other impairments can appear, upon external examination, to be unrelated to the limb weakness, but are nevertheless also caused by damage to the affected side of the brain.<ref name="FactsInfo" />

===Loss of motor skills===
People with hemiparesis often have difficulties maintaining their balance due to limb paralysis, leading to an inability to properly shift body weight. This makes performing everyday activities, such as dressing, eating, grasping objects, or using the bathroom, more difficult. Hemiparesis with origin in the lower section of the brain creates a condition known as [[ataxia]], a loss of both gross and fine motor skills, which often manifests as a staggering and stumbling gait. Pure motor hemiparesis, a form of hemiparesis characterized by one-sided weakness in the leg, arm and face, is the most commonly diagnosed form of hemiparesis.<ref name="FactsInfo" />

===Pusher syndrome===
{{main|Pusher syndrome}}
Pusher syndrome is a clinical disorder following left- or right-sided brain damage, in which patients actively push their weight away from the non-hemiparetic side to the hemiparetic side. This is in contrast to most [[stroke]] patients, who typically prefer to bear more weight on their nonhemiparetic side. Pusher syndrome can vary in severity and leads to a loss of postural balance.<ref name=Karnath03>{{cite journal | vauthors = Karnath HO, Broetz D | title = Understanding and treating "pusher syndrome" | journal = Phys Ther | volume = 83 | issue = 12 | pages = 1119–25 | date = December 2003 | pmid = 14640870 | doi = 10.1093/ptj/83.12.1119 | doi-access = free }}</ref> The lesion involved in this syndrome is thought to be in the posterior [[thalamus]] on either side, or in multiple areas of the right [[cerebral hemisphere]].<ref>{{cite journal | vauthors = Karnath HO, Ferber S, Dichgans J | title = The origin of contraversive pushing: evidence for a second graviceptive system in humans | journal = Neurology | volume = 55 | issue = 9 | pages = 1298–304 | date = November 2000 | pmid = 11087771 | doi = 10.1212/wnl.55.9.1298 | s2cid = 19399616 }}</ref><ref>{{cite journal | vauthors = Karnath HO, Ferber S, Dichgans J | title = The neural representation of postural control in humans | journal = Proceedings of the National Academy of Sciences of the United States of America | volume = 97 | issue = 25 | pages = 13931–6 | date = December 2000 | pmid = 11087818 | pmc = 17678 | doi = 10.1073/pnas.240279997 | bibcode = 2000PNAS...9713931K | doi-access = free }}</ref>

A diagnosis of pusher syndrome includes observation of three behaviours. The most obvious one is the patient's regularly occurring (not just occasional) tendency to spontaneously hold a body posture in which the torso is longitudinally tilted toward the paretic side of the body.  The second is the patient's use of the nonparetic extremities including abduction and extension of the extremities of the non-affected side, to help in the push toward the affected (paretic) side, resulting in an abnormal lateral tilt of the body axis. The third is that, when a care provider tries to realign the patient's body to an upright posture, the patient spontaneously pushes back against the attempt, feeling this normal posture to be off balance.<ref name=Karnath03/>

The pusher syndrome is present in 10.4% of patients with acute stroke and hemiparesis,<ref name=Pedersen96>{{cite journal | vauthors = Pedersen PM, Wandel A, Jørgensen HS, Nakayama H, Raaschou HO, Olsen TS | title = Ipsilateral pushing in stroke: incidence, relation to neuropsychological symptoms, and impact on rehabilitation. The Copenhagen Stroke Study | journal = Archives of Physical Medicine and Rehabilitation | volume = 77 | issue = 1 | pages = 25–8 | date = January 1996 | pmid = 8554469 | doi = 10.1016/s0003-9993(96)90215-4 }}</ref> and may increase the time needed for physical rehabilitation. The Copenhagen Stroke Study found that patients who presented with [[ipsilateral]] pushing took an average of 3.6 additional weeks to reach the same functional outcome, as measured by the [[Barthel Index]], compared with acute-stroke and hemiparesis patients who did not engage in ipsilateral pushing.<ref name=Pedersen96/>

Pushing behaviour demonstrates that these patients’ perception of their body [[Human position|posture]] in relation to gravity has been altered. They experience their body as oriented "upright" when the body is actually tilted to the side of the brain lesion. At the same time, their processing of visual and vestibular inputs when determining the [[subjective visual vertical]] seems to be normal. When they are sitting, the pushing presents as a strong lateral lean toward the affected side. When they stand up, the pushing creates a highly unstable situation as they are unable to support their body weight on the weakened lower extremity. The resulting increased risk of falls must be addressed with therapy aimed at correcting their altered proprioceptive perception of vertical.<ref name=Karnath03/>

Pusher syndrome is sometimes confused with [[hemispatial neglect]], and the two terms are sometimes (incorrectly) used interchangeably. Some older theories suggested that hemispatial neglect is what leads to pusher syndrome.<ref name=Karnath03/> However, hemispatial neglect occurs mostly when there is a right-hemisphere lesion, and one study found that pusher syndrome is also present in patients with left hemisphere lesions (which generally also lead to [[aphasia]]).<ref>{{cite book | vauthors = Davies PM |title=Steps to follow: A guide to the treatment of adult hemiplegia : Based on the concept of K. and B. Bobath |publisher=Springer-Verlag |location=New York |year=1985 }}</ref>

