Left hemiplegia is the paralysis of the left part of the body after a lesion of the right hemisphere of the brain (non-dominant hemisphere) caused by a stroke or lack of oxygen. The right side of the brain controls the movements of the left side of the body, in this way people with stroke who suffered an injury in the right hemisphere show a hemiparesis condition on the opposite side of the body.
What causes hemiplegia?
Left hemiparesis usually occurs after a:
- Cerebral stroke
- Cerebral palsy
- Congenital malformations
- Congenital hemiplegia
- Head injury.
- Brain tumor
As well as brain infections such as meningitis. All conditions that determine an alteration of the functionality of an affected hemisphere may be responsible for hemiparesis.
What are the symptoms of hemiplegia on the left side?
The symptoms that help diagnose hemiplegia are:
- Headache
- Face down
- Weakness of the body half
- Muscular stiffness
- Spasm
- Neglect (lack of attention to visual and body information that comes from the left)
- Spastic hemiplegia of that side of the body
- Engine deterioration
- Sensory problems
The symptoms of left hemiparesis are key issues to understand the problems of patients with stroke who have suffered a lesion on the right side of the brain due to stroke in the internal capsule or other abnormalities, to understand the behavior of patients with stroke With left paralysis, it allows us to identify the best strategies for the recovery of patients’ motor functions in their left arm and left leg.
Even in stroke patients suffering from left hemiparesis, mobility diseases are not only caused by an alteration of the muscles on that side, but by a combination of cognitive disorders, including attention deficit, which is one of the most debilitating in life, it is because of this that it is preferred to use the right arm to carry out the actions that use the other arm, as most are usually right-handed, the right hand plays a primary role in any activity and does not become unfit in using the lexical hand.
While stroke survivors with right hemiplegia almost entirely experience speech disease (aphasia) that is not due to a problem in the mouth, apraxia and lack of mobility of the right arm, hand and leg, for left hemiplegia, The disorders tend to be more complex to detect because of the general ignorance of the functions of the right hemisphere. We could say in a gemeral way that the right brain side is responsible for the construction of the space related to the environment, life and with your own body, It is precisely for this reason that in neurology specific attention has never been given to the treatment of patients with hemiparesis left. The main symptoms that are often associated with this type of hemiplegia include:
- Neglect
- Anosognosia
Neglect, also known as hemi-attention or spatial neglect, is not a symptom but a disease that is commonly attributed to the impediment of exploring the left visual space. It is not a visual disability, but it can be understood as a deficit to focus attention and awareness on the affected lateral space, there are even people who do not turn their heads to that side as they can forget that they have another hand.
This clinical disorder also partially explains the movement difficulties faced by stroke patients with left hemiparesis, which are related to their difficulties in focusing attention on the “world of the left”, including their own body and the environment in relation to With his limbs.
Therefore, the sensory disorders found in the left hemiplegics are not only caused by a direct injury to the primary sensory areas, but are also the result of several problems encountered to gather information about their environment through their body. which often causes increased muscle tone in the lower and lower left limb.
Anosognosia: this is another distinctive clinical feature that is often associated with this hemiparesis, and consists of the lack of awareness of the pathology itself, as can happen in a person after a stroke that is in a wheelchair and when asked has passed on his side with affection responds negatively without being aware of his lack of mobility in his left hand.
When combined, these two symptoms give rise to a series of alterations and problems, which patients suffering from hemiplegia meet daily, but at they often only become the object of anecdotes and funny misunderstandings. Those who participate in physiotherapy should translate these “anecdotes” into rehabilitation data that can be used to design the best possible rehabilitation strategies for their motor recovery, with anecdotes we refer to the sensations that can describe which are personal and different in each one , although they can often be similar, such as those that describe an elastic band in the knee that tenses and does not allow them to flex it, just as they can describe feelings of heaviness in the hand that makes it difficult for them to hold the objects, a forearm that can be felt as a lead tube that prevents pronation movement.
In particular, attention-related difficulties associated with the left half imply the ability to focus attention on the most significant element of any problem and the ability to divide attention between multiple aspects of the body simultaneously, it is a double problem that frequently Be careful, an example of this is when patients to pick up an object use a shoulder and elbow movement instead of just moving their hand, they can even move their entire trunk and head to achieve the goal, this is just A simple example of how they can affect your posture to perform simple activities for everyday use. The attention allows us to divide the movement so that it is singular in a joint, which is fundamental for the recovery of the functions of the affected arm and leg.
Learning difficulties in LCA can also be quite pronounced in certain cases, especially when combined with attention disorders, which makes it difficult for the functional recovery of the affected limbs to cope with this situation, the recovery will depend on the therapist’s ability to teaching and the ability of the hemiplegic patient after stroke to learn the most advanced motor functions again, it is as if they were children again, performing the complex functions of the hand will depend on the learning frame to which they must undergo. It is often thought that the quality of recovery depends on whether the brain damage was the result of a haemorrhage or if the Stroke was the product of an ischemia, in both cases, rehabilitation strategies should be oriented according to cognitive processes considering the differences between the right and left hemisphere.
