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Hemiplegia. How to prevent Hemiplegia. Reduce body weight to avoid obesity. Reduce the physical and mental stress. Increasing overall physical conditioning Avoid smoking. Regular use of hypertension drugs. Exercise regularly. Hemiplegia.

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How to prevent hemiplegia
How to prevent Hemiplegia

  • Reduce body weight to avoid obesity.

  • Reduce the physical and mental stress.

  • Increasing overall physical conditioning

  • Avoid smoking.

  • Regular use of hypertension drugs.

  • Exercise regularly.


Hemiplegia

  • Paralysis of one side of the body due to pyramidal tract lesion at any point from its origin in the cerebral cortex down to the fifth cervical segment.


Risk factor of hemiplegia
Risk Factor of Hemiplegia

  • Diabetes Mellitus

  • High Blood Pressure

  • High Cholesterol level

  • Obesity

  • Smoking

  • Sedentary lifestyle


Causes of hemiplegia
Causes of Hemiplegia

  • Vascular Causes:

  • Thrombosis

  • Atherosclerosis.

  • Blood Disease.

  • Embolic

  • Heart

  • Deep venous thrombosis

  • Hemorrhage

  • Hypertension

  • Rupture of intracranial aneurysm


Hemiplegia Back Pain

  • Infective

  • Encephalitis

  • Neoplastic

  • Meningioma

  • Demyelination

  • Disseminated Sclerosis

  • Traumatic

  • Congenital

  • CP

  • Hystrical


Site of lesion
Site of Lesion

  • Spinal Cord

  • At the level of C1-C5

  • Brown - Sequard syndrome

  • Brain Stem

  • Mid brain-Pones-Medulla

  • Cerebral

  • Cortical- Subcortical- Capsular


According to the onset
According to the Onset

  • Gradual Lesion

  • Stage of Spasticity

  • Acute Lesion

  • Stage of Flaccidity

  • Stage of Spasticity

  • Stage of Flaccidity:

  • Last from 2-6 weeks

  • On the paralysed side there is complete lose of muscle tone and absence of deep reflex

  • May be accompanied with Coma


  • Stage of Spasticity:

  • Paralysis of one side of the body

    (Affect the progravity more than the antigravity muscles)

  • Spasticity of the paralysed muscles (Affect the antigravity more than the progravity muscles)

  • Exaggerated deep reflex and lose superficial reflex.


Rehabilitation team
Rehabilitation Team

  • Physician

  • physiotherapist

  • Social workers

  • Psychologist

  • Nurse

  • Occupational therapist

  • Vocational counselor



Consideration before assessment
Consideration Before Assessment

  • The clinic should be cleaned, suitable temperature of room, and ready instrumentation to use.

  • Plinths should be wide, suitable height, clean blankets.

  • Behavior and social aspect should be noticed.

  • Notice patient from head to ankles.

  • Explain to patient what will happen.

  • Covering patient till the beginning the assessment.

  • Discover disabilities that responsible for restriction of ADL.

  • Discover abilities that are suitable for ADL performance.


Considerations during assessment
Considerations During Assessment

  • Good fixation of target joint during assessment.

  • Patient completely relaxed (physically & mentally) during assessment.

  • All movements and test procedure should be within the limit of pain.

  • Removing tight clothes during assessment.

  • Explain the tests procedure to the patient.

  • Close communications during assessment.


Diagnostic interview
DIAGNOSTIC INTERVIEW

Personal History:

  • Name: To be familiar with the patient

  • Age: occurs in people aged 40-50 years (cerbrovascular stroke)

  • Sex:affects men and women equally

  • Marital status: Married or single

  • Style of life: his habits, activities and if he living a sedentary life. It assist in providing the therapist with hint about causes and the expected prognosis.

  • Occupation:as people in certain job are more susceptible to some disease. Most plan of treatment require occupational modification.


Personal history
Personal History

  • Environmental assessment: is the patient living in crowded and noisy area or not, which floor, and availability of Facilities .