Neglect and aphasia are not the cause of pusher syndrome, although both are highly correlated with it (possibly because the brain structures associated with these syndromes are close to each other).<ref name=Karnath03/>

Physical therapists treating patients with pusher syndrome focus on [[motor learning]] strategies that reduce its ill effects, such as the use of verbal cues, consistent feedback, and practice correcting orientation and shifting weight,<ref>{{cite book | vauthors = O'Sullivan S |chapter=Ch. 12: Stroke | veditors = O'Sullivan S, Schmitz T |title=Physical Rehabilitation |publisher=F.A. Davis |location=Philadelphia |year=2007 |pages=705–769 |edition=5th |ref={{harvid|Stroke in Physical Rehabilitation|2007}}}}</ref> for example sitting with their stronger side next to a wall and repeatedly leaning towards the wall, thus gradually re-training the brain to recognize true vertical.<ref name=Karnath03/>

A physical-therapy approach for patients with pusher syndrome debuted in 2003 suggests that the visual control of vertical upright orientation, which is undisturbed in these patients, is the most important intervention. In sequential order, treatment is designed to enable patients to realize their altered perception of vertical, use visual aids for feedback about body orientation, learn the movements necessary to reach proper vertical position, and maintain vertical body position while performing other activities.<ref name=Karnath03 />

===Classification of pusher syndrome===
Individuals who present with pusher syndrome or ''lateropulsion'', as defined by Davies, vary in their degree and severity of this condition and therefore appropriate measures need to be implemented in order to evaluate the level of "pushing". There has been a shift towards early diagnosis and evaluation of functional status for individuals who have had a [[stroke]] and presenting with pusher syndrome in order to decrease the time spent as an in-patient at hospitals and promote the return to function as early as possible.<ref name="Lagerqvist & Skargren">{{cite journal|author1=Lagerqvist, J.  |author2=Skargren, E.|title=Pusher syndrome: reliability, validity, and sensitivity to change of a classification instrument|journal=Advances in Physiotherapy|year=2006|volume=8|issue=4|pages=154–160|doi=10.1080/14038190600806596|s2cid=145015737}}</ref> Moreover, in order to assist therapists in the classification of pusher syndrome, specific scales have been developed with validity that coincides with the criteria set out by Davies' definition of "pusher syndrome".<ref name=Babyar09>{{cite journal | vauthors = Babyar SR, Peterson MG, Bohannon R, Pérennou D, Reding M | title = Clinical examination tools for lateropulsion or pusher syndrome following stroke: a systematic review of the literature | journal = Clinical Rehabilitation | volume = 23 | issue = 7 | pages = 639–50 | date = July 2009 | pmid = 19403555 | doi = 10.1177/0269215509104172 | s2cid = 40016612 }}</ref> In a study by Babyar ''et al.'', an examination of such scales helped determine the relevance, practical aspects and clinimetric properties of three specific scales existing today for lateropulsion.<ref name=Babyar09 /> The three scales examined were the Clinical Scale of Contraversive Pushing, Modified Scale of Contraversive Pushing, and the Burke Lateropulsion Scale.<ref name=Babyar09 /> The results of the study show that reliability for each scale is good; moreover, the Scale of Contraversive Pushing was determined to have acceptable clinimetric properties, and the other two scales addressed more functional positions that will help therapists with clinical decisions and research.<ref name=Babyar09 />

==Causes==
The most common cause of hemiparesis and hemiplegia is [[stroke]]. Strokes can cause a variety of movement disorders, depending on the location and severity of the [[lesion]]. Hemiplegia is common when the stroke affects the [[corticospinal tract]]. Other causes of hemiplegia include [[spinal cord injury]], specifically [[Brown-Séquard syndrome]], [[traumatic brain injury]], or disease affecting the [[brain]]. A permanent brain injury that occurs during the intrauterine life, during delivery or early in life can lead to hemiplegic [[cerebral palsy]]. As a [[lesion]] that results in hemiplegia occurs in the brain or spinal cord, hemiplegic muscles display features of the [[upper motor neuron syndrome]]. Features other than weakness include decreased movement control, [[clonus]] (a series of involuntary rapid muscle contractions), [[spasticity]], exaggerated deep tendon reflexes and decreased endurance.{{citation needed|date=August 2021}}

The incidence of hemiplegia is much higher in premature babies than term babies. There is also a high incidence of hemiplegia during [[pregnancy]] and experts believe that this may be related to either a traumatic delivery, use of [[forceps]] or some event which causes brain injury.<ref>{{cite web | title = hemiplegia in children | work = Children's Hemiplegia and Stroke Association (CHASA) | url = http://www.chasa.org/hemiplegia.htm | archive-url = https://web.archive.org/web/20120204172129/http://www.chasa.org/hemiplegia.htm | archive-date = February 4, 2012 }}</ref> There is tentative evidence of an association with undiagnosed [[celiac disease]] and improvement after withdrawal of [[gluten]] from the diet.<ref name="ShapiroBlanco2017">{{cite journal | vauthors = Shapiro M, Blanco DA | title = Neurological Complications of Gastrointestinal Disease | journal = Seminars in Pediatric Neurology | volume = 24 | issue = 1 | pages = 43–53 | date = February 2017 | pmid = 28779865 | doi = 10.1016/j.spen.2017.02.001 | type = Review }}</ref>

