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Query: UMLS:C0018991 (hemiplegia)
 3,997 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We used spinal cord stimulation (SCS) in patients with postapoplectic spastic hemiplegia in an attempt to reduce the spasticity. Three patients with spastic hemiplegia due to apoplexia were selected for the treatment. Reduction of spasticity was observed 3 to 9 days after the stimulation. Electrophysiological evaluation of the spasticity from the H reflex revealed a remarkable improvement in all three patients. The mechanism of reduction of spasticity has not yet been clarified, although a direct or indirect effect on the reticulospinal tract is thought to play a role.
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PMID:Evaluation of spinal cord stimulation for postapoplectic spastic hemiplegia. 387 2

Shoulder pain is probably the most frequent complication of hemiplegia. In this study 219 hemiplegia patients were regularly followed up after their cerebrovascular accident (CVA) for one year (166 men, 53 women, with a mean age of 47 years). Criteria and parameters for evaluation of these shoulders were established at the outset. Distinction was made between flaccid and spastic hemiplegia. Other influencing factors were subluxation reflex sympathetic dystrophy syndrome (RSD), isolated tendon lesion cuff rotator tear or association of some of these. Roentgen examinations were done for each patient. In our series of patients, 72% had shoulder pain at least once during the course of their recovery. This problem occurred more often in patients having spasticity (85%) than in those with flaccidity (18%). An evolution towards spasticity was noted in 80% of the patients in this series, whereas 20% remained hypotonic. Among the other possible causes of shoulder pain, anteroinferior subluxation was incontrovertibly the most frequently cited. The RSD syndrome was present in only 23% of all cases but was seen more often in spastic patients, that is 27% compared to 7% among flaccid patients. Whatever the cause, the subluxation with flaccid paralysis should be corrected and spasticity should be combatted as early and as vigorously as possible.
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PMID:Painful shoulder in hemiplegia. 394 79

Limited range of motion (ROM) and subsequent soft tissue contractures resulting from spasticity are common developments in patients with acquired hemiplegia from cerebrovascular accidents. The purpose of this study was to examine the effects of a wrapping technique on ROM in patients with a spastic upper extremity. Four adult patients, postcerebrovascular accident of less than one year, received wrapping of the upper extremity for three hours, three times a week on alternating days for a total of two to four weeks. Baseline passive range-of-motion (PROM) measurements were established for shoulder flexion, shoulder abduction, shoulder external rotation, and wrist extension; these movements were commonly limited in all patients. The PROM was recorded after each wrapping session. The results showed a significant change in PROM for all motions in all patients (p = less than .01). In addition, all patients reported a decrease in pain in the upper extremity. Comparisons of videotapes of two patients at baseline and after 12 wrappings revealed an increase in ROM and a decrease in spasticity in the upper extremity during ambulation. These findings should encourage clinicians to experiment further with the wrapping technique and to report their findings.
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PMID:Effects of a wrapping technique on passive range of motion in a spastic upper extremity. 397 78

Acute appearance of hemiparesis or hemiplegia with initial marked spasticity was observed in 8 stroke patients. All had intracerebral hematomas and in 7 it was located in the region of the basal ganglia. By contrast, none of 121 hemiplegic patients with hemispheric ischemic stroke hospitalized during the same period had increased muscle tone in the involved limbs at stroke onset. Study indicates that association of hemiplegia with immediate spasticity at stroke onset is a clinical clue to a possible deeply located intracerebral hematoma.
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PMID:Immediate spasticity with acute hemiplegia is a sign of basal ganglia hemorrhage. 398 83

Reconstructive surgery of the upper limb was performed in an attempt to restore dynamic motor balance in 55 patients with adult-acquired spastic hemiplegia. An eight-level grading system was developed to determine the level of functional capacity. Because this system proved useful in predicting the results of surgery, it was utilized for operative planning. A two-level increase in functional grade was necessary for patients to obtain a meaningful increase in function. The average improvement after surgery was 2.10 functional levels. A two-level increase was achieved in 73.2% of the patients. No patient decreased in grade, and only one remained unchanged. In selected patients with upper limb spasticity, a predictable improvement in functional capacity can be obtained with dynamic motor balancing surgery.
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PMID:Surgery to achieve dynamic motor balance in adult acquired spastic hemiplegia: a preliminary report. 402 68

EMG denervation activity was studied in patients without peripheral neuron disorder but with upper motor neuron lesions. The time course of such central denervation activity, the local distribution and the quantitative relationship between denervation activity and the degree of paresis and spasticity were also studied. A total of 101 patients, who had developed hemiplegia or hemiparesis as a result of a cerebral vascular accident, underwent needle electromyographic examination at regular intervals in proximal and distal muscle groups. The maximum observation time was 1 year. Denervation activity in cases of central paresis first occurred 2-3 weeks after stroke. This could be observed most frequently in the distal arm and hand muscles. In the course of weeks and months the frequency of the denervation activity decreased in parallel with the development of spasticity and the increasing voluntary innervation. The occurrence and the dynamic properties of the denervation activity in cases of central paresis support the assumption of a trans-synaptic degeneration of alpha-motoneurons and of a compensating segmental "sprouting" of afferents.
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PMID:Denervation activity in the EMG of patients with upper motor neuron lesions: time course, local distribution and pathogenetic aspects. 619 9

