Like all forms of cerebral palsy, spastic hemiplegia results from brain damage. Distinguished from other manifestations of the disease, hemiplegia (hemi = half) is a movement defect of one side of the body, either the right side or the left. Generally only the arm and hand are affected, but the damage can extend to the leg of the same side. In the last 40 years, the proportion of diplegia decreased, while the proportion of hemiplegia increased. Approximately two thirds of the cases of hemiplegia date from pregnancy, the remaining cases result either from an illness, trauma at birth or catastrophe in infancy.
Children with spastic hemiplegia CP develop the ability to walk later in life and commonly walk on tip-toe because of their tight heel tendons. The affected limbs (arms and legs) are often thinner and shorter than those on the normal side, not because of a lack of use or spasticity but due to a retarded development whose cause is cerebral. Where the upper limb is affected, the arm will be held rigidly towards the center of the body, the forearm, wrist and fingers are bent and the thumb is pressed into the palm. The arm can usually become fixed and useless in that position. Sensory loss of the affected arm can be so severe that the person will use his unaffected hand (like in getting dressed) without ever resorting to using the affected limb for assistance.
While epilepsy is present in 20 – 40% of the general CP population; it is most common among hemiplegics, which may result in frequent fits or an occasional episode. Epilepsy that appears before the child is 3 years old is correlated with a poor prognosis for later intelligence.
Behavior problems common in hemiplegic children are hyperactivity and sudden unexplained aggressiveness nearly always associated with an abnormal EEG record and with epilepsy.
Hemiplegic children may have delayed language development and may be competent at best. This can be a result of mental retardation or be due to a specific impairment resulting from damage to the speech centers in the affected brain hemisphere.
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On an overall statistical basis, the brain damage associated with infantile hemiplegia depresses the patient’s I.Q. by 20 points. The damage in left hemiplegia is more severe than right, while in the general CP population there are more sufferers of right hemiplegia than left. It is recommended that a psychologist should always be consulted before decisions regarding schooling and employment are undertaken. Hemiplegic children are likely to display attention seeking behavior, temper tantrums, immaturity and overdependence, problems commonly associated with disabled children trying to complete with their peers.
Some children with spastic hemiplegia will develop an abnormal curvature of the spine. This can occur because of the child’s tendency to walk with the heel raised on the affected side (dorsiflexion). In order to walk the child is forced to keep his knee bent (flexed). This causes the hip muscles to move the leg away from the central line of the body, placing undue pressure on the hips, resulting in the scoliosis condition.
With dedicated therapy and stimulation all hemiplegic children should eventually be able to walk. They can and should be trained to use the affected hand as a helping hand in their general physical activities. While hemiplegic children may have specific perceptual difficulties, the vast majority can speak. All hemiplegic children should be watched by an experienced educator to give specific help to the child when needed.
In terms of employment opportunities, while the majority of hemiplegics with and without supervision can find productive and interesting work, placement statistics are higher for those who benefited from organized care and therapy.