Other causes of hemiplegia in adults include [[physical trauma|trauma]], [[bleeding]], brain [[infection]]s and [[cancer]]s. Individuals who have uncontrolled [[diabetes mellitus|diabetes]], [[hypertension]] or those who smoke have a higher chance of developing a stroke.  Weakness on one side of the face may occur and may be due to a viral infection, stroke or a cancer.<ref>{{cite web |url=http://www.hemihelp.org.uk/hemiplegia/what_is_hemiplegia |title=What is hemiplegia? &#124; HemiHelp: for children and young people with hemiplegia (hemiparesis) |publisher=HemiHelp |access-date=2013-03-08 |archive-url=https://web.archive.org/web/20130305060120/http://www.hemihelp.org.uk/hemiplegia/what_is_hemiplegia |archive-date=2013-03-05 |url-status=usurped }}</ref>

===Common causes===
* '''Vascular''': [[cerebral hemorrhage]], [[stroke]], [[cerebral palsy]]
* '''Infective''': [[encephalitis]], [[meningitis]], [[brain abscess]], [[cerebral palsy]], [[spinal epidural abscess]], [[COVID-19]]
* '''Neoplastic''': [[glioma]], [[meningioma]], [[brain tumors]], [[spinal cord tumors]]
* '''Demyelination''': [[multiple sclerosis]], [[disseminated sclerosis]], [[Acute disseminated encephalomyelitis|ADEM]], [[neuromyelitis optica]]
* '''Traumatic''': cerebral lacerations, [[subdural hematoma]], [[epidural hematoma]], [[cerebral palsy]], [[vertebral compression fracture]]
* '''Iatrogenic''': local anaesthetic injections given intra-arterially rapidly, instead of given in a nerve branch.
* '''Ictal''': [[seizure]], [[Todd's paralysis]]
* '''Congenital''': [[cerebral palsy]], Neonatal-Onset Multisystem Inflammatory Disease (NOMID)
* '''Degenerative''': [[ALS]], [[corticobasal degeneration]]
* '''Parasomnia''': [[sleep paralysis]]<ref>{{cite web|url=http://www.lakesidepress.com/pulmonary/Sleep/sleep-paralysis.htm | title = I was awake -- and could not move! | quote =Sleep paralysis, parasomnia, sleep apnea, sleep eat, parasomnias, paresthesias, dysesthesias, obstructive sleep apnea, REM, Stage 1, Sinemet narcolepsy, insomnia, cataplexy, benzodiazepines, opioids, sleepiness, sleep walking, daytime sleepiness, upper airway, CPAP, hypoxemia, UVVP, uvula, Somnoplasty, obesity, airway obstruction, EEG, electroencephalogram, Klonopine, night terrors, bruxism, parasomnias, EMG, Epworth Sleepiness Scale, BiPAP, sleep efficiency | vauthors = Martin L | date = 2009 |publisher=Lakesidepress.com |access-date=2013-03-08}}</ref>

==Mechanism==
Movement of the body is primarily controlled by the [[pyramidal tract|pyramidal (or corticospinal) tract]], a pathway of neurons that begins in the [[motor cortex|motor areas of the brain]], projects down through the [[internal capsule]], continues through the [[brainstem]], decussates (or cross midline) at the '''lower''' [[medulla oblongata|medulla]], then travels down the spinal cord into the [[motor neuron]]s that control each muscle. In addition to this main pathway, there are smaller contributing pathways (including the [[anterior corticospinal tract]]), some portions of which do not cross the midline.{{citation needed|date=August 2021}}

Because of this anatomy, injuries to the pyramidal tract above the medulla generally cause '''[[contralateral]] hemiparesis''' (weakness on the opposite side as the injury). Injuries at the lower medulla, spinal cord, and peripheral nerves result in '''[[ipsilateral]] hemiparesis'''.{{citation needed|date=August 2021}}

