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