PHYSIOTHERAPY ASSESSMENT AND MANAGEMENT OF

HEMIPLEGIA

By
SWETA KUMARI

Summer Project-II

Submitted to

Amity Institute of Physiotherapy

Amity University Uttar Pradesh

In partial fulfillment
of the requirements for the degree of

Bachelor of Physiotherapy

Under the guidance of

Dr. Neha Gupta (PT)

Assistant Professor II

Amity Institute of Physiotherapy

Amity University Uttar Pradesh

Noida

2017
 DECLARATION BY CANDIDATE

I hereby declare that this Summer Project-II entitled physiotherapy assessment and
management of Hemiplegia is a bonafide and genuine work carried out by me under the
guidance of Dr. Neha gupta amity Institute of Physiotherapy, Amity University, Noida.

PLACE NOIDA

DATE

Signature of the student

Sweta Kumari

A1106615078

ii
 CERTIFICATE BY GUIDE

This is to certify that Summer Project-II entitled physiotherapy assessment and

management of Hemiplegia is a bona fide work done by Sweta Kumari, in partial
fulfillment of the requirement for the degree of Bachelors of Physiotherapy from Amity
Institute of Physiotherapy, Noida.

Guide

Dr. Neha Gupta (PT)

Assistant Professor

Amity Institute of Physiotherapy

AMITY UNIVERSITY

Place: NOIDA

Date:

iii
 ACKNOWLEDGEMENT

While bringing out this project on PHYSIOTHERAPY ASSESSMENT AND MANAGEME

NT OF HEMIPLEGIA, I would like to thank my supervisors, Dr. Neha Gupta for their valuab
le guidance, deep-rooted interest, encouragement & constructive criticism throughout the period
of the project.

.This acknowledgement would never be complete if I dont remember my family members, to w

hom I owe all the successes I have achieved so far. The present work is one of them.

In the end I am thankful to all everyone who helped me to complete this project in some way or t
he other and gave me valuable feedback.

iv
TABLE OF CONTENTS

Page

DECLARATION BY CANDIDATE...................................................................... ii

CERTIFICATE BY GUIDE ..................................................................................iii

ACKNOWLEDGEMENT.......................................................................................iv

LIST OF FIGURES .................................................................................................vi

Chapters

1. INTRODUCTION................................................................................................. 1

2. METHODOLOGY ...............................................................................................7

3. DATA ANALYSIS ...............................................................................................8

4. RESULTS ..............................................................................................................8

5. DISCUSSION ........................................................................................................9

6. CONCLUSION .....................................................................................................9

7. REFERENCES..11

APPENDICES

v
LIST OF FIGURES

1) Representation of effects of Hemiplegia3

2) The representation of Hemiplegia..4
3) Pie chart of gender diversity of hemiplegic patients.8
4) Pie chart of dominance of patients9

vi
 1

INTRODUCTION

"Plegia" implies shortcoming and "Hemi" implies half of the body i.e Hemiplegia
is the total loss of motion of half of one side of body. i.e one arm and one leg. It happens
by various conditions like injury, tumors, stroke or any infection or damage in motor
areas of brain.

The brain is isolated into two equal sides, isolated by bundles of fibers called the corpus
callosum .the right side of the mind controls muscles and different capacities on the left
half of the body, while the left half of the mind controls a great part of the right side of
the body. Therefore hemiplegia quite often demonstrates an issue with one side of the
brain. Hemiplegia may go ahead all of a sudden, or grow gradually after some time. A
condition which is identified with hemiplegia, spastic hemiplegia, makes the muscles
stuck out in a constriction, bringing about little muscle control, interminable muscle
distress, and inconstant developments. Individuals with hemiplegia regularly hint at other
brain harm or head damage, and May encounter issues with different zones of their
bodies. Hemiplegia causes critical loss of sensation and control in influenced range.