In a few cases, lesions above the medulla have resulted in ipsilateral hemiparesis:
* In several reported cases, patients with hemiparesis from an old ''contralateral'' brain injury subsequently experienced worsening of their hemiparesis when hit with a second stroke in the ''ipsilateral'' brain.<ref name="Ago2003">{{cite journal | vauthors = Ago T, Kitazono T, Ooboshi H, Takada J, Yoshiura T, Mihara F, Ibayashi S, Iida M | display-authors = 6 | title = Deterioration of pre-existing hemiparesis brought about by subsequent ipsilateral lacunar infarction | journal = Journal of Neurology, Neurosurgery, and Psychiatry | volume = 74 | issue = 8 | pages = 1152–3 | date = August 2003 | pmid = 12876260 | pmc = 1738578 | doi = 10.1136/jnnp.74.8.1152 }}</ref><ref name="Song2005">{{cite journal | vauthors = Song YM, Lee JY, Park JM, Yoon BW, Roh JK | title = Ipsilateral hemiparesis caused by a corona radiata infarct after a previous stroke on the opposite side | journal = Archives of Neurology | volume = 62 | issue = 5 | pages = 809–11 | date = May 2005 | pmid = 15883270 | doi = 10.1001/archneur.62.5.809 | doi-access = free }}</ref><ref name="Yamamoto2007">{{cite journal |author4-link=Jean-Claude Baron | vauthors = Yamamoto S, Takasawa M, Kajiyama K, Baron JC, Yamaguchi T | title = Deterioration of hemiparesis after recurrent stroke in the unaffected hemisphere: Three further cases with possible interpretation | journal = Cerebrovascular Diseases | volume = 23 | issue = 1 | pages = 35–9 | year = 2007 | pmid = 16968984 | doi = 10.1159/000095756 | s2cid = 40273792 }}</ref> The authors hypothesize that brain reorganization after the initial injury led to more reliance on uncrossed motor pathways, and when these compensatory pathways were damaged by a second stroke, motor function worsened further.{{citation needed|date=July 2021}}
* A case report describes a patient with a congenitally uncrossed pyramidal tract, who developed right-sided hemiparesis after a hemorrhage in the right brain.<ref name="Terakawa2000">{{cite journal | vauthors = Terakawa H, Abe K, Nakamura M, Okazaki T, Obashi J, Yanagihara T | title = Ipsilateral hemiparesis after putaminal hemorrhage due to uncrossed pyramidal tract | journal = Neurology | volume = 54 | issue = 9 | pages = 1801–5 | date = May 2000 | pmid = 10802787 | doi = 10.1212/WNL.54.9.1801 | s2cid = 15086685 | url = http://www.utdallas.edu/~tres/int2001/hoang.pdf }}</ref>

==Diagnosis==
Hemiplegia is identified by clinical examination by a health professional, such as a [[physiotherapist]] or doctor. [[Radiological]] studies like a [[Full-body CT scan|CT scan]] or [[magnetic resonance imaging]] of the brain should be used to confirm injury in the brain and spinal cord, but alone cannot be used to identify movement disorders. Individuals who develop [[seizure]]s may undergo tests to determine where the focus of excess electrical activity is.<ref>{{cite web |url=http://www.originsofcerebralpalsy.com/02-forms/06-hemiplegia.html |title=Spastic Hemiplegia : Cerebral Palsy |publisher=OriginsOfCerebralPalsy.com |access-date=2013-03-08 |archive-date=2018-01-26 |archive-url=https://web.archive.org/web/20180126162320/http://www.originsofcerebralpalsy.com/02-forms/06-hemiplegia.html |url-status=dead }}</ref>

Hemiplegia patients usually show a characteristic gait.  The leg on the affected side is extended and internally rotated and is swung in a wide, lateral arc rather than lifted in order to move it forward.  The upper limb on the same side is also adducted at the shoulder, flexed at the elbow, and pronated at the wrist with the thumb tucked into the palm and the fingers curled around it.<ref>{{cite web | title = Gait Abnormalities | work = The Stanford 25 | url = http://stanford25.wordpress.com/gait-abnormalities/ | archive-url = https://web.archive.org/web/20101011002705/http://stanford25.wordpress.com/gait-abnormalities/ | archive-date=October 11, 2010 }}</ref>

===Assessment tools===
There are a variety of standardized assessment scales available to [[physiotherapists]] and other [[health care professionals]] for use in the ongoing evaluation of the status of a patient's hemiplegia. The use of standardized assessment scales may help physiotherapists and other health care professionals during the course of their treatment plant to:{{citation needed|date=August 2021}}
* Prioritize treatment interventions based on specific identifiable motor and sensory deficits
* Create appropriate short- and long-term goals for treatment based on the outcome of the scales, their professional expertise and the desires of the patient
* Evaluate the potential burden of care and monitor any changes based on either improving or declining scores

Some of the most commonly used scales in the assessment of hemiplegia are:
* The [[Fugl-Meyer Assessment of sensorimotor function]] (FMA)<ref>{{cite journal | vauthors = Fugl-Meyer AR, Jääskö L, Leyman I, Olsson S, Steglind S | title = The post-stroke hemiplegic patient. 1. a method for evaluation of physical performance | journal = Scandinavian Journal of Rehabilitation Medicine | volume = 7 | issue = 1 | pages = 13–31 | year = 1975 | doi = 10.2340/1650197771331 | pmid = 1135616 | s2cid = 19245788 | doi-access = free }}</ref>

