Infantile Hemiplegia

Infantile hemiplegia refers to brain injuries that occur before(pre natal) or at birth that lead to hemiplegia/ total paralysis of one side of the body, including the face, arm and leg.

It occur in infancy and is caused by a vascular accident such as cerebral infarction or thrombosis; associated with seizures.

It is a rare condition of the nervous system that usually appers in children prior to the age of 4.

1.CNS  infection ( e.g encephalitis, meningitis and abscess)

2. Neoplastice intrarlopcranial space occupying lesion
3. Trauma
4. Developmental anomalies of the brain
5. congenital heart disease
6. purulent venous thrombosis
7. sickle cell anemai
8. homocysteinuria

Pain

Muscle spasms

Difficulty in gait and balance

Emotion-depression

Hemiplegia

Epilepsy

Mental changes

• Persistent posturing and patterning movements
• Stiffness of movements of several types
• Floppiness and weakness
• Limited useful range of movement
• Intellectual difficulties or motivation
• Central sensory deficits
• Epilepsy

Diagnosis

Complete blood count

Blood biochemistry test

Cranial CT

Cranial MRI

Electroencephalogram (EEG)

Doppler ultrasound

• Conventional therapies ( therapeutic exercise, traditional functional retraining)
• Range of motion exercise
• Muscle stretching exercise
• Splinting
• Fitness training
• Compensatory techniques
• Bed positioning

Lying on the affected side;

• One or two pillows for head
• Affected shoulder positioned comfortably
• Place unaffected leg forward on one or two pillows
• Place pillows in front or behind to give support

Lying on the unaffected side

• One or two pillow for the head
• Affected arm forward and supported on pillows
• Affected leg backwards on one or two pillows
• Place pillows behind
• Neurofacilitatory technique such as
• Bobath: It is an approach that focuses to control responses from demaged postural reflex mechanism. Emphasis is placed on affected inputs facilitation and normal movement patterns.
• Rood: Emphasize the use of activities in developmental sequences, sensation stimulation and muscle work classification. Cutaneous stimuli such as icing, tapping and brushing are employed to facilitate activities.
• Proprioceptive neuromuscular facilitation(PNF): they advocated the use of peripheral inputs as stretch and resisted movement to reinforce existing motor response. Total patterns of movement are used in treatment and are followed in a developmental sequence.

• Learning theory approach such as
• conductive education
• motor relearning theory: it emphasizes the practice of functional tasks and importance of relearning real-life activities for patients. Principles of learning and biomechanical analysis of movements and tasks are important.
• Biofeedback: it is a modality that facilitates the cognizant of electromyographic activity in selected muscle or awareness of joint position sense via visual or auditory cues.

(e) Functional Electrical stimulation

this is a modality that applied a short burst of electrical current to hemiplegic muscle or nerve. It reduces spasticity in hemiplegic patient.

(f)  Conventional Gait training:

Conventional gait training has focused on part-practice of components of gait in preparation for walking. Includes

• Symmetrical weight bearing training
• Weight shifting
• Stepping training(swinging/clearance)
• Heel strike
• Single leg standing
• Push off/ Calf rise.