What To Know about Hemiplegia (One-Sided Paralysis)

Hemiplegia is partial or total paralysis on one side of the body. It happens when blood flow to one side of the brain is limited or restricted due to injury to the brain and/or spinal cord due to stroke, traumatic brain injury (TBI), tumor, or infection.

Hemiplegia can affect both children and adults, and symptoms vary from person to person depending on the location and severity of the brain injury. Hemiplegia can affect fine and gross motor skills and cause problems with muscle control, muscle weakness or stiffness, memory problems, numbness or loss of sensation, vision problems, and trouble concentrating. 

There is no cure for hemiplegia, but it is not a progressive disease and does not usually worsen over time. Hemiplegia is sometimes temporary, though it is usually lifelong. Treatments, such as physical and occupational therapy, can help people with hemiplegia live active and independent lives.

Types

Hemiplegia can be congenital or acquired. Congenital hemiplegia is present from birth and develops when damage to the brain occurs before, during, or shortly after birth. Acquired hemiplegia is when damage to the brain occurs after the first two years of life.

There are several forms of hemiplegia, including:

• Facial hemiplegia: Also known as facial paralysis, facial hemiplegia is paralysis of the muscles on one side of the face, causing the affected side to droop.
• Spastic hemiplegia: This type causes stiff muscles and increased muscle tone. People with spastic hemiplegia generally experience stiff or awkward movements in their arms and legs. This type is most commonly caused by cerebral palsy, stroke, or tumors.
• Spinal hemiplegia: Also known as Brown-Sequard syndrome (BSS), spinal hemiplegia is a rare neurological disorder that develops due to an injury to one side of the spinal cord, causing loss of sensation and muscle control on one side of the body.
• Alternating hemiplegia: This type is characterized by recurrent, temporary episodes of one-sided paralysis. Alternating hemiplegia begins in early childhood (before 18 months), and paralysis episodes can last from minutes to days.

Hemiplegia Symptoms 

Hemiplegia refers to paralysis on one side of the body. Symptoms vary from person to person, depending on the severity and location of the brain or spinal cord injury.

Physical Symptoms

Hemiplegia can cause a range of physical signs and symptoms, including:

• Muscle stiffness or tightness 
• Muscle weakness
• Difficulty walking
• Poor balance
• Trouble grasping or holding objects 
• Balance problems
• Difficulty swallowing (dysphagia)
• Seizures 
• Vision impairments
• Decreased sensory sensations (e.g., hot/cold/touch) on the affected side  

Cognitive Symptoms

Conditions that cause hemiplegia, such as stroke or cerebral palsy, can lead to cognitive impairments, such as:

• Difficulty concentrating 
• Memory problems
• Struggles to process information 
• Trouble speaking or expressing thoughts
• Difficulty processing information
• Delayed language development (in children)
  

Emotional and Social Symptoms

Living with hemiplegia can have an impact on your psychological well-being. Some people with hemiplegia experience emotional and social challenges, such as mood swings, depression, anxiety, irritability, social isolation, and impulsivity (risk-taking behaviors).

What Causes Hemiplegia? 

Hemiplegia occurs when one side of the brain or spinal cord is damaged, usually due to restricted or limited blood flow to one side of the brain. A person with an injury on the right side of their brain will experience left-side paralysis, and a person with a left-brain injury will experience right-side paralysis.

Most hemiplegia cases develop due to stroke, which occurs when a blood vessel in the brain ruptures or is blocked. A stroke limits blood supply to the brain, depriving it of oxygen and other nutrients. Other causes of hemiplegia include: 

• Traumatic brain injury (TBI): A blow to the head from a fall, car accident, sports injury, or other forms of blunt force trauma can cause a brain bleed (hemorrhage) or damage one side of the brain or spinal cord.
• Spinal cord injury: This can occur when a fall or accident causes a broken back or neck. Rarely, a herniated cervical disc (in the neck) can cause hemiplegia.
• Cerebral palsy: This is a group of neurological disorders that affect movement and coordination due to damage to the developing brain that occurs before, during, or shortly after birth.
• Brain tumor: Brain tumors can cause hemiplegia, especially those located in the motor cortex of the brain.
• Infection: Viral or bacterial infections that cause encephalitis (brain inflammation) or meningitis (inflammation of the tissues surrounding the brain and spinal cord) can cause hemiplegia. 
• Multiple sclerosis (MS): This is a chronic disease that affects the central nervous system, including the brain and spinal cord.
• Genetics: A mutation in the ATP1A3 gene causes alternating hemiplegia in childhood, a rare form of hemiplegia that causes recurrent paralysis episodes.