The FMA is often used as a measure of functional or physical impairment following a [[cerebrovascular accident]] (CVA).'''<ref>{{cite journal | vauthors = Sullivan KJ, Tilson JK, Cen SY, Rose DK, Hershberg J, Correa A, Gallichio J, McLeod M, Moore C, Wu SS, Duncan PW | display-authors = 6 | title = Fugl-Meyer assessment of sensorimotor function after stroke: standardized training procedure for clinical practice and clinical trials | journal = Stroke | volume = 42 | issue = 2 | pages = 427–32 | date = February 2011 | pmid = 21164120 | doi = 10.1161/STROKEAHA.110.592766 | doi-access = free }}</ref> '''It measures sensory and motor impairment of the upper and lower extremities, balance in several positions, range of motion, and pain. This test is a reliable and valid measure in measuring post-stroke impairments related to [[stroke recovery]]. A lower score in each component of the test indicates higher impairment and a lower functional level for that area. The maximum score for each component is 66 for the upper extremities, 34 for the lower extremities, and 14 for balance'''. '''<ref>{{cite book | vauthors = Sullivan SB |chapter=Stroke | veditors = O'Sullivan SB, Schmitz TJ |title=Physical Rehabilitation |publisher=F.A. Davis |location=Philadelphia PA |year=2007 |edition=5th}}</ref>  Administration of the FMA should be done after reviewing a training manual.<ref>{{cite web|url=http://www.rehabmeasures.org/lists/rehabmeasures/dispform.aspx?id=908 |title=Fugl-Meyer Assessment of Motor Recovery after |publisher=Rehab Measures |access-date=2013-03-08 |url-status=dead |archive-url=https://web.archive.org/web/20160924083300/http://www.rehabmeasures.org/lists/rehabmeasures/dispform.aspx?id=908 |archive-date=2016-09-24 }}</ref>
* The [[Chedoke-McMaster Stroke Assessment]] (CMSA)<ref>{{cite journal | vauthors = Gowland C, Stratford P, Ward M, Moreland J, Torresin W, Van Hullenaar S, Sanford J, Barreca S, Vanspall B, Plews N | display-authors = 6 | title = Measuring physical impairment and disability with the Chedoke-McMaster Stroke Assessment | journal = Stroke | volume = 24 | issue = 1 | pages = 58–63 | date = January 1993 | pmid = 8418551 | doi = 10.1161/01.STR.24.1.58 | doi-access =  }}</ref>
This test is a reliable measure of two separate components evaluating both motor impairment and [[disability]].<ref>{{cite journal | vauthors = Valach L, Signer S, Hartmeier A, Hofer K, Steck GC | title = Chedoke-McMaster stroke assessment and modified Barthel Index self-assessment in patients with vascular brain damage | journal = International Journal of Rehabilitation Research | volume = 26 | issue = 2 | pages = 93–9 | date = June 2003 | pmid = 12799602 | doi = 10.1097/00004356-200306000-00003 }}</ref> The disability component assesses any changes in physical function including gross motor function and walking ability. The disability inventory can have a maximum score of 100 with 70 from the gross motor index and 30 from the walking index. Each task in this inventory has a maximum score of seven except for the 2 minute walk test which is out of two. The impairment component of the test evaluates the upper and lower extremities, postural control and pain. The impairment inventory focuses on the seven stages of recovery from stroke from [[flaccid paralysis]] to normal motor functioning.  A training workshop is recommended if the measure is being utilized for the purpose of data collection.<ref>{{cite web |url=http://www.rehabmeasures.org/Lists/RehabMeasures/DispForm.aspx?ID=918&Source=http%3A%2F%2Fwww%2Erehabmeasures%2Eorg%2FLists%2FRehabMeasures%2FAdmin%2Easpx |title=Chedoke-McMaster Stroke Assessment Measure |publisher=Rehab Measures |access-date=2013-03-08 |archive-url=https://web.archive.org/web/20141006184204/http://www.rehabmeasures.org/Lists/RehabMeasures/DispForm.aspx?ID=918&Source=http%3A%2F%2Fwww%2Erehabmeasures%2Eorg%2FLists%2FRehabMeasures%2FAdmin%2Easpx |archive-date=2014-10-06 |url-status=dead }}</ref>
* The [[Stroke Rehabilitation Assessment of Movement]] (STREAM)<ref>{{cite journal | vauthors = Daley K, Mayo N, Wood-Dauphinée S | title = Reliability of scores on the Stroke Rehabilitation Assessment of Movement (STREAM) measure | journal = Physical Therapy | volume = 79 | issue = 1 | pages = 8–19; quiz 20–3 | date = January 1999 | doi = 10.1093/ptj/79.1.8 | pmid = 9920188 | url = http://www.ptjournal.org/cgi/pmidlookup?view=long&pmid=9920188 | doi-access = free }}</ref>

The STREAM consists of 30 test items involving upper-limb movements, lower-limb movements, and basic mobility items. It is a clinical measure of voluntary movements and general mobility (rolling, bridging, sit-to-stand, standing, stepping, walking and stairs) following a stroke. The voluntary movement part of the assessment is measured using a 3-point ordinal scale (unable to perform, partial performance, and complete performance) and the mobility part of the assessment uses a 4-point ordinal scale (unable, partial, complete with aid, complete no aid). The maximum score one can receive on the STREAM is a 70 (20 for each limb score and 30 for mobility score).  The higher the score, the better movement and mobility is available for the individual being scored.<ref>{{cite book | vauthors = O'sullivan S, Schmitz T | title = Physical Rehabilitation |edition= 5th  | publisher = F.A. Davis | year = 2007 | location = Philadelphia PA | page = 736 }}</ref>

