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    Hemiplegia

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    Stefany Celine
    Hemiplegia is a clinical sign characterized by motor impairment on one side of the body. During early stages, there is flaccidity and lack of voluntary motion, which is later replaced by spasticity developing first in anti-gravity muscles. Resting posture includes shoulder adduction, elbow flexion, and forearm pronation. Motion occurs in synergies including shoulder abduction and elbow flexion. Physical therapy treatment focuses on positioning, range of motion exercises, facilitation of active contractions, and improving motor control, synergy patterns, and functional activities. Goals include reducing spasticity and improving mobility, transfers, balance, and ambulation.

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    Hemiplegia

    Uploaded by

    Stefany Celine
    127 views17 pages
    Hemiplegia is a clinical sign characterized by motor impairment on one side of the body. During early stages, there is flaccidity and lack of voluntary motion, which is later replaced by spasticity developing first in anti-gravity muscles. Resting posture includes shoulder adduction, elbow flexion, and forearm pronation. Motion occurs in synergies including shoulder abduction and elbow flexion. Physical therapy treatment focuses on positioning, range of motion exercises, facilitation of active contractions, and improving motor control, synergy patterns, and functional activities. Goals include reducing spasticity and improving mobility, transfers, balance, and ambulation.

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    Stroke

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    Hemiplegia is a clinical sign characterized by motor impairment on one side of the body. During early stages, there is flaccidity and lack of voluntary motion, which is later replaced by spasticity developing first in anti-gravity muscles. Resting posture includes shoulder adduction, elbow flexion, and forearm pronation. Motion occurs in synergies including shoulder abduction and elbow flexion. Physical therapy treatment focuses on positioning, range of motion exercises, facilitation of active contractions, and improving motor control, synergy patterns, and functional activities. Goals include reducing spasticity and improving mobility, transfers, balance, and ambulation.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    127 views17 pages

    Hemiplegia

    Uploaded by

    Stefany Celine
    Hemiplegia is a clinical sign characterized by motor impairment on one side of the body. During early stages, there is flaccidity and lack of voluntary motion, which is later replaced by spasticity developing first in anti-gravity muscles. Resting posture includes shoulder adduction, elbow flexion, and forearm pronation. Motion occurs in synergies including shoulder abduction and elbow flexion. Physical therapy treatment focuses on positioning, range of motion exercises, facilitation of active contractions, and improving motor control, synergy patterns, and functional activities. Goals include reducing spasticity and improving mobility, transfers, balance, and ambulation.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 17

    Hemiplegia

    Clinical sign
    Motor function
    1. During early stages , flaccidity with no voluntary
    motion
    2. Flaccidity replaced by spasticity , frequently develops
    first in the antigravity muscles
    3. Resting posture ; strong scapular retraction , shoulder
    adduction, elbow flexion and forearm pronation
    4. In the lower extremity , flexor spasticity in sitting , and
    extensor muscle groups is dominant on weightbearing
    5. Motion synergies
    Synergy pattern
    Flexion component of UE synergy :
    1 retraction and/or elevation of the scapula
    2. shoulder abduction
    3. shoulder external rotation
    4. elbow flexion ( strongest component )
    5. supination ( pronation may also be a component of
    this synergy )
    Note : hyperextension of the shoulder may be present
    instead of abduction and external rotation
    Extension components of UE
    1. protraction of the scapula
    2. shoulder adduction ( strongest component )
    3. shoulder internal rotation
    4. elbow extension and
    5. pronation
    Flexion components of LE
    1. hip flexion ( strongest component )
    2. hip abduction
    3. hip external rotation
    4. knee flexion
    5. dorsiflexion of toes and ankles and
    6. inversion
    Extension components of LE
    1. hip extension
    2. hip adduction
    3. hip internal rotation
    4. knee extension
    5. plantar flexion and inversion of ankle
    6. toe plantar flexion ( great toe may extend )
    Note : patient with less severe involvement will progress
    to the utilization of isolated motions outside the synergy
    pattern
    Influence of reflexes
    1. STNR
    2. ATNR
    3. TLR
    4. tonic lumbar reflex
    5. Tonic thumb reflex
    STNR = flexion of the neck --- flexion of the arm and extension
    of the leg VV
    ATNR = head rotation to the left extension left arm n left leg ,
    flexion right arm n right leg VV
    TLR ( tonic labyrinthine reflex ) prone facilitate flexion VV
    Tonic lumbar reflex = rotation to the right --- flexion of the right
    UE and extension of the right LE , rotation to the left ---
    extension of the right UE n flexion of the right LE VV
    Tonic Thumb reflex = elevated arm above horizontal with
    forearm supination , thumb extension is facilitated , pronation is
    facilitatory to finger extension
    Associated reactions
    1. Souqoues Phenomenon
    2. Raimistes phenomenon
    3. Homolateral limb synkineses
    DECREASED ENDURANCE
    BALANCE PROBLEMS
    SENSORY IMPAIRMENT
    PERCEPTUAL , INTELLECTUAL AND SPEECH DEFICITS
    VISUAL DEFECTS
    Secondary complications
    1. decreased ROM
    2. shoulder subluxation
    PT EVALUATION
    1. Intellectual and cognitive abilities
    2. Memory
    3. Orientation
    4. Ability to follow instructions
    5. Perseveration
    6. Attention span
    PT EVALUATION
    1. Intellectual and cognitive abilities
    2. Memory
    3. Orientation
    4. Ability to follow instructions
    5. Perseveration
    6. Attention span
    7. Visual and perceptual defects
    SPEECH
    RESPIRATORY EVALUATION
    SENSORY AND COORDINATION EVALUATION
    ROM ASSESSMENT
    MOTOR FUNCTION
    FUNCTIONAL ACTIVITY LEVEL
    GAIT ANALYSIS
    PT Treatment ( special method or
    eclectic ? )
    Early recovery stages
    Treatment suggestion :
    1. positioning program
    2. rom exercises
    3. facilitation of active contraction in proximal muscle
    groups
    4. sensory facilitation technique
    5. utilization key point of control and RIP
    6. facilitation of early development of synergy pattern
    7. utilization of reflexes and or associated reaction
    8. facilitation of early developmental activities to
    improve motor control
    9. substituting for lost function by utilization of
    uninvolved extremities ( at least for temporary )
    Mid recovery stages
    The goals :
    1. promote development of weak synergy component
    2. facilitate isolated movements
    3. improve postural stability
    4. improve level of skill in self-care and ADL
    5. increasing endurance
    6. improve standing balance
    7. improve wheel chair mobility
    8. improve transfer ability
    9. maintain respiratory status
    10. reduce spasticity
    11. manage sensory , visual and perceptual deficit
    12. decrease pain
    13. improve righting and equilibrium reactions
    14. improve ambulation
    Advance recovery stages
    Treatment goals :
    1. improve skill and coordination in isolated movements
    2. inhibit residual spasticity
    3. improve skill in self-care and ADL
    4. improve ambulation
    5. improve skill in elevation activities and outdoor
    activity
    6. improve endurance

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