Risk Factors

Hemiplegia can affect anyone, but certain factors can increase your risk, especially risk factors for stroke—the most common cause of hemiplegia. About 80% of people who experience a stroke develop hemiplegia or hemiparesis (weakness on one side of the body).

Risk factors for stroke and hemiplegia include:

• Age: Infants under 12 months and older adults (55+) have a higher risk of stroke and hemiplegia. 
• Sex: People assigned female at birth have a higher lifetime risk of stroke than people assigned male at birth, especially during pregnancy, several weeks postpartum, and those taking hormone replacement therapy. 
• Ethnicity: Adults with Black, American Indian, Alaska Native, and Hispanic ancestry have higher rates of stroke than white adults.
• Family history: People with a parent or other family member with a history of stroke are at an increased risk, especially people with AB blood type. 
• Other medical conditions: High blood pressure (hypertension), high cholesterol, obesity, sleep apnea, kidney disease, and a history of migraines can all increase your risk of hemiplegia.
• Lifestyle factors: Smoking, excessive alcohol consumption, sedentary lifestyle (lack of physical activity), sleeping 9+ hours/night, and chronic stress can also increase your risk.

Diagnosis

Hemiplegia is diagnosed based on a physical examination, medical history review, and diagnostic tests.

During the physical examination, your healthcare provider (usually a neurologist, or a medical doctor who specializes in the nervous system) will ask about your symptoms and how they impact your daily functioning. They will also perform a neurological exam to test your reflexes and check for weakness or paralysis on one side of the body, muscle spasticity (stiffness), and balance and coordination problems. 

The neurological tests may include:

• Balance, coordination, and walking: Your provider will look for signs of hemiplegia by testing your balance, coordination, and gait (walk). They may ask you to walk straight, check your handwriting, or bring your finger to your nose with your eyes closed. 
• Cranial nerves: If you have facial hemiplegia, they may ask you to stick out your tongue while talking or smile to observe the function of your cranial nerves. 
• Reflexes: Using a rubber hammer, your healthcare provider will tap your knees to test your reflexes. This shows how the nerves between your muscles and spinal cords are functioning. 
• Sensory nerves: Your healthcare provider may touch your skin with a dull needle, ice, cotton swab, or other items and ask you to describe how each feels to determine whether your sensory nerves are affected.

In some cases, additional tests may be necessary to confirm a hemiplegia diagnosis and determine the underlying cause. Diagnostic tests for diagnosing hemiplegia may include:

• Magnetic resonance imaging (MRI): An MRI scan creates detailed images of the brain and spinal cord to help identify the location and extent of damage and confirm the diagnosis. 
• Blood tests: Help screen for underlying medical conditions that may cause hemiplegia, such as blood clotting disorders or infection. 
• Myelography: An imaging scan that involves injecting a dye into the spinal canal, which makes it easier for your provider to view your blood vessels, organs, and other tissues and detect herniated discs, tumors, infections, and other conditions that affect the brain and spinal cord that can cause problems with muscle control.
• Electromyography: This test checks the function of your muscles and nerves that control your muscles by placing thin needles through the skin and into the muscle. Electrodes on the needles detect electrical activity in your muscles.
  

Treatments for Hemiplegia  

Once the underlying cause of hemiplegia is addressed, treatment focuses on increasing muscle strength and improving mobility and coordination. There is no cure for hemiplegia, but treatments help manage symptoms and improve functional skills to improve the quality of life of people with hemiplegia.