==Treatment==
Treatment for hemiparesis is the same treatment given to those recovering from strokes or brain injuries.<ref name="FactsInfo" /> Health care professionals such as [[physical therapists]] and [[occupational therapists]] play a large role in assisting these patients in their recovery. Treatment is focused on improving sensation and motor abilities, allowing the patient to better manage their activities of daily living. Some strategies used for treatment include promoting the use of the hemiparetic limb during functional tasks, maintaining range of motion, and using [[neuromuscular electrical stimulation]] to decrease [[spasticity]] and increase awareness of the limb.<ref>{{Cite journal |last1=Knutson |first1=Jayme S. |last2=Fu |first2=Michael J. |last3=Sheffler |first3=Lynne R. |last4=Chae |first4=John |date=November 26, 2015 |title=Neuromuscular Electrical Stimulation for Motor Restoration in Hemiplegia |journal=Physical Medicine and Rehabilitation Clinics of North America |volume=26 |issue=4 |pages=729–745 |doi=10.1016/j.pmr.2015.06.002 |issn=1558-1381 |pmc=4630679 |pmid=26522909}}</ref><ref>{{Cite journal |last1=Beebe |first1=Justin A. |last2=Lang |first2=Catherine E. |date=March 5, 2009 |title=Active range of motion predicts upper extremity function 3 months after stroke |journal=Stroke |volume=40 |issue=5 |pages=1772–1779 |doi=10.1161/STROKEAHA.108.536763 |issn=1524-4628 |pmc=2718540 |pmid=19265051}}</ref>

At the more advanced level, using [[constraint-induced movement therapy]] will encourage overall function and use of the affected limb.<ref>{{cite journal | vauthors = Sterr A, Freivogel S | title = Motor-improvement following intensive training in low-functioning chronic hemiparesis | journal = Neurology | volume = 61 | issue = 6 | pages = 842–4 | date = September 2003 | pmid = 14504336 | doi = 10.1212/wnl.61.6.842 | s2cid = 43563527 }}</ref> [[Mirror box|Mirror Therapy]] (MT) has also been used early in stroke rehabilitation and involves using the unaffected limb to stimulate motor function of the hemiparetic limb. Results from a study on patients with severe hemiparesis concluded that MT was successful in improving motor and sensory function of the distal hemiparetic upper limb.<ref>{{cite journal | vauthors = Dohle C, Püllen J, Nakaten A, Küst J, Rietz C, Karbe H | title = Mirror therapy promotes recovery from severe hemiparesis: a randomized controlled trial | journal = Neurorehabilitation and Neural Repair | volume = 23 | issue = 3 | pages = 209–17 | year = 2009 | pmid = 19074686 | doi = 10.1177/1545968308324786 | s2cid = 14252958 | doi-access = free }}</ref>  Active participation is critical to the motor learning and recovery process, therefore it's important to keep these individuals motivated so they can make continual improvements.<ref>{{harvnb|Stroke in Physical Rehabilitation|2007|p=746}}</ref><br />
Also speech pathologists may work to increase function for people with hemiparesis.<ref>{{Cite web |title=Right Hemisphere Damage |url=https://www.asha.org/Practice-Portal/Clinical-Topics/Right-Hemisphere-Damage/ |access-date=2023-10-06 |website=American Speech-Language-Hearing Association |language=en}}</ref>

Treatment should be based on assessment by the relevant health professionals, including [[physiotherapists]], doctors and [[occupational therapists]]. Muscles with severe motor impairment including weakness need these therapists to assist them with specific exercise, and are likely to require help to do this.<ref>{{cite journal | vauthors = Patten C, Lexell J, Brown HE | title = Weakness and strength training in persons with poststroke hemiplegia: rationale, method, and efficacy | journal = Journal of Rehabilitation Research and Development | volume = 41 | issue = 3A | pages = 293–312 | date = May 2004 | pmid = 15543447 | doi = 10.1682/JRRD.2004.03.0293 | s2cid = 563507 }}</ref>

===Medication===
Drugs can be used to treat issues related to the Upper Motor Neuron Syndrome. Drugs like [[Chlordiazepoxide|Librium]] or [[diazepam|Valium]] could be used as a relaxant. Drugs are also given to individuals who have recurrent seizures, which may be a separate but related problem after [[brain injury]].<ref name="mcgill">{{cite web |url=http://sprojects.mmi.mcgill.ca/gait/hemiplegic/intro.asp |title=Hemiplegia/Hemiparesis |access-date=2014-10-02 |url-status=dead |archive-url=https://web.archive.org/web/20090420141222/http://sprojects.mmi.mcgill.ca/gait/hemiplegic/intro.asp |archive-date=2009-04-20 }}</ref>
Intra-muscular injection of [[botulinum toxin]] A is used to treat spasticity that is associated with hemiparesis both in cerebral palsy children and stroke in adults. It can be injected into a muscle or more commonly muscle groups of the upper or lower extremities. Botulinum toxin A induces temporary muscle paralysis or relaxation. The main goal of botulinum toxin A is to maintain the range of motion of affected joints and to prevent the occurrence of fixed joint contractures or stiffness.<ref>{{cite journal | vauthors = Farag SM, Mohammed MO, El-Sobky TA, ElKadery NA, ElZohiery AK | title = Botulinum Toxin A Injection in Treatment of Upper Limb Spasticity in Children with Cerebral Palsy: A Systematic Review of Randomized Controlled Trials | journal = JBJS Reviews | volume = 8 | issue = 3 | pages = e0119 | date = March 2020 | pmid = 32224633 | pmc = 7161716 | doi = 10.2106/JBJS.RVW.19.00119 }}</ref><ref>{{cite journal | vauthors = Blumetti FC, Belloti JC, Tamaoki MJ, Pinto JA | title = Botulinum toxin type A in the treatment of lower limb spasticity in children with cerebral palsy | journal = The Cochrane Database of Systematic Reviews | volume = 2019 | pages = CD001408 | date = October 2019 | issue = 10 | pmid = 31591703 | doi = 10.1002/14651858.CD001408.pub2 | pmc = 6779591 }}</ref> A randomized trial pointed out that individualized homeopathic medication in addition to the standard physiotherapy might have some effect in post-stroke hemiparesis.<ref>{{Cite journal |last1=Dutta |first1=Abhijit |last2=Singh |first2=Subhas |last3=Saha |first3=Subhranil |last4=Rath |first4=Prasanta |last5=Sehrawat |first5=Nisha |last6=Singh |first6=Navin Kumar |date=2022-08-29 |title=Efficacy of individualized homeopathic medicines in treatment of post-stroke hemiparesis: A randomized trial |url=https://pubmed.ncbi.nlm.nih.gov/36115790/ |journal=Explore |volume=19 |issue=2 |pages=S1550–8307(22)00160–4 |doi=10.1016/j.explore.2022.08.017 |issn=1878-7541 |pmid=36115790|s2cid=251943815 }}</ref>