Life structures of Brain: Human mind comprises of forebrain, mid cerebrum and hind
brain, brain stem incorporates mid cerebrum, pons and medulla, hindbrain incorporates
pons medulla and cerebellum. Brain has three meninges namely Dura mater, arachnoid
mater and pia mater. Brain is secured by CSF (cerebro spinal fluid) that gives protection
to the cerebrum and cerebrum essentially drifts in this liquid. The arteries of the brain are
provided by sympathetic nerves which keep running from carotid and vertebral plexuses.
They are very much delicate to wounds and respond by passing into delayed spasms.
Total loss of blood supply for a period more than 3 to 7 minutes can make harm brain.
 2

Types of Hemiplegia:

The diverse sorts of hemiplegia incorporate the accompanying:

1. Facial hemiplegia: For this situation, loss of motion happens on one side of face.

2. Cerebral hemiplegia: In cerebral hemiplegia, a brain injury disturbs the flow of

stream of blood to the mind.

3. Spastic hemiplegia: This sort of hemiplegia is portrayed by loss of motion and

spastic developments on the influenced side.

4. Spinal hemiplegia: This last instance of hemiplegia is caused by sores that have
framed on the spine.

The motion of the body is controlled by corticospinal tract, which starts in the motor
areas of the brain, expand down through the internal capsule, proceeds through the brain
stem and cross at the lower medulla, at that point goes down the spinal cord into the
motor neurons that control each muscles. Wounds at the corticospinal tract and at the
lower medulla, spinal cord, brings about hemiplegia

Pathology:

The loss of motion of the muscles of the lower face, arm and leg on one side of
the body is named as Hemiplegia. Harm to the corticospinal tract in one half part of the
brain is the most widely recognized reason for this disorder. It happens because of
hindrance or crack of a cerebral artery or to brain tumor. Cortico spinal tracts expand out
from the lower spinal tract to the cerebral cortex. The loss of motion of the left half of the
body happens because of harm to the right side of cerebral hemisphere as they cross in
the brain stem.
 3

Fig. 3.1 Representation of effects of Hemiplegia

Cause for Hemiplegia:

The part of the brain which can't deliver, send or illuminate signals attributable to
illness or injury related harm is the fundamental place where Hemiplegia issues dwell.
These outcomes in harm to the other side of the spinal cord. However these sorts of harm
or wounds deliver worldwide issues, not just loss of motion on one side of the body.

Maybe a couple of the most well-known reasons for hemiplegia are as per the following:

Car accidents, unplanned fall etc. may cause serious brain injuries to one side of
the brain
Problems identified with cardiovascular and hemorrhages in the brain
Strokes, contamination especially encephalitis and meningitis, sclerosis, and some
immune system ailments.
Brain tumors, choking and so forth may make loss of oxygen in brain.
Brain Lesions, innate anomalies and cerebral paralysis.
 4

Symptoms of Hemiplegia:

Symptoms of Hemiplegia rely on the influenced side of the brain which are as per
the following:

Difficulty in movement
Lack of adjust and coordination
Having trouble in gulping
Difficulty with vision, discourse ends up noticeably slurred
Numbness, shivering, loss of sensation on one portion of the body
Loss of control over bladder and solid discharges prompting a powerlessness to
clutch stool or urine.

Fig. 4.1 The representation of Hemiplegia

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The introduction of hemiplegia will likewise rely upon which side of the cerebrum is
harmed.

Right hemiplegia is caused by harms in left side of the hemisphere and the other
way around.
Right hemiplegia frequently demonstrates loss of sensation on left side
Left hemiplegia frequently introduces itself directly after the cerebral half of the
damage.
Person suffering with hemiplegia would have circumductory gait pattern

Diagnosis of hemiplegia:

Clinical examination is finished by wellbeing experts, for example,

physiotherapists or specialists, is utilized to distinguish Hemiplegia. With a specific end
goal to affirm damage in mind and spinal cord, CT scan of the brain is utilized. A
qualities stride is typically appeared by patients experiencing Hemiplegia. This trademark
walk may incorporate the accompanying:

The leg on the influenced side is broadened and inside turned and is swung in a
wide, horizontal circular segment as opposed to lifted with a specific end goal to
advance it.
The upper limb on a similar side is likewise adducted at the shoulder, flexed at the
elbow, and pronated at the wrist with the thumb tucked into the palm and the
fingers twisted around it.

