Hemiplegia and its main challenges

Hemiplegia and its main challenges

The word hemiplegia refers to the paralysis of one half of the body, it is a disorder that affects one side of the body (Greek hemi = half) We speak of a right or left hemiplegia, depending on the affected side. It is caused by an injury to parts of the brain that control the movements of the limbs, trunk, face, etc. Its origin is found in a lesion of the Central Nervous System, either due to an AVC or a traumatic brain injury.

Hemiplegia has been increasing among the world population, a classic symptom within this neurological condition is lateralized paralysis, it can affect only the upper, lower limbs, the face or a whole half of the body, altering the capacity for autonomy to varying degrees of the person to perform some daily activities.


  • 1 Symptomatology
  • 2 Phases of Hemiplegia
  • 3 Topographic classification of hemiplegia
  • 4 Etiology
  • 5 Cognitive rehabilitation
  • 6 Treatment


The main symptomatic picture includes difficulty in gait, in voluntary control of movements, coordination, balance and have an alteration of the postural tone. Likewise, it usually affects some cognitive processes such as: language, sensory perception, memory and attention.

Each hemisphere of the brain controls the opposite half of the body, when a brain injury occurs on the right side, the left part of the body is the one that is affected and vice versa. So in hemiplegia the side of the body that has symptoms, will be the opposite of the one that has the damage. Not to be confused with the hemiparesis, which is a neurological condition in which the movement of one half of the body is hindered without reaching paralysis.

Phases of Hemiplegia

The phases in hemiplegia include the flaccid, spastic stage, synergies of movements, isolated muscle contractions, increased coordination, endurance, muscular strength and sometimes the restoration of muscle activity.

It is common that hemiplegia affects other important functions such as vision and hearing; Some symptoms can become disabling, so they require special support.

Next, some are described clinical classifications of the stages:

Initial or flaccid

Its duration can be a few days or several weeks, in which the muscle is inhibited and stops contracting, yielding brain activity on that hemicibody. The muscles do not paralyze all in the same degree, usually associated with hyporeflexia, suppression of reflexes, hypotonia, motor paralysis and can leave moderate to severe sequelae.


It originates when the flaccid phase evolves, it begins to be replaced by spasticity, generating hypertonia of the affected side, sinsinecias (involuntary movements) and deformities.

Certain cases of infantile hemiplegia who have spasticity, can improve their motor skills through surgery.

Skinny-Spastic or Mixed

It contains characteristics of the flaccid and spastic phase.

Stroke phase

It is of variable duration, it goes from a few minutes to several weeks, the severity is based on the cause that is causing the damage, such as hemorrhages, thrombosis and embolisms among others, in which the individual manifests stupor, being able to reach the coma.

The vision, hearing and bone lesion problems which can be due to falls or postural disorders, which can aggravate the suffering of the person with hemiplegia, so it is convenient adapt spaces inside the home to avoid falls and risks they represent for the quality of life of the patient and their caregivers.

You may be interested: 8 signs for the early detection of a hearing impairment

Topographic classification of hemiplegia

Depending on the injury, hemiplegia is divided into direct, spinal or alternate. According to the topographic diagnosis it can be:

Topographic classification of Hemiplegia

TotalIt corresponds to hemiplegia in its pure form with the classic symptoms.
ProportionalThey are affected with equal intensity face, upper and lower limb.
CapsularTotal and proportional, it often occurs due to internal capsule hemorrhage.
Symmetric & directInjury to the brainstem, it can be cortical, subcortical, pyramidal, capsular and thalamic or syndrome of Déjerine-Roussy, in which they show severe allergic symptoms (hyperalgesia), allodynia, transient mild hemiparesis, hemihypoesthesia, hemicoreoatetosis and hemiataxia with astereognosia of changing intensity. A rare variant is the pyramidal hemiplegia, associated with bradilalia, tremors and stiffness.
HintCaused by brain stem injury.
AlternateThey often produce sensory, cerebellar and extrapyramidal alterations, they occur when there is lesion in: brainstem, protuberancial or Peduncular, also known as Weber's syndrome, in which the ocular motor nerve common side of the lesion (not paralysis) and the facial nerve on the opposite side.


In hemiplegia there is a total or partial interruption of the pyramidal route, specifically at a point where said path associates the movement conductors that go to the middle of the body When can a brain injury cause hemiplegia? When does it affect the first motor neuron, damage can occur in any area between the spinal cord and the cerebral cortex. Cases in which it is produced by poisoning usually transient.

Cognitive rehabilitation

In Spain, The Institut Guttmann, recognized worldwide neurorehabilitation hospital, together with AMPANS, a foundation that works to promote education, quality of life and inclusion of people with intellectual disabilities, mental illness or vulnerable situations, have developed the adaptation of the cognitive rehabilitation platform : "Neuro Personal Trainer”For people with intellectual disabilities.

According to recent research, more than 70% of patients who performed the treatment through this platform have progressed significantly in terms of their executive functions and cognitive processes; sand reflects in the improvement of its performance and in the development of some basic life skills, not only within the program. Cognitive training is also followed within the home, so parents can manage their time more easily.

Neurofeedback has been used with excellent results in patients with attention deficit hyperactivity disorder (ADHD), learning problems, memory, lack of emotional regulation, improving in general cognitive processes, while contributing to muscle training, together With Cognitive Behavioral Therapy they have proven to be a good therapeutic option.


It is possible to achieve a certain degree of development in the motor, cognitive, linguistic and social areas thanks to the stimulation and learning. The ideal multidisciplinary approach includes: neurologist, other specialists, physiotherapist, speech therapist, occupational therapist, psychologist and may require nursing care.

The goal of the therapy, ideally should be focused on identifying physical and psychic disabilities, trying to minimize them, the psychoeducation It is indicated to promote personal autonomy and facilitate reintegration or adaptation to the family, social and work environment:

It is convenient to promote self-reliance as far as humanly possible and prevent unnecessary dependency situations.

It is recommended to avoid bad adaptation mechanisms, promoting practices and traditions for emotional well-being, ensuring that: they do not develop toxic habits, your diet is functional and your body takes full advantage of the nutrients it consumes, thus: it reduces the risk of suffering from chronic non-communicable diseases (NCDs), such as metabolic diseases.

The application of a rehabilitation program that includes alternate and coordinated exercises in patients with hemiplegia improves their muscle strength and gait.

Through the stages and some challenges of hemiplegia



Other references

Raya, E. Rocon, R. Ceres, J. Harlaar and J. Geytenbeek. Characterizing Head Motor Disorders to Create Novel Interfaces for People with Cerebral Palsy. IEEE International Conference on Rehabilitation Robotics 2011.

Estévez Perera, A .; Estévez Perera, A .; Coll Costa, J. de L .; and Hardy Martínez, Y. “Degree of disability in hemiplegic patients of the“ University Teaching Polyclinic of the Hill ””. Cuban Journal of Comprehensive General Medicine magazine on the Internet. December 2012 access date April 03, 2015; 28 (4): 682-693.

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