===Surgery===
Surgery may be used if the individual develops a secondary issue of [[contracture]], from a severe imbalance of muscle activity. In such cases the [[surgeon]] may cut the [[ligament]]s and relieve joint contractures. Individuals who are unable to swallow may have a tube inserted into the stomach. This allows food to be given directly into the stomach. The food is in liquid form and instilled at low rates. Some individuals with hemiplegia will benefit from some type of [[prosthesis|prosthetic]] device. There are many types of braces and splints available to stabilize a joint, assist with walking and keep the upper body erect.{{citation needed|date=June 2022}}

===Rehabilitation===
Rehabilitation is the main treatment of individuals with hemiplegia. In all cases, the major aim of rehabilitation is to regain maximum function and quality of life. Both physical and [[occupational therapy]] can significantly improve the quality of life.

===Physical therapy===
[[Physical therapy]]  (PT) can help improve muscle strength & coordination, mobility (such as standing and walking), and other physical function using different sensorimotor techniques.<ref>{{cite journal | vauthors = Barreca S, Wolf SL, Fasoli S, Bohannon R | title = Treatment interventions for the paretic upper limb of stroke survivors: a critical review | journal = Neurorehabilitation and Neural Repair | volume = 17 | issue = 4 | pages = 220–6 | date = December 2003 | pmid = 14677218 | doi = 10.1177/0888439003259415 | s2cid = 23055506 | doi-access = free }}</ref>  Physiotherapists can also help reduce shoulder pain by maintaining shoulder range of motion, as well as using [[Functional electrical stimulation]].<ref>{{cite journal | vauthors = Price CI, Pandyan AD | title = Electrical stimulation for preventing and treating post-stroke shoulder pain: a systematic Cochrane review | journal = Clinical Rehabilitation | volume = 15 | issue = 1 | pages = 5–19 | date = February 2001 | pmid = 11237161 | doi = 10.1191/026921501670667822 | s2cid = 1792159 }}</ref>  Supportive devices, such as braces or slings, can be used to help prevent or treat shoulder subluxation<ref>{{cite journal | vauthors = Ada L, Foongchomcheay A, Canning C | title = Supportive devices for preventing and treating subluxation of the shoulder after stroke | journal = The Cochrane Database of Systematic Reviews | issue = 1 | pages = CD003863 | date = January 2005 | volume = 2005 | pmid = 15674917 | pmc = 6984447 | doi = 10.1002/14651858.CD003863.pub2 | s2cid = 10451803 | veditors = Ada L }}</ref> in the hopes to minimize disability and pain.  Although many individuals with stroke experience both shoulder pain and shoulder subluxation, the two are mutually exclusive.<ref>{{cite journal | vauthors = Zorowitz RD, Hughes MB, Idank D, Ikai T, Johnston MV | title = Shoulder pain and subluxation after stroke: correlation or coincidence? | journal = The American Journal of Occupational Therapy | volume = 50 | issue = 3 | pages = 194–201 | date = March 1996 | pmid = 8822242 | doi = 10.5014/ajot.50.3.194 | doi-access =  }}</ref> A treatment method that can be implemented with the goal of helping to regain motor function in the affected limb is [[constraint-induced movement therapy]]. This consists of constraining the unaffected limb, forcing the affected limb to accomplish tasks of daily living.<ref>{{cite journal | vauthors = Wittenberg GF, Schaechter JD | title = The neural basis of constraint-induced movement therapy | journal = Current Opinion in Neurology | volume = 22 | issue = 6 | pages = 582–8 | date = December 2009 | pmid = 19741529 | doi = 10.1097/WCO.0b013e3283320229 | s2cid = 16050784 }}</ref>