Treatment of hemiplegia:

Physiotherapy assumes an extensive part in helping patients for their recuperation.

Treatment is centered around enhancing sensation and motor abilities. Make patients to
deal with their exercises of everyday living. Some treatment incorporate hemi paretic
limb during performing different tasks, keeping up scope of movement and utilizing
neuromuscular electrical stimulation to diminish spasticity. In treatment design, it is
critical to make patients persuaded so they can make consistent change.
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Muscles with extreme motor hindrance including shortcoming need these therapists to
help them with particular exercise and furthermore by helping them. Muscles quality and
coordination ought to be moved forward. Physiotherapists can likewise decrease shoulder
pain by keeping up shoulder range of of movement, by utilizing electrical stimulation.
Steady gadgets, for example, braces or slings can be utilized to anticipate or treat
shoulder subluxation. A treatment design ought to be with the objective to recapture
works in influenced limb by constraining the influenced limb to finish piece of work of
everyday living.

Prognosis:

Hemiplegia is not a dynamic issue with the exception of developing brain tumor.
Once the damage has happened, symptoms ought not become serious. may, on account of
absence of mobility, different complexities can happen. It might incorporate muscles and
joint firmness, muscle fit, bed bruises, and blood clots.

Prevention:

Assaults of Hemiplegia have positive triggers. Exposures to high and in addition

cool temperatures, enthusiastic anxiety, physical weariness, showering contaminations
particularly of the respiratory framework and so on are known triggers of Hemiplegia.
Discovering trigger and avoiding them can help in keeping the long term sequel that
normally create.
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METHODOLOGY
Study Design: Qualitative study
Study Population: 5 samples
Place of Data Collection: Ruban memorial Hospital
Sample Size: 5
Selection Criteria
1. Inclusion criteria:
Hemiplegia patients
Old age population
2. Exclusion Criteria:
Any trauma or surgery
Dominant paralysis

Instruments required: Muscle stimulator, Hand towel, hand gripper

Outcome Variables
Repetitive facilitation exercises
Assisted Exercises
Progressive range of motion

Procedure/ Data collection:

The samples are assessed by observing the patients condition, by observing their
gait pattern, by measuring their assisted range of motion and by examining all the X-ray,
CT- Scan or other imaging reports. After the patient is diagnosed with Hemiplegia, the tre
atment plan mentioned above follows.
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DATA ANALYSIS
Observed 5 patients suffering from Hemiplegia.
Formula of mean= Sum of total no of patients/ total no of patients.

RESULT
Total No of Male Patients Female Patients Right Dominant Left Dominant
patients Patients Patients
5 2 3 2 3

Gender of Hemiplegic Patients

Fig. 8.1 Pie Chart of Gender diversity of hemiplegic patients

Male

Fig. 8.1 Pie Chart of Gender diversity of hemiplegic patients

 9

Dominance of Patients

Right Dominant
Left Dominant

Fig. 8.2 Pie Chart of Dominance of Patients

DISCUSSION
I have taken this project to learn more about Hemiplegia. It is a cause of major disability
and associated with damage to brain tissue. I wanted to observe how the assessment and
management is carried out in physiotherapy clinical set up.
It is mostly seen in hypertensive patient, old aged people. However it can occur at any ag
e. Its recovery is not to its complete discharge.

CONCLUSION

In Hemiplegia, patients under dynamic recovery strolled with asymmetry gait, employme
nts of walking aids helps diminishes weight bearing on paretic limb. Along these lines, w
alking aids helps ought to be stayed away from for this situation, muscle stimulator is util
ized an ought to be performed. Electrical stimulation can be utilized to diminish spasticity
 10

The patients experiencing Hemiplegia, can be given helped works out, legitimate position
ing should be possible of patient. Muscle reinforcing ought to be done of the weaker mus
cles.

