Clinical vignettes
Kenneth I. Shulman, Anthony Feinstein in Quick Cognitive Screening for Clinicians, 2003
A 75-year-old widower was admitted to a chronic care hospital following a major stroke causing right-sided hemiplegia. In the post-stroke period he was noted to be emotionally labile and tearful and was started on amitriptyline with increasing doses up to 150 mg daily. Psychiatric consultation was requested because of persistent lability and mood symptomatology. On initial assessment, he showed evidence of marked disorientation to time and place. He was in a hospital in London, England and while sitting in front of the lift (elevator) he imagined that he was in a tube (subway) station.
Neurological rehabilitation of gait and balance disorders
Adolfo Bronstein, T. Brandt, T. Brandt in Clinical Disorders of Balance, Posture and Gait, 2Ed, 2004
Restoration of mobility is a major goal in neurological rehabilitation, preventing long-term disability and handicap. Mobility includes walking, standing up, sitting down, weight shifting from one leg to the other, turning around, initiating and stopping locomotion, as well as climbing stairs. Therapeutic methods to retrain gait functions in the most common syndromes will be presented (i.e. in hemiplegia caused by stroke or traumatic brain injury, paraplegia caused by spinal cord injuries and in Parkinson’s disease). Goals of therapy include security and safety, speed and endurance, accuracy and low variability, flexibility and adaptability to the surroundings.
The Use of Biofeedback Techniques in Occupational Therapy for Persons with Chronic Pain
Florence S Cromwell in Occupational Therapy and the Patient With Pain, 1984
Shoulder pain in the affected arm of patients with hemiplegia is a fundamental concern of occupational therapists who are working for increased independence with patients. Because of finding persistent occurrences of shoulder pain in early stages of recovery of patients with hemiplegia, the author engaged in an informal review of the why's and how's of the phenomenon as seen in occupational therapy clinics. Accordingly, a simple three-part exploration was conducted, comprised of informal discussions with occupational therapy colleagues. The purpose of this exploration was to determine how common shoulder pain is in this population, and also to assess their abilities to perform functional activities. Further investigation is needed if the therapists are to understand whether pain identified during the acute stage of rehabilitation will continue, despite early treatment, into the chronic phase. Also effort must be made to clarify whether or not all pain identified in hemiplegia is part of the shoulder-hand-syndrome.
Comorbidities in amputation: a systematic review of hemiplegia and lower limb amputation
Published in Disability and Rehabilitation, 2012
Jacqueline S. Hebert, Michael W. C. Payne, Dalton L. Wolfe, A. Barry Deathe, Michael Devlin
Purpose: The purpose of this review of the scientific literature was to investigate the incidence and prevalence of hemiplegia with lower limb amputation, and to identify outcomes following the dual disability of hemiplegia and amputation. Methods: Electronic searching of the literature identified major studies examining the effects of hemiplegia on rehabilitation following amputation. Data were extracted and levels of evidence assigned for each subtopic area. Results: The summary conclusions are Level 4 evidence. The prevalence of amputation and hemiplegia is 8–18% and amputation and hemiplegia occur most often in the same leg. Once individuals with hemiplegia and lower limb amputation are selected for prosthetic rehabilitation, rate of successful functional ambulation is greater than 58%. In general there is a lower rate of prosthetic success and independence with hemiplegia than without. Predictive factors associated with success include less severe hemiplegia, laterality of hemiplegia (ipsilateral and right side), transtibial level of amputation and absence of impaired mental function. There is wide variation in length of hospital stay, but a specialty multidisciplinary team reduces length of stay. Conclusions: Patients with dual disability of hemiplegia and amputation generally benefit from a prosthetic rehabilitation program. Further study on predictive factors for outcome would be beneficial. Implications for RehabilitationThe prevalence of hemiplegia with lower limb amputation ranges from 8 to 18%, most frequently affecting the same leg.The majority of patients attain successful functional levels of ambulation with prosthetic rehabilitation, although lower rates than nonhemiplegic patients.Predictive factors associated with greater success include less severe hemiplegia, ipsilateral hemiplegia, transtibial level of amputation and absence of impaired mental function.
Motor Imagery of the Unaffected Hand in Children With Spastic Hemiplegia
Published in Developmental Neuropsychology, 2012
Jacqueline Williams, Vicki Anderson, Susan Reid, Dinah Reddihough
This study examined the ability of children with hemiplegia to perform motor imagery of their unaffected hand. Children (8–12 years) formed three groups—R-HEMI: right-sided hemiplegia, n = 21; L-HEMI: left-sided hemiplegia, n = 19; and Comparisons, n = 21. We expected no group differences on a simple imagined grasping task, but the hemiplegia groups to perform atypically on an imagined pointing task. Results showed no group differences on the grasping task, while only the L-HEMI group performed atypically on the pointing task— the functional level of the children played a likely role in this finding. Children with hemiplegia can engage in motor imagery, although task complexity and functional level may have an impact.
Dry eye in chronic stroke patients with hemiplegia: A cross-sectional study
Published in Topics in Stroke Rehabilitation, 2020
Esin Benli Küçük, Erkut Küçük, Ercan Kaydok, Kürsad Ramazan Zor, Gamze Yıldırım Biçer
ABSTRACT Objective: Dry eye is reported to be associated with several neurological diseases. The aim of this study is to evaluate the patients with hemiplegia after stroke for dry eye and compare their results with a control group. Materials and methods: Forty-five patients with hemiplegia and 45 individuals as the control group were included in the study. Tear function tests (Schirmer and tear breakup time) and a dry eye questionnaire for dry eye symptoms (ocular surface disease index) were performed and the results of the two groups were compared. Results: Schirmer test results were significantly lower in the post-stroke hemiplegia group compared to the control group (11.3 ± 8.2 mm and 20.6 ± 11.6 mm, respectively, p < .001). Tear breakup time results were significantly lower in the post-stroke hemiplegia group compared to the control group (7.9 ± 3.1 s and 12.1 ± 4.3 s, respectively, p < .001). Ocular surface disease index scores were not significantly different between hemiplegia and control groups (21.6 ± 20.0 and 19.8 ± 13.9, respectively, p = .635). Schirmer scores lower than 10 mm (60% and 30%, p < .001) and tear breakup time results lower than 10 s (65.6% and 28.9%, p < .001) were also higher in the hemiplegia group compared to control group. Conclusion: We found lower Schirmer test and tear breakup time results and similar OSDI scores in hemiplegia patients compared to controls. Hemiplegia patients may have dry eye without typical symptoms. This should be taken into consideration in the follow-up and rehabilitation of post-stroke hemiplegia patients.