Hemiparesis

Hemiparesis – Overview

Hemiparesis is weakness affecting one side of the body (face, arm, leg, or a combination). It is a neurological symptom, not a disease itself, and indicates a problem in the brain, spinal cord, or peripheral nerves.

⚠️ Sudden-onset hemiparesis is a medical emergency and should be treated as a possible stroke until proven otherwise.

Key Clinical Features

  • One-sided muscle weakness

  • Reduced power compared to the opposite side

  • May involve face, upper limb, lower limb, or all three

  • Can occur with:

    • Speech difficulty

    • Facial droop

    • Vision changes

    • Balance or coordination problems

       

Why Hemiparesis Happens (Neuroanatomy Explained Simply)

Location of the problem: Side affected

  1. Above decussation (brain): Opposite side (contralateral)

  2. Below decussation (spinal cord/peripheral nerves): Same side (ipsilateral)

  3. Cranial nerves (face/head): Usually same side

Decussation refers to the crossing of motor nerve fibers in the brainstem, which explains why brain lesions affect the opposite side of the body.

Common Causes of Hemiparesis

Vascular

  • Stroke (ischemic or hemorrhagic)

  • Transient Ischemic Attack (TIA)

  • Lacunar infarcts (small-vessel disease)

  • Brain aneurysm or hemorrhage

     

Traumatic

  • Traumatic brain injury (TBI)

  • Spinal cord injury+

  • Birth injury (e.g., cerebral palsy)

     

Neurological & Medical

  • Brain tumors

  • Multiple sclerosis (MS)

  • Seizures (post-ictal weakness)

  • Infections (encephalitis, meningitis)

  • Bell’s palsy (facial hemiparesis)

  • Hemiplegic migraine

     

Treatment of Hemiparesis

Treatment depends entirely on the underlying cause:

Cause type: Management approach

  1. Stroke/TIA: Emergency care, thrombolysis, secondary prevention

  2. Infection: Antivirals/antibiotics

  3. Tumors: Surgery, radiotherapy, chemotherapy

  4. MS/autoimmune: Immunomodulatory therapy

  5. Permanent damage: Rehabilitation (physiotherapy, OT, neuro-rehab)

➡️ In cases of permanent CNS injury, strength may not fully return, but function can often improve with rehabilitation.

Risks of Not Treating Hemiparesis

  • Permanent brain damage

  • Paralysis

  • Loss of function

  • Disability

  • Death (in stroke cases)

     

What Is Ataxic Hemiparesis?

Ataxic hemiparesis is a combination of:

  • Weakness (hemiparesis)

  • Poor coordination (ataxia)

🔹 Most commonly caused by lacunar strokes affecting small blood vessels in the brain.

Goals of the Initial Phase (first 4-5 weeks)

  • Prevent joint stiffness, contractures, and shoulder subluxation

  • Maintain range of motion in all Upper & Lower Limb

  • Promote early activation of the affected side

  • Improve postural control and bed mobility

  • Prevent complications (pressure sores, chest infection, DVT)

Do’s

1. Positioning (VERY IMPORTANT)

2. Passive & Assisted Range of Motion (ROM)

Performed slowly, pain-free, 1–2 times/day.

Upper Limb

  • Shoulder flexion, abduction, external rotation

  • Elbow flexion/extension

  • Forearm pronation/supination

  • Wrist and finger extension (important to prevent flexor tightness)

     

Lower Limb

  • Hip flexion/extension, abduction

  • Knee flexion/extension

  • Ankle dorsiflexion/plantarflexion

3. Early Active or Active-Assisted Exercises (as soon as possible)

In the early stage avoid resistance training

❌ DON’Ts

1. ❌ Do NOT Pull the Affected Arm

  • Never lift or turn the patient by the affected arm

  • Avoid pulling during transfers
    ➡ Can cause shoulder subluxation and pain

     

2. ❌ Avoid Forceful Stretching

  • No jerky or fast movements

  • No pushing into pain
    ➡ Can increase spasticity and cause injury

     

3. ❌ Do NOT Ignore the Affected Side

  • Don’t let the patient use only the strong side

  • Encourage looking at, touching, and moving the affected side

     

4. ❌ Avoid Prolonged Poor Positioning

  • No dangling arm unsupported

  • No prolonged wrist/finger flexion

  • No ankle left in plantarflexion (foot drop risk)

     

5. ❌ No Resistance Exercises Early On

  • Avoid weights or strong resistance

  • Especially if muscle tone is flaccid or just emerging

     

6. ❌ Don’t Over-Fatigue

  • Stop if:

    • Increased weakness

    • Dizziness

    • Excessive spasticity

    • Pain

Fatigue slows recovery.

Warning Signs – Stop and Seek Medical Advice

  • Sudden increase in weakness

  • Severe shoulder pain

  • New confusion or headache

  • Chest pain or breathlessness

  • Swelling or redness in leg (possible DVT)

     

Key Principles to Remember

  • Early, gentle, repetitive movement

  • Quality over quantity

  • Use the affected side safely

  • Consistency every day