It has been mentioned several times that muscle movements are the result of complex organizational activities in the cerebral hemisphere, each part of the brain exerts its role in the modulation of movement and can not only be attributed to the role of the spinal cord, walking is not only Due to the muscular contraction of the legs, this act is the result of a complex organization that receives information from each leg joint that allows us to establish a relationship with ourselves and space, the same happens with the arms, if we do not have An adequate organization of cognitive processes in each joint that makes up the arm would move by releasing primitive reflexes, the hand requires many different types of information to execute a grip, a simple example of how the weakness of cognitive processes (and the attention of the patient in particular not only in the stroke) can cause changes in the Vimientos is that of children with attention deficit disorder.
Therefore, the rehabilitation of LCA independent of the type of paralysis, should not focus on the strength training of the muscles in the lower limb, this is a problem inferior to the true cause of the deficit, it should not be attributed to a strength deficit when The wheelchair user is not able to straighten his spine and stand up, since spasticity is not considered a muscular problem, we should better consider the use of medications such as botulinum toxin (which can be counterproductive for the recovery of hand and leg, this is frequently applied to the arm to decrease spasticity). In contrast, rehabilitation efforts following stroke and left hemiparesis should simultaneously focus on: the body, altered functions (such as walking and the ability to grab and manipulate objects with the upper limb and hand), cognitive processes / emotional and information gathering that requires the cerebral cortex to perform an action for example in the arm, an example that a person with stroke is not collecting enough information to know what happens with their environment is one who walks looking at his foot instead of observing the direction in which you walk, our foot should give us information about how At the degrees of pressure we exert at each step, by not doing it properly, our eyes supplant the information that our feet should provide.
Stroke Rehabilitation
Often, in this field of neurology, occupational therapy and medical treatment must be accompanied by physiotherapy, we are used to seeing hemiplegic patients treated by:
Restriction-induced movement therapy
Frequently performed on the arm, the hemiparetic patient benefits from being pushed to realize his affected side due to negligence, on the other, we must consider the side effects of this choice on arm spasticity. After a stroke due to hemorrhage or ischemia, it is prone to generate spasticity, this is common in the elbow and for this reason they keep their elbow flexed near their chest, the neurological professionals involved in their recovery, such as the physiotherapist and Occupational therapist, should not focus too much on strength training because that could increase symptoms, this does not happen only in stroke, the increase in spasticity can occur in children with cerebral palsy when the necessary precautions are not taken into account.
Strength training
We must take into account that a stroke generates a brain injury and does not affect the muscles and bones due to fracture or hematoma, as mentioned above, paying attention only to the muscles of our patient after the stroke, only offering Strength training on the left side of the body where you have paralysis may not improve weakness and spastic symptoms, all brain damage should be in order of priorities of any intervention, this can be verified by an MRI as each function is structured takes care of an action and not just the lower part of the brain.
- Orthotic to treat shoulder pain.
- After a stroke or stroke, it is easy to find patients suffering from shoulder pain. In general, this is reduced in the weakness of the left arm due to the paralysis that raises the limb of the floor.
- Electrical stimulation directed to muscle weakness.
That is another possible treatment that patients can receive during stroke rehabilitation for facial and muscle paralysis. At that time, the therapeutic choice is directed to the visible part of the problem, it means the paralysis of the left body part and not the alteration of the cognitive processes that make motor functions possible. The other reason why this treatment is proposed is for the regeneration of the nerves, wheelchair patients are given this method in order to return, but so far no clinical trial can prove the effectiveness of that approach . Neurocognitive rehabilitation (or the Perfetti method) has been recognized as one of the best options for the treatment of patients with stroke hemiplegia caused by thrombosis, cortex infarction, among other causes in recent years, because in addition to the recovery of Muscle contraction also takes into account cognitive processes.
That is, cerebral infarction is actually a brain disease: it does not directly affect the muscles of the upper limb, but our ability to organize motor functions through cognitive processes such as attention, learning, memory, perception and Motor images In summary: Although disorders associated with stroke are manifested as muscle deficits (spasticity, contractures, abnormalities when walking and moving the upper limb), these visible expressions are simply the result of a brain injury that has affected the patient’s ability to organize their brain processes in each joint, the march that is observed in the left hemiplegics with elevation of the pelvis is not only due to an alteration of the pelvis, it is due to a lack of organization of the information that the knee should provide us to flex it in the takeoff phase, by not doing so physiologically, the only way to bring the leg forward is by raising the hip excessively.
Therefore, in order to obtain the best possible recovery in cases of left hemiparesis, the brain functions that we understand are the basis of the movement should be the focus of our efforts for attention and rehabilitation of strokes as well as the risk factors that can trigger this event as arteriosclerosis. As a result, the rehabilitation of left hemiparesis requires a therapeutic treatment approach that focuses on the recovery of these cognitive abilities. The family plays a role of fundamental importance in the hemiplegic recovery process, and if they are well instructed, family members can actively participate in recovering from their loved one’s stroke through neurocognitive rehabilitation exercises. Personally, I rarely find patients who intend to undergo treatment without the participation of a family member or caregiver, and it is difficult to imagine getting a good level of recovery with just the work done in the clinic or treatment center, without the contribution of the family.