  • Weight:obesity increase the difficulty in performing activities.


Past history
Past history

  • Hereditary and Genetic diseases.

  • Previous and multiple trauma.

  • Diabetes Mellitus.

  • Cardiac problems and Hypertension.

  • Previous surgery.

  • Associated Trauma or injury.

  • Drug use.

  • Cancer or tumor.


Present history
Present history

Mechanism of injury.

Onset and course of disease:

  • Acute onset and regressive course (Vascular, Infective. Traumatic lesion)

  • Gradual onset and progressive course (Neoplastic lesion)

  • Remittent and relapsing course (DS)

    Duration of symptoms:

  • Flaccid Stage: 2-6 weeks

  • Spastic Stage: After Flaccid Stage


Functional activities of daily living
Functional activities of daily living

There are 4 grades for evaluation:

*Can’t do it.

*Do it with maximum assistance.

*Do it with minimal assistance.

*Do it without assistance.

What problems interfere with ADL:

  • Hygiene: affected

  • Dressing and undressing: affected.

  • Feeding: affected

  • Gait ambulation: affected.

  • Transfer activities: affected.

Assistive Devises


Social and psychological status
Social and psychological status

  • Attitude and behavior: Nervous, depressed, accepted.

  • Relationship with family.

  • Review of a patient’s home, work, recreational activities.

  • Information should be obtained on patient’s prior functional and present functional levels on these tasks.


Vocational assessment
Vocational assessment

If the patient can return to his job or need new suitable one?


Chief complain
Chief complain

  • Difficulties in performing ADL

  • Difficulty walking

  • Problems with balance

  • Difficulty using arms to dress, feed self, or perform other tasks

  • Urinary incontinence

  • Decreased sensation, numbness, or tingling on affected side of the body

  • Difficulty speaking and/or or understanding words

  • Depression


Medical record
Medical Record

  • Drugs:(according to the cause of the disease).

  • Reports:(all reports from other physician- previous investigations).

  • Laboratory tests. (blood test)

  • Vital signs.

  • Bowel or bladder incontinence

  • Vision, hearing, speech records.

  • Cardiopulmonary reports.

  • Electrocephalogram EEG (to measure electrical activity of the brain)





Screening and scanning examination
Screening and scanning examination

General inspection:

  • General health.

  • Wearing glasses, hearing aids

  • Relation between family.

  • Proportion of body parts.

  • Weight& height.


Posture assessment;

  • Posterior, anterior and lateral views.

  • From static and dynamic positions.

  • Position of head & neck.

  • Levels of shoulders.

  • Scoliosis

  • Chest shape .

  • Level of waist (ASIS).

  • Anterior or posterior pelvic tilting.

  • Any deformities of upper and lower limbs.


Screening and scanning examination1
Screening and scanning examination

  • Involuntary Movement

  • Function:

    Observe any functional disabilities during taking his cloth off.

  • Gait:

  • Phases of gait or any abnormalities in gait

  • wearing assisted devices.


Specific inspection

Inspect the trunk and extremities for signs of asymmetry, lesions, scars, trauma, deformities or previous surgery.

Involuntary movement: Chorea, Athetosis, Tremors

Convulsion

Face Texture: Deviation of mouth angle

Skin: color, hair patches, scars, wounds , of the skin

Bones: alignment, deformity.

Muscle: Spasticity, spasm, atrophy

Specific Inspection


Palpation
Palpation asymmetry, lesions, scars, trauma, deformities or previous surgery.

  • Soft tissues of upper and lower limbs .

  • Changes in temperature or texture.

  • Mobility of the skin.

  • Tenderness.

  • Spastic and atrophied muscles.


Comprehensive motor control assessment
Comprehensive Motor Control Assessment asymmetry, lesions, scars, trauma, deformities or previous surgery.

Examination of the Mental Function

  • State of consciousness:

    Alert Drowsiness Coma

  • Orientation for Time and Place.

