Hemiplegia: Causes, Symptoms and Rehabilitation

Hemiplegia means paralysis of one side of the body, with little or no voluntary movement in the arm and leg. It differs from hemiparesis, in which some movement remains. Over time, many patients with initial hemiplegia regain some movement and move into the hemiparesis range.

Causes

• Stroke, both ischaemic and haemorrhagic (the most common cause)
• Traumatic brain injury
• Brain tumours and infections
• Cerebral palsy in children

Further reading: the guide “Stroke” and the articles Stroke Rehabilitation: Ischaemic and Haemorrhagic Stroke and Balance Problems and Preventing Falls After Stroke.

Common problems

• Loss of movement and, often, sensation on one side
• Spasticity developing in the weeks after the injury
• Painful shoulder and shoulder subluxation [3]
• Balance problems and falls
• Swallowing, speech and visual field problems, depending on the affected area

Rehabilitation in hemiplegia

The rehabilitation programme begins with correct positioning, prevention of complications and early mobilisation, then progresses to more intensive, task-oriented training [2, 4]. Typical components are:

• Positioning and protection of the shoulder
• Sitting and standing balance, transfers and gait training
• Repetitive task practice for arm and leg
• Orthoses: in our study of patients with chronic spastic hemiparesis, an ankle-foot orthosis improved balance and reduced fall risk [1]
• Spasticity management
• Robot-assisted therapy where suitable

The typical course of recovery

The first weeks after the cause of hemiplegia, most commonly a stroke, are often the time of most rapid change. Initially, the affected side may be floppy (low muscle tone); later, spasticity (increased muscle tightness) may develop. Movement often returns first in large muscle groups, such as the hip and shoulder, and later in the hand and foot. Some patients progress from hemiplegia (no movement) to hemiparesis (partial weakness). The speed and extent of recovery vary widely.

How hemiplegia is assessed

The PM&R physician examines strength, muscle tone, reflexes, sensation, balance, swallowing, communication, attention to the affected side, bladder and bowel control, and skin. Brain or spinal imaging shows the cause and location of the damage. The team assesses what the patient can do in daily life, such as turning in bed, sitting, transfers and walking, and sets realistic, measurable goals.

Treatment options in general terms

• Positioning, turning and skin care to prevent pressure sores and joint stiffness
• Task-specific training for sitting, standing, transfers and walking
• Spasticity management with stretching, splints, medication or injections where indicated
• Orthoses (supportive braces), wheelchairs and walking aids, chosen individually
• Electrical stimulation and robot-assisted training as additions to active therapy in selected patients
• Treatment of associated problems such as shoulder pain, depression and swallowing difficulty

Home safety and what families can do

• Learn safe transfer techniques from the team to protect both the patient and yourself
• Arrange the room so the patient can reach essentials and call for help
• Ensure enough space for a wheelchair or walker and remove trip hazards
• Help with regular position changes if the patient spends long periods in bed or a chair
• Encourage participation in daily activities as much as safely possible

When to see your physical medicine and rehabilitation specialist

After acute hospital care, the rehabilitation process is best led and advised by a physician specialised in physical medicine and rehabilitation (PM&R, also called physiatry). At home, too, it is worth consulting a PM&R specialist, who examines the patient, sets goals and guides therapy and supportive treatments together with the physiotherapist and the wider team. Ask for a review if:

• function is getting worse instead of better, or progress has stalled for several weeks
• new pain, stiffness, swelling or falls appear
• mood, sleep, swallowing or bladder control change
• you are wondering whether a robotic or other advanced therapy might be suitable

Whether robotic or other advanced therapies are suitable is decided by a PM&R specialist focused on neurorehabilitation. Prof. Dr. Engin Çakar works in this field and can be consulted online or in person; otherwise, consult a PM&R specialist near you.

Call emergency services immediately for sudden new weakness, facial drooping, difficulty speaking, a severe headache or loss of consciousness: these can be signs of a new stroke.

Frequently asked questions

Can a person with hemiplegia walk again? Many patients regain some walking ability, often with aids. It depends on the severity, the cause and rehabilitation. See When will a stroke patient walk?

Which side is more serious? Neither side is simply more serious. Left-hemisphere damage often affects language, right-hemisphere damage often affects attention and spatial awareness.

Is hemiplegia always caused by a stroke? No. It can also follow a brain injury, a brain tumour, infection or, less commonly, other conditions. The cause influences the treatment plan.

Does muscle tightness mean the patient is getting worse? Not necessarily. Spasticity is part of the course in many patients, but if it causes pain or limits function it should be assessed and treated.

Assessment and contact

You can request an appointment or a second-opinion review of existing reports and imaging: Contact & second opinion (WhatsApp). This page is general health information. Diagnosis and treatment decisions are made individually after examination.

Sources

1. Cakar E, et al. The ankle-foot orthosis improves balance and reduces fall risk of chronic spastic hemiparetic patients. Eur J Phys Rehabil Med. 2010. PMID: 20927002
2. French B, et al. Repetitive task training for improving functional ability after stroke. Cochrane Database Syst Rev. 2016. PMID: 27841442
3. Wilson RD, et al. Hemiplegic Shoulder Pain. Phys Med Rehabil Clin N Am. 2015. PMID: 26522903
4. Pollock A, et al. Physical rehabilitation approaches for the recovery of function and mobility following stroke. Cochrane Database Syst Rev. 2014. PMID: 24756870