From the Guidelines
Hemiplegia treatment should prioritize a multidisciplinary approach, including physical therapy, occupational therapy, and medications to manage spasticity, with botulinum toxin injections considered for severe muscle spasticity, as evidenced by the most recent guidelines from the American Heart Association/American Stroke Association 1.
Treatment Approach
The treatment of hemiplegia involves a comprehensive approach to manage the condition and improve the patient's quality of life. This includes:
- Physical therapy to maintain muscle tone and improve mobility
- Occupational therapy to develop strategies for daily activities
- Speech therapy if language is affected
- Medications to manage spasticity, such as baclofen (10-25mg three times daily) or tizanidine (2-8mg three times daily)
Management of Hemiplegic Shoulder Pain
Hemiplegic shoulder pain can be managed through various interventions, including:
- Gentle stretching and mobilization techniques to increase external rotation and abduction
- Analgesics, such as acetaminophen or ibuprofen, for pain relief
- Botulinum toxin injections into the subscapularis and pectoralis muscles to treat spasticity-related pain
- Subacromial corticosteroid injections for pain related to injury or inflammation of the subacromial region
Rehabilitation and Recovery
Rehabilitation should start as early as possible to achieve the best outcomes. The brain's neuroplasticity allows for some recovery, and undamaged areas can sometimes take over functions of damaged regions. Emotional support and psychological counseling are also essential components of treatment, as patients often experience depression and anxiety while adjusting to their condition, as noted in the guidelines for adult stroke rehabilitation and recovery 1.
From the Research
Definition and Treatment of Hemiplegia
- Hemiplegia is a condition characterized by weakness or paralysis of one side of the body, often resulting from a stroke, brain injury, or other neurological conditions 2.
- Spasticity is a common component of hemiplegia, which can be treated with botulinum toxin (BoNT) therapy, a preferred treatment for focal spasticity 3, 4.
Effects of Botulinum Toxin on Spasticity and Motor Performance
- BoNT injections have been shown to reduce spasticity and muscle strength in patients with spastic hemiplegia, but may not improve voluntary movement or motor performance 3, 4.
- Studies have demonstrated that BoNT injections can decrease the Modified Ashworth Scale (MAS) score and reflex torque, indicating a reduction in spasticity, but may not significantly change motor performance or muscle strength on the contralateral arm 4.
Comparison of Treatment Options for Spasticity
- Research has compared the effectiveness of different treatment options for spasticity, including BoNT injections, oral baclofen, and oral tizanidine, with varying results 5, 6.
- One study found that combination of BoNT injections with oral tizanidine was more effective with fewer side effects than combination of BoNT injections and oral baclofen for spastic cerebral palsy 5.
- Another study found that BoNT injections and oral baclofen treatment both decreased MAS and Visual Analog Scale (VAS) values, but had different effects on the electromyographic nociceptive flexor reflex (NFR) threshold 6.
Therapy Evaluation and Management of Hemiplegia
- Appropriate treatment of hemiplegia depends on a thorough evaluation of sensation and motion in the affected extremities, with realistic goals for self-care, mobility, and community skills 2.
- Therapy programs for hemiplegia may include occupational and physical therapy, as well as medical intervention to augment these programs and relieve pain or correct deformities 2.