Treatments for hemiplegia may include rehabilitative therapies, orthotic devices, constraint-induced movement therapy (CIMT), and medications.

Rehabilitative Therapies

Rehabilitation therapies help improve strength, coordination, balance, and mobility. Rehabilitative therapy for hemiplegia usually involves a multidisciplinary approach, including:

• Physical therapy: Physical therapists teach and assist with exercises that improve mobility, strength, coordination, and range of motion. 
• Occupational therapy: Occupational therapists help improve fine motor skills and provide strategies and tools to help with daily living activities.
• Speech therapy: Speech therapists offer assistance and strategies for people with speech and swallowing difficulties. 

Orthotic Devices 

Using orthotics, such as braces or splints, helps support weakened muscles and improves stability and mobility in people with hemiplegia. Some people with hemiplegia may use assistive devices, such as canes, walkers, or wheelchairs, to help them move around more easily.

Constraint-Induced Movement Therapy (CIMT) 

Constraint-induced movement therapy works by restraining the arm and hand on the unaffected side of the body, such as with a splint or cast, necessitating using the affected limb for daily activities. Using the affected side can strengthen the muscles and improve coordination. It may also improve neural plasticity, which is the ability of the brain to rewire itself and form new connections.

Medications

Prescription medications can help manage specific symptoms, such as muscle spasticity (stiffness) or pain. Medicines commonly prescribed for hemiplegia include Gablofen (baclofen) and Botox (botulinum toxin A) injections.

Baclofen is an oral medication that acts on spinal cord nerves to reduce muscle spasms and pain and improve muscle movement.

Botox injections help improve muscle tone and function in people with spastic hemiplegia.

Prevention

Hemiplegia can occur unpredictably, and there is no guaranteed way to prevent it. However, there are things you can do to lower your risk of events or conditions that can cause hemiplegia. This includes:

• Head protection: Wear a helmet when riding a bicycle or motorcycle or engaging in contact sports, and wear a seatbelt when riding in or operating a motor vehicle to lower your risk of a traumatic brain injury.
• Avoid smoking: Don’t smoke, and if you do, consider quitting to reduce your risk of stroke and other vascular problems that can lead to hemiplegia. 
• Eat a healthy diet: Choose healthy foods, such as fresh fruits and vegetables, lean proteins, and whole grains. Limit your intake of saturated and trans fats and consume plenty of fiber to help keep your blood pressure and cholesterol levels within healthy ranges. 
• Exercise regularly: Regular physical activity—at least 30 minutes a day, 5 days a week of moderate-intensity exercise—helps keep your heart healthy, controls blood sugar levels, and supports your overall health. 
• Manage underlying conditions: If you have a diagnosis of a condition linked to an increased risk of stroke, such as high blood pressure or high cholesterol, take your medications as prescribed and see your healthcare provider regularly for check-ups.

Related Conditions 

People with hemiplegia have an increased risk of developing other medication conditions, such as: 

• Heart disease: Children with alternating hemiplegia of childhood are at increased risk of heart disease later in life.
• Stroke: People with hemiplegia who have already had a stroke are at increased risk of having another stroke.
• Deep vein thrombosis (DVT): DVT is a condition in which a blood clot forms in a vein in the lower body, such as the leg. People with hemiplegia are at increased risk of DVT if they are inactive or have mobility challenges.
• Epilepsy: Brain injuries and abnormalities can increase the risk of epilepsy and seizures.
• Anxiety and depression: The physical, social, and emotional impacts of hemiplegia increase the risk of anxiety and depression.

Living With Hemiplegia

Although living with hemiplegia comes with challenges, most people with hemiplegia can lead fulfilling lives. With proper treatment and support, many people with hemiplegia can improve their muscle function and learn to use mobility aids and assistive devices to maintain independence. Home modifications, such as shower grab bars, ramps, and assistive kitchen devices, can make daily activities easier.

Emotional support from family, friends, and healthcare professionals is important for people with hemiplegia. Talk to your healthcare provider if you need physical or emotional support. They can offer guidance and resources to help connect you with support.