Hemiplegia is a term which refers to a loss of muscular strength or partial paralysis that effects movement and function on one side on the body. This movement disorder can be caused by an injury to the area of the brain which is responsible for muscular control and movement of the arms, legs and facial muscles. Therefore, hemiplegia is one of the common symptoms of Cerebral Palsy, Stroke and other acquired brain injuries. People with hemiplegia can present with the following symptoms:
Exercise has been shown to help improve and optimise muscular strength, range of motion and limb function. However, due to the imbalance in strength and movement difficulties, some may find it hard to exercise effectively. When working with patients with hemiplegia there are 3 principles that I follow when designing an exercise program to optimise functional outcomes and strength gains.
Range of Motion & Flexibility
One common presentation of hemiplegia is muscle contractures/spasticity. This refers to a tightening of muscles, tendons or ligaments which result in a loss of movement at a joint or in severe cases permanent inability to move a joint or limb. Whilst full range of motion of the particular joint may not be able to be regained, it is important to maintain and optimise movement as much as possible to preserve function. This can be achieved through active and passive movements. For example, extending the affected arm into the full limit of extension achievable by the person and having the assistance of another to aid in achieving full extension of the joint without resistance. It is crucial that flexibility and range of motion activities are performed on the affected side on a regular basis, as this will reduce the risk of decline in function and atrophy of the muscular (ie; permanent inability to move the joint).
Unilateral Strength & Stability
In conjunction with flexibility, exercise treatment should also focus on strength. Without strength, functional movements – such as standing up from a seated position, walking up and down stairs, pulling/pushing objects and lifting/carrying objects – become difficult to perform. However, due to a reduction in strength on the affected side of the body, it is common to see people present with a clear bias toward the non-affected side when performing functional movements. Consequently, the non-affected side bears the majority of the load which can place the joint and surrounding structures (cartilage, ligaments, muscles and tendons) at an increased risk of injury. This is why when initially prescribing exercises I focus on unilateral (one sided) and isolated exercises. Depending on the level of function and presentation, these exercises may be in the form of a machine-based single leg press, alternating dumbbell bicep curls or seated single arm row. If the person struggles with isolating one side of the body when performing unilateral exercises using equipment such as TheraBands and free weights is a great way to load each limb individually to avoid any compensation.
In addition, it is significant to highlight that improving the strength of the stabilising muscles around the joints – specifically, the hips, knees and ankles – will help with improving balance and gait.
Postural Awareness & Proprioception
Proprioception and postural awareness are influenced by visual and sensory feedback. As people with hemiplegia may experience loss of sensation along with compensatory patterns favouring the non-affected side of the body, people can find it challenging to know where their body is in space without visual input (ie, standing in front of a mirror). Not all functional movements that are completed on a daily basis are unilateral and/or isolated movement, thus, it is important to create this awareness when completing an exercise program so that the exercises can be performed with correct technique and can be transferable into everyday activities. This can be implemented by initially having the person complete their exercises with visual feedback. An example is to have the person standing in front of a mirror and transfer their weight back and forth between each foot and try to then evenly place the weight through both feet. However, to optimise postural awareness that can be translated into everyday living the person should progress to completing their exercises with verbal cues from an adequate external party (ie, Exercise Physiologist).
It is important to note that there is no one program which will be beneficial to all, and each exercise program needs to be individualised based on the person’s goals, level of function, assistive technology (eg; AFOs, wheelie walkers, walking stick or wheelchair) and other conditions /health considerations. Hence, it is imperative to discuss one’s involvement in an exercise regime with a health professional and/or Exercise Physiologist prior to commencement.
If you would like to know more on how we can help with hemiplegia or associated conditions, please give our reception a call on 46 383 777.