  • Memory:

    Immediate Recent Remote

  • Communication Abilities:

    Vision Hearing Speech

  • Behavior and Psychological Status:

    Depression Angry

  • Intelligence: IQ


Examination of speech
Examination of Speech asymmetry, lesions, scars, trauma, deformities or previous surgery.

  • Sensory Aphasia:

    1)Visual:

  • Visual Agnosia

  • Alexia

    2)Auditory:

  • Auditory Agnosia

  • Motor Aphasia:

  • Verbal aphasia

  • Agraphia


Sensory examination
Sensory Examination asymmetry, lesions, scars, trauma, deformities or previous surgery.

  • Superficial sensation

    Touch, Pain, Temperature ( compare on each side of limbs)

  • Semmes Weinstein monofilament test

  • Pin prick test


Sensory examination1
Sensory Examination asymmetry, lesions, scars, trauma, deformities or previous surgery.

  • Deep Sensation

  • Vibration sense

    The use of a 256-Hz tuning fork over different bony prominance.

  • Joint Sense

  • Sense of position

  • sense of movement


Deep sensation
Deep Sensation asymmetry, lesions, scars, trauma, deformities or previous surgery.

  • Romberg’s Test

  • Muscle sense


Sensory examination2
Sensory Examination asymmetry, lesions, scars, trauma, deformities or previous surgery.

  • Cortical Sensation

  • Tactile Localization

  • 2-point discrimination


Cortical sensation
Cortical Sensation asymmetry, lesions, scars, trauma, deformities or previous surgery.

  • Stereognosis

  • Graphosthesia

  • Perceptual Sense


Examination of cranial nerves
Examination of Cranial Nerves asymmetry, lesions, scars, trauma, deformities or previous surgery.

  • Oculomotor Nerve (3rd cranial nerve):

  • Ask patient to look upward

  • abducent Nerve (6th cranial nerve):

  • Ask patient to look laterally

  • Facial Nerve (7th cranial nerve):

  • Ask patient to smile and showing teeth

  • Absence of nasolabial fold and dropping angle of mouth

  • Hypoglossal nerve (12th cranial nerve):

  • Deviation of tongue toward the affected side

  • Ask patient to push his check with the tip of tongue


Muscle tone assessment
Muscle Tone Assessment asymmetry, lesions, scars, trauma, deformities or previous surgery.

  • Spasticity or hypertonia of the paralysed muscles of the clasp-knife type:

    It affect the antigravity more than the progravity muscles.

  • In UL:the flexors more spastic than the extensors

  • In LL:the extensors more spastic than the flexors


Factors affecting muscle tone
Factors affecting Muscle tone asymmetry, lesions, scars, trauma, deformities or previous surgery.

  • Anxiety

  • Temperature

  • Tension

  • Drugs

  • Fear

  • Fullness of bladder

  • Position of the head

  • Environmental condition

  • Vision and hearing

  • Pain


Assessment of muscle tone
Assessment of Muscle Tone asymmetry, lesions, scars, trauma, deformities or previous surgery.

  • Passive Movement

    Ashworth Scale :

    To perform this test, the part is moved through the joint range-of-motion (ROM).

    Ashworth Score Criteria:

    0No increase in tone

    1Slight increase in tone, giving a “catch” when the limb is moved in flexion or extension

    2More marked increase in tone, but limb easily flexed

    3Considerable increase in tone; passive movement difficult

    4Limb rigid in flexion or extension


Assessment of muscle tone1
Assessment of Muscle Tone asymmetry, lesions, scars, trauma, deformities or previous surgery.

  • Shaking:

    Wrist and Ankle

  • Drop arm Test

  • Postural tone:

    Righting and Equilibrium Reactions


Examination of muscle power
Examination of Muscle Power asymmetry, lesions, scars, trauma, deformities or previous surgery.

  • Paralysis or Weakness of one side of the body.

