The most common movement impairment is hemiparesis, which refers to one-sided (“hemi”) weakness (“paresis”). Hemiparesis affects roughly 80 percent of stroke survivors, causing weakness or the inability to move one side of the body. Weakness can impact arms, hands, legs and facial muscles. Those impacted may have trouble performing everyday activities such as eating, dressing, using the bathroom and grabbing objects.
Hemiparesis in the arms, hands, face, chest, legs or feet can cause:
Left Hemisphere Right-sided Hemiparesis
Injury to the left side of the brain, which controls language and speaking, can result in right-sided hemiparesis. Because the left side of the brain is involved in speech and language, a person with right-sided hemiparesis can have problems expressing (using facial muscles and speaking) and comprehending language (aphasia).
Right Hemisphere Left-sided Hemiparesis
Left-sided hemiparesis results from injury to the right side of the brain, which controls the process of how we learn, nonverbal communication and certain types of behavior. Stroke survivors with damage to the right side of the brain may also have trouble with memory and attention span, and may talk excessively. Left-sided hemiparesis can also inhibit a stroke survivor's sensation and spatial skills.
Damage to the lower part of the brain, the cerebellum, can affect the body’s ability to coordinate movement. This is called ataxia and it can lead to problems with posture, coordination and balance.
Pure Motor Hemiparesis
This is the most common type of one-sided weakness. Stroke survivors with pure motor hemiparesis have weakness in their face, arms and/or legs.
The brain stem controls the swallowing process. Paralysis of the throat muscles can lead to dysphagia.
Ataxic Hemiparesis Syndrome
Weakness or clumsiness on one side of the body is referred to as ataxic hemiparesis syndrome. Ataxia causes individuals to over- or under-reach for things (dysmetria), as well as delayed initiation, difficulty with maintaining force and rhythm (dysdiadochokinesia), tremors and difficulty coordinating muscles groups. This usually affects legs more than arms and can occur over the course of hours or days.
It is possible to increase or regain strength and movement with immediate rehabilitation. Working with a physiatrist, physical therapist and/or occupational therapist has proven to have a favorable impact on mobility.
A variety of treatments are used to help improve use and movement in the affected arms and legs. These include the following.
Modified constraint-induced therapy (mCIT) is an intensive motor practice. The therapy involves restricting the use of a less affected part of the body, which forces the patient to use the weakened part of the body. While mCIT is a behavior therapy, regular practice can improve nerve function in the central nervous system. The therapy is applied with varying intensity and duration over time depending on the individual’s motor functioning.
Electrical stimulation has been used in the treatment of hemiparesis to enhance sensory awareness, strengthen a weakened body part (such as the arm, leg, hand or foot) and improve range of motion. This procedure consists of placing small electrical pads on the weakened muscles of the affected body part. An electrical charge helps the muscles contract as the patient works to make it move. Many of these electrical stimulation devices are covered by insurance and can be used at home.
Cortical stimulation is a type of electrical stimulation, but instead of directly on the arm or hand, the electrodes stimulate the part of the brain called the cortex. The tiny electrode is placed on the dura, the tough membrane that covers the brain. The electrode sends an electrical current to the brain while the stroke survivor undergoes rehabilitation exercises. This treatment is a safe way to regain mobility.
Motor imagery is the process of imagining the movement of the affected part of the body. This mental practice activates areas of the brain and muscles as if the patient is actually doing an activity. The network of nerves in the brain involved in visualization and physical movement overlap, making this an effective activity when paired with other therapies.
In addition to rehabilitation treatment, exercise at home and assistive aids can help increase mobility.
Repeated practice and regular activity will help increase control and flexibility and re-establish nerve circuitry. Patients can learn specific activities to do at home that will help continue recovery after inpatient therapy. Consistency and concentration are key to increased accuracy, range of motion and strength.
Always consult a healthcare professional before starting these exercises.
Home modification such as the following can improve safety.
Braces, canes, walkers and wheelchairs can lead to increased strength and movement.
An ankle-foot orthosis brace starts below the knee to encompass and control the ankle and foot. Certain types of these braces or adjustments to these braces can also influence knee movement. Other variations and adjustments can be made to braces to fit individual needs.
A physical therapist can recommend the appropriate device. Training in safety procedures and the proper use of orthotics, including proper fit and maintenance, is essential.
Making simple lifestyle changes can help prevent falls and promote a healthier recovery. Some examples include:
National Stroke Association’s Living After Stroke is a series of archived webinars and accompanying resource guides. Use these resources to get valuable information and strategies.