Strokes and Hemiplegia

Strokes & Hemiplegia Overview

• Strokes involve the blockage of blood flow to the brain or sudden bleeding in the brain.
• Hemiplegia is a non-progressive paralysis on one side of the body.
• A stroke is an insult, injury, or event to the brain. Consequences can range from death to full recovery.
• Hemiplegia is a state often resulting from a stroke, but can be caused by genetics, spinal cord injury, or other brain injuries.
• Paralysis in hemiplegia occurs on the opposite side of the brain lesion.
• Effects of hemiplegia depend on the location and severity of brain damage.
• Hemiplegia can be temporary or permanent, ranging from unnoticeable to severely disabling.
• Hemiplegia may involve spasticity and sensory or perceptual loss.
• Damage to one side of the brain results in paralysis on the opposite side of the body.
• Left brain damage can cause right-side paralysis along with speech and memory deficits and cautious behavior.
• Right brain damage lead to left-side paralysis, perceptual, and memory deficits and quick, impulsive behavior.

Hemiplegia Symptoms and Observations

• Immediately post-stroke, muscles on the affected side are weak or flaccid (acute phase).
• Gradually, flaccid paralysis leads to spastic paralysis, although some flaccidity may remain.
• Lesions interfere with the brain's control, leading to uninhibited alpha motor neuron firing.
• Paralysis can develop into a flexor or extensor pattern based on dominant reflexes.
• A common pattern is flexor pattern in the upper limbs and extensor pattern in the lower limb.
• Altered posture often results from spasticity.
• Altered gait, such as circumducted gait, may occur.
• Hemiplegic shoulder involves GH adduction, internal rotation, and scapular retraction.
• Seizures, edema, pain, and compensatory changes can be present.
• Sensory deficits can occur.
• Shoulder-hand syndrome may develop, with decreased ROM, throbbing pain.
• Neglect of the affected side.
• Behavioral and emotional changes.
• Visual impairment and speech difficulties
• Cognitive impairment can occur.
• Spasticity patterns on the affected side.
• Balance and weight shifting may be impaired.
• Ambulatory aids such as canes or walkers.
• Muscle bulk differences between affected and unaffected sides.
• Functional abilities vary based on stroke severity and spasticity or flaccidity.
• Postural asymmetries may be observed.
• Neglect of the affected side.
• Hemiplegic or hemiparetic gait involves swinging the leg outward in a circle (circumduction).
• The affected upper limb is carried across the trunk for balance when walking.

Strokes - Types, Risk Factors, and Warning Signs

• A stroke occurs when blood supply to part of the brain is interrupted, leading to brain cell impairment.
• There are 3 main types of strokes: ischemic, hemorrhagic, and transient ischemic attack (TIA).
• Transient ischemic attacks (TIA) last less than 24 hours.
• In rare cases, underlying conditions like tumors, infections, or brain swelling can cause strokes.
• Controllable risk factors include unhealthy weight, hypertension, high cholesterol, diabetes, heart disease, physical inactivity, excessive alcohol and drug abuse, smoking, stress, and birth control/hormone replacement therapy.
• Uncontrollable risk factors include sex, age, family history, ethnicity, personal circumstances, and history of stroke or TIA.
• High blood pressure (hypertension) is associated with hemorrhagic strokes.
• Atherosclerosis is associated with ischemic strokes.
• Key warning signs are sudden and severe: numbness or weakness, confusion or trouble speaking, vision problems, difficulty walking or dizziness, severe headache.

Stroke - First Aid and Recovery

• FAST is an acronym for stroke first aid.
• Face: check for facial drooping.
• Arms: check if the person can raise both arms.
• Speech: check if the person's speech is slurred or jumbled.
• Time: call EMS/9-1-1 immediately.
• The Brunnstrom stages of recovery describe the progression of motor recovery after a stroke.
• Stage 1: Flaccidity immediately after the onset with no voluntary movements.
• Stage 2: Spasticity appears, basic synergy patterns emerge, and minimal voluntary movements may be present.
• Stage 3: Patient gains voluntary control over synergies and spasticity increases.
• Stage 4: Some movement patterns out of synergy are mastered and spasticity decreases.
• Stage 5: More complex movement combinations are learned and the basic synergies lose dominance.
• Stage 6: Spasticity disappears, and individual joint movements become possible.
• Stage 7: Normal function is restored
• Progression through stages may not be linear or complete.
• Synergy refers to recruitment of a whole series of muscles when just a few are needed.
• In upper limb spasticity patterns, the most common is the flexor synergy, and 5 is the extensor synergy pattern.

Assessment, Treatment Planning, and Rationale

• Assessment involves palpation, postural assessment, ROM testing, and sensory testing.
• Goals include promote relaxation, decrease pain, addressing postural changes, decrease edema, decrease spasticity, maintain joint health and full body integration.
• Treatments should include relaxation, stress management, PROM, stretching, lowering tone, edema reduction, stimulating, joint ROM, and full body integration.
• PROM and stretching are important to prevent neglect of the affected limb.
• The treatments are important to prevent contracture formation, promoting tissue health, stimulate muscles, and maintain good joint health.