  • It affect theprogravitymore than theantigravitymuscles.

  • Upper limbs:The Extensors are weaker than the Flexors.

  • Lower limbs:The Flexors are weaker than the Extensors


Examination of muscle power1
Examination of Muscle Power asymmetry, lesions, scars, trauma, deformities or previous surgery.

Shoulder Joint:C4-C5

Flexion

Extension

Medial and Lateral Rotation

Abduction

Adduction

Elbow Joint:C5,6,7

Flexion

Extension


Examination of muscle power2
Examination of Muscle Power asymmetry, lesions, scars, trauma, deformities or previous surgery.

Wrist joint:C7,8

Extension

Flexion

Hand:C8-T1

Fingers and Thumb

Flexion, Extension

Abduction, Adduction


Examination of muscle power3
Examination of Muscle Power asymmetry, lesions, scars, trauma, deformities or previous surgery.

Abdominal Muscles:T6-T12


Examination of muscle power4
Examination of Muscle Power asymmetry, lesions, scars, trauma, deformities or previous surgery.

Flexion: L1-2-3

Extension: L4-5-S1-2

Hip Joint

Adduction: L2-3-4

Abduction: L5-S1

Flexion: L5-S1-2

Extension: L2-3-4

Knee Joint

Dorsiflexion: L4-5

Inversion: L4-L5

Ankle Joint and Foot

Eversion: L5-S1

Plantarflexion: S1-2


Examination of reflexes
Examination of Reflexes asymmetry, lesions, scars, trauma, deformities or previous surgery.

  • Deep Reflexes

    Exaggerated deep reflex in Hemiplegia

Biceps Reflex(C5,6)

Triceps Reflex(C6,7)


Deep reflexes
Deep Reflexes asymmetry, lesions, scars, trauma, deformities or previous surgery.

  • Brachioradialis reflex (C5,6)


Deep reflexes1
Deep Reflexes asymmetry, lesions, scars, trauma, deformities or previous surgery.

Knee reflex(L2,3,4)

Achilles tendon (Ankle) reflex(S1,2)


B) Superficial Reflexes asymmetry, lesions, scars, trauma, deformities or previous surgery.

Abdominal Reflex (T6-T12)

Lost on the paralysed side

Planter Reflex (S1-S2)

Positive Babinski Sign


Test for clonus
Test For Clonus asymmetry, lesions, scars, trauma, deformities or previous surgery.

Clonus :Is a rhythmical series of contraction in response to the sudden sustained stretch of the tendon of the muscle.it appear in the UMNL.

  • Ankle Clonus


Range of motion assessment
Range of Motion Assessment asymmetry, lesions, scars, trauma, deformities or previous surgery.

  • Active and Passive ROM


Range of motion assessment1
Range of Motion Assessment asymmetry, lesions, scars, trauma, deformities or previous surgery.

Electrogoniometer

Universal goniometer


Long and round measurement
Long and Round measurement asymmetry, lesions, scars, trauma, deformities or previous surgery.

  • Circumferential measurements: By tape measurement to determine atrophy of lower limb muscles (quadriceps, calf muscles).

  • Long Measurement: Measure leg lengths from anterior superior iliac spine to medial malleolus by Tape measurement.


Functional assessment
Functional Assessment asymmetry, lesions, scars, trauma, deformities or previous surgery.

  • Dressing and undressing

  • Transferee activities

  • Gait and ambulation

  • Ability to get up from chair or on/off the examination table

  • Using assistive device

    There are 4 grade for evaluation:

    *Can’t do it.

    *Do it with maximum assistance.

    *Do it with minimal assistance.

    *Do it without assistance.


Balance assessment
Balance Assessment asymmetry, lesions, scars, trauma, deformities or previous surgery.


Coordination assessment
Coordination assessment asymmetry, lesions, scars, trauma, deformities or previous surgery.