Progressive range of movement activities ought to be given to the patient to enhance shou
lder range of movement and maintain a strategic distance from shoulder subluxation. Spli
nts and braces ought to be encouraged to the patient to avoid muscle in coordination.
 11

REFERENCES

https://www.askdrshah.com/hemiplegia.aspx

study.com/.../the-brain-hemispheres-left-brain-right-brain-communication-and-
contro...

www.brainandspinalcord.org/hemiplegia/

https://www.virtualtrials.com/brain-cancer-symptoms.cfm

https://en.wikipedia.org/wiki/Hemiparesis
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APPENDICES
CASE STUDY

CASE 1:

Name Vimla Devi

Age 47 years

Gender Female

Occupation - Housewife

Address Patna

Chief complaints- Sudden fall from bed in the morning after normal sleep in night,

Patient is unable to stand properly, patient having right side

Weakness, having difficulty in speaking.

History hypertension

Observation Disorientation, edema, right sluggish, improper gait pattern

Examination CT scan, pain while touching, preserved touch

Diagnosis Right Hemiplegia

Treatment percussion/ vibration,

Passive ROM

Passive stretching

Positioning, Muscle stimulator

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CASE 2:

Name Sharda Devi

Age 54 years

Gender Female

Occupation Housewife

Address Muzzafarpur

Chief complaints Patient having weakness in right lower and upper limb, unable

to speak properly, tendency to fall to the right side.

History Occurrence of Bells palsy 1 week before, Hypertension.

Observation patient was ectomorphic, Improper Gait pattern, slurred speech.

Examination CT scan was done , muscles were tight

Diagnosis- Patient was diagnosed with right side Hemiplegia

Treatment- Passive range of motion exercises,

Bed side sitting with assistance,

Positioning of patient with assistance

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CASE 3:

Name Jeet singh

Age 77 years

Gender Male

Occupation Retired employee

Address Patliputra colony

Chief complaints: Patient having lack of movement in left side, difficulty in walking,

Difficulty in speaking.

History- Past medical history- Diabetes, Hypertension

Present medical history- had recent heart attacks

Observation- Left wrist flexed, Shoulder internally rotated,

Fingers of left hand were flexed,

Left big toe flexed, Left foot inverted.

Examination Muscles were more rigid on left side,

No contraction were observed,

Lack of flexibility with respect to right hand.

Diagnosis Patient was diagnosed with left Hemiplegia.

Treatment Passive range of motion were given on left side,

Passive movement for left shoulder lower limb

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CASE 4:

Name Mamta Devi

Age 45 years

Gender Female

Occupation Housewife

Address Patel Nagar, Patna

Chief complaints Patient having weakness in right side of the body, not able to speak,

Loss of consciousness

, History Hypertension, joint pain problem

Observation Deviation of angle of mouth to left,

Weakness of right upper and lower limb,

Problem in speaking

Examination Pallor present, drowsy, patient is hypotonic, deep tendon reflex is

Mute on right side.

Diagnosis Patient is diagnosed with right sided hemiplegia, with right upper

Motor neuron facial palsy.

Treatment Passive range of motion exercises on right side (both upper and lower limb)

Positioning on the bed side with assistance,

Bed side sitting with assistance.

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Case 5:

Name Sunil Kumar

Age 55 years

Gender Male

Occupation Shopkeeper

Chief complaints patient having pain in left side of the body, weakness,

Headache,

Difficulty in speaking, unable to do daily activity things.

History Previous illness, chronic alcoholism, Hypertension

Observation patient having difficulty in gait pattern,

Patient was bed ridden,

Decreased strength,

Lack of balance and coordination.

Examination Patient was hypotonic, muscles were tight, decreased range of motion

Diagnosis Patient was diagnosed with Left side Hemiplegia.

Treatment Balance training,

Passive range of motion exercises,

Bed side sitting with assistance,

Self-assistance and dynamic exercises.