This information aims to provide an overview of hemiplegia, the impacts it may have on a child and the support available. Although this information only covers childhood, hemiplegia is a lifelong condition and so it also affects adults. It is our goal to develop services and information for adults with hemiplegia in the future, but in the meantime we hope this will give you general idea of hemiplegia and the effects of the condition.
Hemiplegia (sometimes called hemiparesis) is a condition that affects one side of the body (Greek ‘hemi’ = half). We talk about a right or left hemiplegia, depending on the side affected. It is caused by injury to parts of the brain that control movements of the limbs, trunk, face, etc. This may happen before, during or soon after birth (up to two years of age approximately), when it is known as congenital hemiplegia (or unilateral cerebral palsy), or later in life as a result of injury or illness, in which case it is called acquired hemiplegia. Generally, injury to the left side of the brain will cause a right hemiplegia and injury to the right side a left hemiplegia.
One child in 1,000 is born with hemiplegia, making it a relatively common condition. About 80% of cases are congenital, and 20% acquired.
You may also be told that hemiplegia is a form of cerebral palsy, a descriptive name for a wider group of conditions in which movement and posture are affected owing to injury to the brain. These conditions are lifelong and non-progressive i.e. they do not get worse, but they may look different over time, partly because the child is growing and developing.
How does hemiplegia occur?
The causes of congenital hemiplegia are mostly unknown, and usually parents only become aware of their child’s hemiplegia during infancy or early childhood as the child’s difficulty with movement on one side gradually becomes obvious. There is a higher risk in very premature babies and with multiple pregnancies, and it is unclear whether a difficult birth may be an occasional factor. But in most cases, the injury occurs at some point during pregnancy, and researchers have as yet been unable to isolate any contributory factors. However, some studies suggest that there could be an increased risk in communities where marriage between close relatives is common. Parents often worry that they may be somehow to blame, but this is not the case as it would appear to be mostly a matter of chance.
Acquired hemiplegia results from brain injury. The most common cause is a stroke (when a bleed or blood clot damages part of the brain), but it can also result from a head injury or infection.
What are the effects of hemiplegia?
It is difficult to generalise: hemiplegia affects each child differently. The most obvious result is a varying degree of weakness, stiffness (spasticity) and lack of control in the affected side of the body, rather like the effects of a stroke. In one child this may be very obvious (he or she may have little use of one hand, may limp or have poor balance); in another child it will be so slight that it only shows when attempting specific physical activities.
What can be done to help?
Hemiplegia cannot be cured, but a lot can be done to minimise its effects and help children achieve their potential. Your child, once diagnosed, will probably be referred to a Child Development Centre (CDC) or the children’s department of your local or regional hospital. A paediatrician and therapists, who work as part of a wider network of professionals including paediatric neurologists and orthopaedic and neurosurgeons, will work in partnership with you to develop his or her abilities.
Understanding hemiplegia and knowing how you can help your child achieve his or her potential is vital.
The immature brain is very flexible, and some of the functions of the damaged area can be taken over by undamaged parts of the brain in a process known as neuroplasticity. An adult, whose brain pathways are already organised, has much less neuroplasticity and so after a stroke may lose very specific functions, depending on which part of the brain was affected. In contrast, which area of the brain was damaged and which side of the body is affected makes relatively little difference in children and young people with hemiplegia.
Your child’s management will probably be based on a multidisciplinary approach, involving physiotherapy, occupational therapy, and possibly speech therapy where required. A physiotherapist and often an occupational therapist will work closely with each other and with parents or carers, to agree a programme of management with specific goals that are tailored to the child’s development and needs. The aim will be to improve the child’s participation in everyday activities e.g. play, feeding, dressing, school life. The therapists will work to develop the child’s skills, assessing posture and providing muscle stretching, and possibly strengthening activities. This will help prevent possible second