===Occupational therapy===
[[Occupational therapy|Occupational therapists]] may specifically help with hemiplegia with tasks such as improving hand function, strengthening hand, shoulder and torso, and participating in activities of daily living (ADLs), such as eating and dressing.  Therapists may also recommend a hand splint for active use or for stretching at night. Some therapists actually make the splint; others may measure your child's hand and order a splint. OTs educate patients and family on compensatory techniques to continue participating in daily living, fostering independence for the individual - which may include, environmental modification, use of adaptive equipment, sensory integration, etc.{{citation needed|date=August 2021}}

===Orthotic intervention===

Orthotic devices are one type of intervention for relieving symptoms of hemiparesis. Commonly called braces, orthotics range from 'off the shelf' to custom fabricated solutions, but their main goal is alike, to supplement diminished or missing muscle function and joint laxity. A wide range of orthotic treatment can be designed by a Certified Orthotist (C.O.) or Certified Prosthetist Orthotist (C.P.O).  Orthotics may be made of metal, plastic, or composite material (such as fiberglass, dyneema ([[UHMWPE]],) carbon fiber, etc.), and design may be changed to address many different conditions.<ref>{{Cite journal |last1=Choo |first1=Yoo Jin |last2=Chang |first2=Min Cheol |date=2021-08-13 |title=Commonly Used Types and Recent Development of Ankle-Foot Orthosis: A Narrative Review |journal=Healthcare |volume=9 |issue=8 |pages=1046 |doi=10.3390/healthcare9081046 |issn=2227-9032 |pmc=8392067 |pmid=34442183 |doi-access=free }}</ref>

==Prognosis==
Hemiplegia is not a progressive disorder, except in progressive conditions like a growing brain tumour. Once the injury has occurred, the symptoms should not worsen. However, because of lack of mobility, other complications can occur. Complications may include muscle and joint stiffness, loss of aerobic fitness, muscle spasms, bed sores, pressure ulcers and [[thrombus|blood clots]].<ref name="healthopedia">{{cite web|url=http://www.healthopedia.com/hemiplegia/ |title=Hemiplegia (Hemiparalysis) |publisher=Healthopedia.com |date=2009-04-06 |access-date=2013-03-08}}</ref>

Sudden recovery from hemiplegia is very rare. Many of the individuals will have limited recovery, but the majority will improve from intensive, specialised rehabilitation. Potential to progress may differ in cerebral palsy, compared to adult acquired brain injury. It is vital to integrate the hemiplegic child into society and encourage them in their daily living activities. With time, some individuals may make remarkable progress.<ref name="healthopedia" />

==Popular culture==
* In [[Barbara Kingsolver]]'s novel, ''[[The Poisonwood Bible]]'', the character Adah is incorrectly diagnosed, in childhood, as having hemiplegia.<ref>{{cite web|url=http://litmed.med.nyu.edu/Annotation?action=view&annid=1686 |title=Kingsolver, Barbara : The Poisonwood Bible |publisher=Litmed.med.nyu.edu |date=2000-05-17 |access-date=2013-03-08}}</ref><ref>{{cite web|url=http://www.enotes.com/poisonwood-bible |title=The Poisonwood Bible Barbara Kingsolver Study Guide, Lesson Plan & more |publisher=eNotes.com |access-date=2013-03-08}}</ref>
* Rock band [[HAERTS]] released an EP called ''Hemiplegia'' via [[Columbia Records]] in 2013.<ref>{{cite web|url=http://www.broadwayworld.com/bwwmusic/article/HAERTS-Announce-Debut-EP-Hemiplegia-Out-917-on-Columbia-Records-20130808 |title=HAERTS Announce Debut EP Hemiplegia, Out 9/17 on Columbia Records |publisher=broadwayworld.com |date=2013-08-08 |access-date=2013-10-19}}</ref>
* In the 1994 [[Jodie Foster]] film ''[[Nell (film)|Nell]]'', the title character portrayed by Foster has developed her own language ([[idioglossia]]), developed in part due to the distinct speech patterns of her mother, caused by her hemiplegia due to a stroke.
* In the [[anime]] series ''[[Mobile Suit Gundam: Iron-Blooded Orphans]]'', the protagonist Mikazuki Augus is paralyzed in the entire right half of his body after a fierce battle with the Mobile Armor Hashmal. In order to defeat the Mobile Armor, he was forced to deactivate the safety limiter on his Gundam's neural interface and overloading the connection between him and the Mobile Suit for the necessary power.
* In the game [[Identity V]] the hunter "Sculptor" / Galatea Claude is paralysed on the left side of her body.

== See also ==
* [[Alternating hemiplegia]]
* [[Brunnstrom Approach]]
* [[Hemiplegic migraine]]
* [[Laryngeal paralysis]]
* [[Paraplegia]]
* [[Paresis]]

== References ==
{{Reflist}}

{{Medical resources
|   ICD11          = {{ICD11|MB53.Z}}, {{ICD11|6B60.6}}
|   ICD10          = {{ICD10|G81.9}}
|   ICD9           = {{ICD9|342.9}}, {{ICD9|094.89}}, {{ICD9|438.2}}
|   ICDO           =
|   OMIM           =
|   MedlinePlus    =
|   eMedicineSubj  =
|   eMedicineTopic =
|   MeshID         = D006429
}}
{{Movement and gait symptoms and signs}}

[[Category:Cerebral palsy and other paralytic syndromes]]
[[Category:Symptoms and signs: Nervous system]]