WHAT IS HEMIPARESIS?
A neurological alteration that renders the mobility of a part of the body incapacitated.
Hemiparesis is not defined as a disease, but rather as a neurological condition of variable causes that hinders the movement of one half of the body. Specifically, hemiparesis refers to decreased motor force or partial paralysis that affects an arm and leg on the same side of the body.
This decrease in movement does not constitute a paralysis, and is considered a lesser degree than hemiplegia, which does cause total paralysis. When this decrease in movement affects the head and face may not be too obvious
TYPES OF HEMIPARESIS
Hemiparesis can be grouped into different types depending on the causes of onset, so there are different types depending on the degree of muscle weakness and its causes.
1. Right-side hemiparesis
This hemiparesis is caused by an injury to the left hemisphere of the brain, so the person will have their muscle mobility waning from the right part of their body.
2. Left-sided hemiparesis
When brain injury occurs in the right hemisphere, it is the left side of the body that is affected by this decrease in muscle mobility.
3. Child’s hemiparesis
Infant hemiparesis affects infants or young children, and is usually caused by spinal cord problems or brain damage from birth.
CAUSES
As mentioned in the previous point, the causes of hemiparesis are varied. The particular muscle weakening can be caused by spinal cord injuries affecting the nerves that inert the muscles and causing their weakness.
This spinal cord damage includes injuries caused by trauma, such as that could result in a car accident. Similarly, diseases such as multiple sclerosis and some cancers can also cause spinal cord injuries that interfere with nerve activity.
Brain damage can also lead to a decay of muscle strength, with stroke being one of the most common reasons that causes a person to suffer from hemiparesis. In addition, this muscle weakness is one of the main signs that a person will suffer a stroke.
DIAGNOSTIC
When a patient comes to the health center with hemiparesis, the first step is to determine the germ of muscle weakness. Medical imaging studies are necessary to accurately detect the location of the lesion; An interview with the patient of information collection is also needed to develop a medical history in order to identify the most obvious risk factors.
TREATMENT
To stop the effects of hemiparesis and reduce the consequences that these have on the body it is essential to resolve and/or treat the affected part that has caused it. This way, as a bounce effect, it should improve and even fix.
Another very common intervention with remarkable positive results is physical treatment through physiotherapy exercises, in which it is forced to work and move directly the areas that have been affected by this decrease in mobility.
With this treatment the patient restores the control they have over their muscles, strengthens their muscle mass and motor capacity. The person affected by hemiparesis may also be assisted by devices, such as walkers or braces, that help complement treatment; and to support the execution of their daily activities and to move the affected area with greater and better development of the activity.
There is no minimum amount of time for partial or total recovery of hemiparesis, since recovery depends on the intensity of treatment, the degree of muscle weakening or the causes that have caused the involvement.
Normally, hemiparesis can be solved in its entirety, leaving, at most, minor sequelae that can be perfectly harmonized with the normal patient’s rhythm of life.
BOBATH CONCEPT
One of the possible treatments for hemiparesis is the Bobath Concept through physiotherapy and occupational therapy.
The Bobath Concept refers to a therapeutic approach focused on problem solving in the evaluation and treatment of patients with function disorders or problems, postural control and movement, due to central nervous system injuries; including here the hemiparesis.
This is a therapy that relies on the brain’s ability to reorganize from peripheral sensory stimulus, seeking intact brain areas to compensate for functions that were performed by injured parts of the brain.
The main part of the Bobath Concept is to promote the functioning of the affected side of the body as much as necessary, and thus adapt its movements consonantly with the less affected side of the body; seeking to balance the body in terms of functionality and mobility.
Another characteristic essence of this method is the modification of abnormal movement patterns resulting from the injury itself, facilitating the activity functionally and following the milestones of the neurophysiological neurofunction of the person.
Another point is that it does not require strict treatment regimens that need to be followed rigorously, but instead supplies the person with elements that they can apply according to individual needs and responses, involving so to the patient in their own recovery.
WHAT THERAPIES WORK IN CHILDREN WITH HEMIPARESIA?
Children spend all day with their family, so what they do during that time will perform better than what the child does in a clinical session time.
We need to start thinking that a child is not a young adult, has its own form of learning (trial & error through the game), and that development occurs in different situations and set ups and throughout the whole day (everything is new to them).
The main job of the professional is to train the child to have more learning and neurodevelopment opportunities, and for this it is very important to establish common goals (based on the needs of the child and the family).
The purpose of all therapy is to increase AUTONOMY. It is not a question of looking for “normal” movements but functional and routine-based movements, which allow the use of the affected hand throughout the day and, therefore, increasing learning, and participation in the activities of daily life.
MORE does not mean BETTER: more clinical services is no better than more learning opportunities in your natural environment.
It is important that the child does not forget the affected hand: The dominance of one of the hands is very early in the hemiparesis, and the child tends to encourage the use of that hand and to “forget” the affected hand, because there is no experience with the environment , the brain does not get sensory information from that hand and tends not to use it. The disuse of the affected hand restricts development, movement is increasingly reduced and that further encourages disuse.
It is also important to generate learning opportunities in different situations so that the child can use the affected arm within the situations of daily life, so valuations can not focus on deficits but on the overall functioning of the Child.
When we talk about hemiparesis we have to differentiate the roles of the hands: one hand is going to be the dominant (precise, skillful, fast) and the other hand the assistant, who can not perform all the movements, but it allows to stabilize and keep the object so that the hand dominant can work properly.
… So what are the best therapies?
Current evidence tells us that they are those who use intensive, routine-based training and in common environments, which aim to increase the use, functionality, and generalization of use in daily life, and affect the “representation” of the hand affected at the cortical level, changes occur in the brain (reorganization).
There are two therapies based on these premises, which tend to take advantage of neuroplasticity, overcome the restriction of development, and be able to encourage greater spontaneous use of the child: the MOVEMENT THERAPY INDUCED BY RESTRICTION OR RESTRICTIVE THERAPY AND THE BIMANUAL INTENSIVE TRAINING.
Both use high doses of treatment, giving the option of repetition of scheduled tasks, depending on the needs of the child and the family, performed within the natural environment (frequent tasks), so that you can use your hand in those contexts and increase learning, that has the option to experiment, to get it wrong, and from that mistake arises the functional strategy (not the strategy to achieve a “normal” movement but the one that allows it to achieve its goal).
They should be simple activities at first to avoid frustration, that are motivating, attend to the preferences of the child, and can be individual or group, and always as a game.
The bi-manual starts from the same principles, but it addresses that in daily life most activities require the intervention of both hands and is intended to improve coordination between the dominant hand and the assistant.