Although the therapeutic effect of spinal cord stimulation (SCS) for spastic movement disorders is still controversial, its effect for multiple sclerosis has been supported by several authors. Among various clinical beneficial effects, reduction of the spasticity may be attractive for physical therapy of post-apoplectic patients. Two patients suffered from post-apoplectic spastic hemiplegia were selected for SCS. Electrodes of Medtronic's SCS system were placed at lower cervical or upper thoracic spinal cord extradura. Stimulation of 30-75 Hz in frequency and 0.3-0.5 in voltage continued for 12-14 hours during daytime every days. U.S., a 74-year-old man, suffered from cerebral infarction in the right internal capsule was treated by SCS at one year after the stroke . At the fourth day after SCS spasticity of the lower extremity reduced and his gait improved remarkably. Upper extremity also showed reduction of spasticity at the seventh day after SCS. H/M ratio before SCS was 0.85 and reduced to 0.77 at 68 th day after SCS. Recovery curve of H-wave also improved after SCS. Y.K., a 47-year-old man, suffered from pontine hemorrhage showed right spastic hemiplegia. He was treated by SCS at 13th month after the hemorrhage. Spasticity of the upper extremity reduced slightly and his gait improved obviously. H/M ratio which was 1.05 before SCS, reduced to 0.75 at 122 nd day after SCS. Recovery curve of H-wave improved remarkably after the treatment. It was obvious that the spasticity reduced after SCS and function of the extremities recovered to some extent in above patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Spinal cord stimulation for post-apoplectic spastic hemiplegia]. 661 Aug 36

Plastic ankle-foot orthoses (PAFOs) are worn by persons with hemiplegia to correct gait abnormalities such as foot drop during swing and insufficient pushoff during stance. A PAFO should resist plantarflexion sufficiently to provide toe clearance during the swing phase of gait without excessively increasing the knee bending moment during heelstrike. It should resist dorsiflexion during late stance to raise the heel to simulate gastrocnemiussoleus muscle group function. Five PAFOs were evaluated as to the amount of plantarflexion-dorsiflexion resistance that was provided when worn by hemiplegic and able-bodied subjects. A self-aligning goniometer measured ankle angle as the subject walked, and a gait event marker system recorded occurrences of gait events. The Seattle design polypropylene orthosis which enclosed the malleoli was the least flexible; it provided the greatest plantarflexion resistance to ensure against toe drag during swing for patients with severe plantarflexion spasticity. It offered the greatest dorsiflexion resistance to provide a good substitute for the gastrocnemiussoleus during the latter part of stance as required by patients with flaccid plantarflexors and full ankle range of motion. Progressive trimming of the Seattle design polypropylene orthosis made it more flexible and comparable in function to the commercially available Engen and Teufel orthoses. The latter 2 orthoses did not provide a pushoff substitute as well as the Seattle design orthosis which enclosed the malleoli, but they did provide an adequate amount of toe clearance during swing. The more flexible orthoses would be appropriate for subjects with mild to moderate plantarflexor spasticity.
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PMID:Plastic ankle-foot orthoses: evaluation of function. 661 77

The rehabilitation of hemiplegic patients is often prolonged by the problem of painful shoulder. The specific etiology of this problem is controversial and treatment does not always produce the desired results. Thirty hemiplegic patients with painful, stiff ipsilateral shoulder joints were studied. The mean interval from the onset of stroke to the onset of painful shoulder was 3 months. On shoulder arthrography, 23 patients had capsular constriction typical of frozen shoulder (adhesive capsulitis). Seven patients had normal arthrograms. None showed rotator cuff or capsular tears. Electromyography revealed electrical silence in the shoulder musculature at rest. These findings indicate that the painful, stiff shoulder developing after hemiplegia is not caused by rotator cuff tear or by spasticity, but probably has a pathogenesis similar to that of idiopathic frozen shoulder.
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PMID:Arthrographic studies in painful hemiplegic shoulders. 671 51

This study investigated rationales underlying splinting decisions involving patients with hemiplegia. The survey incorporated a limited-choice, multiple-option questionnaire based on the case study of a man with a left hemiparesis at three hypothetical stages of recovery. Ninety-three occupational therapists who answered indicated whether they would or would not recommend a splint at each stage, and selected one or more reasons for their decisions. The respondents fell into three major categories: those who would 1. never splint, 2. always splint, and 3. splint only in the presence of moderate to severe spasticity. Those with longer clinical experience reflected more tendency to splint. The results indicated conflicting practices in splinting and showed the need for further clinical research in this area.
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PMID:A survey of rationales for and against hand splinting in hemiplegia. 722 29


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