Finger-to-nose test

Finger-to-finger test

Finger-to-doctor's finger test


Coordination assessment1
Coordination assessment asymmetry, lesions, scars, trauma, deformities or previous surgery.

Heel-to-knee test


Gait assessment
Gait Assessment asymmetry, lesions, scars, trauma, deformities or previous surgery.

  • The gait of hemiplegic patients is circumduction Gait

  • 1)patient walk across the room under observation and gross gait abnormalities should be noted.

2)Heel to toes

3)Walk on toes

4)Walk on heels


Special tests
Special Tests asymmetry, lesions, scars, trauma, deformities or previous surgery.

  • Upright Motor Control Test:


Upright motor control test
Upright Motor Control Test asymmetry, lesions, scars, trauma, deformities or previous surgery.

A) Knee extension:

patient bends both knees to approximately 30 degrees and then lifts the unaffected leg off the ground.

Grades:

  • Strong: straightens the flexed knee to full extension.

  • Moderate: supports body weight on the flexed knee.

  • Poor: unable to support body weight on the flexed knee


Upright motor control test1
Upright Motor Control Test asymmetry, lesions, scars, trauma, deformities or previous surgery.

B) Knee flexion:

The patient stands as straight as possible and brings the knee and foot on the affected side up toward the chest as high and as fast as possible, repeated three times.

Grades:

  • Strong: joint flexes more than 60 degrees

  • Moderate: joint flexes less than 60 degrees or cannot complete three efforts in 10 seconds.

  • Poor: cannot make flexion.


Postural assessment
Postural Assessment asymmetry, lesions, scars, trauma, deformities or previous surgery.

  • Computerized Posture Analysis


Postural assessment1
Postural Assessment asymmetry, lesions, scars, trauma, deformities or previous surgery.

  • Moire Topography


3d 4d formetric
3D/4D Formetric asymmetry, lesions, scars, trauma, deformities or previous surgery.

Postural Assessment


Postural assessment2
Postural Assessment asymmetry, lesions, scars, trauma, deformities or previous surgery.

  • posturalprint


Postural assessment3
Postural Assessment asymmetry, lesions, scars, trauma, deformities or previous surgery.

Posture Evaluation Kit


3d motion analysis system

Range of Motion Assessment asymmetry, lesions, scars, trauma, deformities or previous surgery.

3D Motion Analysis System


Evaluation of muscles strength
Evaluation of Muscles Strength asymmetry, lesions, scars, trauma, deformities or previous surgery.

Isokinetic Dynamometer


Isokinetic dynamometer
Isokinetic Dynamometer asymmetry, lesions, scars, trauma, deformities or previous surgery.


Evaluation of muscles strength1
Evaluation of Muscles Strength asymmetry, lesions, scars, trauma, deformities or previous surgery.

Dynamometer :

  • For trunk and lower limb movements

Lumbar Extension

Lumbar Rotation


Dynamometer
Dynamometer asymmetry, lesions, scars, trauma, deformities or previous surgery.

Ankle dorsi Flexion

Ankle Plantar Flexion

Hip Flexion

Knee Flexion


Evaluation of muscles strength2
Evaluation of Muscles Strength asymmetry, lesions, scars, trauma, deformities or previous surgery.

  • Digital Muscle Tester


Gait evaluation
Gait Evaluation asymmetry, lesions, scars, trauma, deformities or previous surgery.

3D motion analysis and force platform

  • Detect different kinetics and kinematics of gait.


Gait evaluation1
Gait Evaluation asymmetry, lesions, scars, trauma, deformities or previous surgery.

  • Detect any abnormalities in gait


Balance assessment1
Balance Assessment asymmetry, lesions, scars, trauma, deformities or previous surgery.

Tetrax

Balance Master

Balance Manager


Muscle tone assessment1
Muscle Tone Assessment asymmetry, lesions, scars, trauma, deformities or previous surgery.

Electromyography

Detect abnormalities of muscle tone.


Thank you asymmetry, lesions, scars, trauma, deformities or previous surgery.