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Hemiplegia
The injury to one side of the brain that causes hemiplegia / hemiplaegia can be present at birth (congenital), or it can occur later on through events such as infection, accident, tumour or stroke (acquired). It can be a part of cerebral palsy. Hemiplegia is paralysis / weakness on one side of the body. It can also come with subtle emotional, behavioural, sensory and perceptual difficulties. Ref: 1002 Last Updated: February 2013

Effects
Children with hemiplegia find it difficult to use and control one side of their body, opposite the side of the brain damage, also sometimes facial muscles on the same side as the damage (because of the way the nerves cross over). The stronger side of the body may also be affected slightly. Muscles may be stiff (spastic) or floppy (flaccid). If there is a tightness (spasticity) to muscles and tendons, it leads to a characteristic way of walking (hemiplegic gait); a semicircular movement of the leg from the hip on one side, with a tendency for the foot to drop. This tilts the pelvis upwards and may affect the knee and ankle. The forefoot may hit the ground first, then the weight goes on to the edge of the foot with the toes bent (equinovarus). One arm may be held differently. If there is no tightness, the hip and knee move too much, resulting in a tiptoe movement on one side. In mild cases, a slight difference in gait due to dropfoot on one side may be the only physical effect apparent. (There are also other conditions that involve dropfoot and other gait variations.) There may be slow development of other physical effects as a result of uneven posture and movement. Also worth noting is that the child has to use more energy to move around, and tiredness may set in. Other effects may include: short concentration span easily distracted low retention of short-term memory hyperactivity (severe in 10% of those studied1 spatial disorientation and low visual perception shyness and self-consciousness lack of confidence inability to make/sustain friendships

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anxiety irritability, aggressiveness, tantrums and defiance (including 25% of 6-10 year olds) immature behaviour poor co-ordination of both movement and information worries and fears affecting well-being, activities, work and sleep. Again, hemiplegia is not the only condition where these effects might be seen. However, studies show that while they apply in some way to 10% of children in general, they apply in some way to over 50% of hemiplegic children. (Figures vary between 57% and 61%.) It is not clear why this is so: one theory is that the original injury has also caused changes to patterns of neuronal connections in the brain. It has been suggested that all children with hemiplegia need monitoring for these problems4.

Types of hemiplegia
The International Classification of Diseases (ICD-10) defines types according to what the diagnostician understands about their causes: G80.2, spastic hemiplegic cerebral palsy G80.8, other cerebral palsy; mixed cerebral palsy syndromes G81, hemiplegia (complete) or hemiplegia (incomplete) where the cause is unknown or general / unusual. Subsections are; G81.0, flaccid hemiplegia G81.1, spastic hemiplegia G81.9, unspecified type

G83.8, Todds paralysis (related to epilepsy) G95.8, from specified diseases of spinal cord I63.3 and I63.4, from one of several types of stroke P11.9, from a birth injury to the central nervous system, unspecified P91.8, from other specified disturbances of cerebral status of the newborn.

Alternating hemiplegia / hemiplegia alternans can be of several kinds ranging from mild to severe. It affects both sides of the body in different ways. A temporary hemiplegia appears on each side at different times, possibly including facial and eye muscles. In severer cases there can also be changes to body temperature, seizures and / or learning disabilities, and there can be some deterioration of the condition; this however is very rare. Some conditions can cause transient hemiplegic effects, notably type 2 diabetes and migraine. Hemiplegia is also a feature of a few rare conditions, such as Rasmussens encephalitis and some of the metabolic disorders. Other terms that may crop up hemiamyosthenia ~ lack of muscular power on one side of the body (or hemiparesis, see below); hemianopia/hemiopia/hemianopsia ~ loss of half of the visual field; hemiapraxia ~ inability to learn and perform coordinated movements accurately on one side; hemiataxia ~ coordination disorder on one side, possibly affecting balance; hemiathetosis ~ involuntary movement on one side; hemiatrophy ~ atrophy of one side of the body or one half of an organ or part; hemidysesthesia ~ a disorder of sensation affecting only one side; hemihypalgesia ~ lower pain sensitivity on one side; hemihypertonia (or hemihypotonia) ~ increased (or decreased) muscle tone on one side; hemiparalysis ~ paralysis of one side; hemiparaplegia ~ paralysed lower half of one side; hemiparesthesia ~ abnormal sensations on one side; hemiparesis ~ a milder weakness on one side. hemispasm ~ spasm affecting one side.

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Help available
Weakness, posture and any knock-on physical effects can be helped by physiotherapy and by using the affected side in everyday activities. Occupational therapy can help to work around the weakness in everyday tasks, and work on fine motor movements, spatial and sensory awareness, general perception problems and effects of hemianopia. Speech therapy help may also be necessary for speaking clearly, perception related to communication, and eating. This team can become involved through referral (medical, educational etc). School SEN and/or mental health provision may help with psychological issues. Where muscles are very tight, muscle relaxants, splints or surgery may relieve this, through NHS physiotherapy, orthopaedic and orthotic services. Splints and orthoses are not always rigid devices: they can be special shoes or fitted lycra garments. Cerebras postal lending library has some relevant books and sensory toys and the Winter 2006 Bulletin contains a detailed article on hemianopia. HemiHelp is a support charity for hemiplegia, with useful resources, tel: 0845 123 2372, www.hemihelp.org.uk/. If one of the rarer hemiplegic conditions has been diagnosed, help may also be available from; The Encephalitis Society, tel: 01653 699599, www.encephalitis.info/; Climb: the National Information Centre for Metabolic Diseases, tel: 0800 652 3181, www.climb.org.uk; or Contact a Family (for other rare conditions), tel: 0808 808 3555, www. cafamily.org.uk/.

Some conditions can cause transient hemiplegic effects, notably type 2 diabetes and migraine.

References
1. Hemi-Help factsheets on emotional and behavioural difficulties

2. Hemi-Help factsheet: The Child with Hemiplegia in Primary Education (2nd ed.) 3. Hemi-Help factsheet: The Student with Hemiplegia in Secondary Education 4. Goodman R. 1998 Mar. The longitudinal stability of psychiatric problems in children with hemiplegia. Journal of Child Psychology and Psychiatry 39(3):347-54. 5. World Health Organisation, International Classification of Diseases (10th ed.) 6. NINDS (National Institute of Neurological Disorders and Stroke, USA): factsheet on alternating hemiplegia, http://tinyurl.com/3tfe9u. 7. NORD (National Organization for Rare Disorders, USA) List of rare conditions involving hemiplegia

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