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Understanding Hemiplegia: Paralysis of One Side of the Body

physiotherapist helping patient with hemiplegia use stationary bike

Hemiplegia is a neurological condition that involves paralysis of one side of the body. Hemiplegia is a secondary effect of certain medical conditions that damage the nervous system such as stroke, brain injury, or cerebral palsy. Sometimes, this affects the way people move, walk, or care for themselves.

Because of this, individuals with hemiplegia often rely on assistive devices, such as wheelchairs, and the help of caregivers to carry out daily tasks. Fortunately, regaining movement is often possible thanks to the nervous system’s ability to rewire itself.

To help you understand the symptoms and treatment methods for hemiplegia, this guide will discuss:

Hemiplegia Definition

Hemiplegia is a condition caused by damage to the nervous system that results in paralysis of one side of the body. It can cause difficulty moving the lower part of one’s face, arm, and leg on the right or left side of the body.

Types of Hemiplegia

One of the most common causes of hemiplegia is stroke. When a stroke occurs, the supply of blood in the brain is compromised and causes brain damage.

Other neurological conditions that can cause hemiplegia are brain injury, spinal cord injury, and cerebral palsy. Hemiplegia in individuals with cerebral palsy is congenital, meaning that it is caused by damage to the brain before, during, or shortly after birth.

Here are the possible types of hemiplegia:

Contralateral hemiplegia

The brain is divided in two hemispheres, each controlling movement on the opposite side of the body. This is the phenomenon behind contralateral hemiplegia, which refers to paralysis on the side of the body that’s opposite to the side where the brain damage occurred.

A person with right hemiplegia experiences paralyzed muscles on the right side of the body after injury to the left hemisphere of the brain. A person with left hemiplegia experiences paralyzed muscles on the left side of the body after right hemisphere injury.

Spinal hemiplegia (ipsilateral)

Unlike the brain, each side of the spinal cord controls movement on the same side (ipsilateral) of the body. After spinal cord injury, right hemiplegia describes paralysis on the right side of the body after injury to the right side of the spinal cord whereas left hemiplegia reflects paralysis on the left side of the body after injury to the left side of the spinal cord. This is also referred to as Brown-Sequard syndrome.

Spastic hemiplegia

Spastic hemiplegia refers to a type of hemiplegia that is common with cerebral palsy. Spastic hemiplegia affects movement one side of the body opposite to the side of the brain that was injured before, during, or shortly after birth. It is the most common type of cerebral palsy, and the arm is usually more affected than the leg.

The term ‘spastic’ refers to a condition called spasticity, which involves stiff, involuntarily-contracted muscles. Individuals with spastic hemiplegia demonstrate stiff movements while individuals with flaccid hemiplegia experience loose, floppy muscles on the affected side.

Facial hemiplegia

Facial hemiplegia refers to paralyzed muscles on one side of the face. It can occur on its own or in conjunction with hemiplegia elsewhere in the body, like the arm and/or leg.

One of the hallmark signs of a stroke is facial drooping on half of the face. Facial hemiplegia is often temporary and goes away once the stroke has been treated and normal blood flow in the brain has been restored. However, in some cases, it may persist for individuals with facial hemiplegia.

Hemiplegia Symptoms and Signs

Because hemiplegia is a neurological condition, the symptoms vary based on the characteristics of the injury. Some factors that impact the symptoms involve the size and location of the injury.

For example, a spinal cord injury only impairs movement below the level of injury while a brain injury can impair movement anywhere on the affected side, ranging from the face to the arm to the leg.

Every neurological injury is unique and therefore every individual with hemiplegia experiences different characteristics. Some of these signs and symptoms can include:

  • Paralysis of the arm, leg, and/or lower face on the affected side
  • Difficulty with walking and balance
  • Loose, floppy muscles (flaccidity) on the affected side
  • Stiff, rigid muscles (spasticity) on the affected side
  • Delay in developmental milestones for children with spastic hemiplegia

Hemiplegia is a secondary effect of a primary neurological injury. Individuals with a primary injury involving stroke or brain injury may also experience other secondary symptoms such as:

Hemiplegia does not cause these signs or symptoms directly. Rather, they are complications of the primary neurological injury.

Hemiplegia Treatment

Treatment for hemiplegia occurs in two phases. First, the primary neurological injury is treated, if possible. For example, when a stroke occurs, initial treatment involves stopping the stroke and restoring normal blood flow in the brain.

The second phase of hemiplegia treatment involves healing the nervous system and encouraging it to rewire itself. This is possible through neuroplasticity, which is the nervous system’s ability to create, strengthen, and reorganize neural pathways.

After an areas of the brain becomes damaged, neuroplasticity allows unaffected areas of the brain to take on the function of movement. For spinal cord injuries, neuroplasticity allows neural pathways in the spine to be reorganized and rewired — although this is only possible if the spinal cord was not completely severed (complete spinal cord injury).

Neuroplasticity is strengthened through experience and repetition. When movement is practiced, for example, that experience encourages the nervous system to create and strengthen neural pathways responsible for that movement. Through experience and repetition, individuals with hemiplegia may be able to regain movement in the paralyzed side. This is why exercise is a staple of hemiplegia treatment (more on this later).

Not all individuals can regain movement, but it’s possible for many. Regardless of the individual’s prognosis, every neurological injury is unique, which means that even when the odds are not favorable, recovery might still be possible. No one knows the true outcome of any single neurological injury. Therefore, the only way to know how much movement a person can recover is to pursue rehabilitation and see what happens.

Rehabilitation Methods for Hemiplegia

Up next, you’ll discover various rehabilitation methods that may help improve hemiplegia. Each rehabilitation method involves exercise because experience and repetition is how neuroplasticity is activated.

Rehabilitation exercise

Rehabilitation exercises are designed to help rewire the brain through repetition. When therapeutic movements are practiced with good form, it helps stimulate neuroplasticity and encourage better movement patterns.

Passive exercise

Individuals with hemiplegia may struggle to perform rehabilitation exercises due to limited strength or range of motion. This is where passive exercises can help. During passive exercise, the targeted muscle group is assisted through the exercise with help from a therapist or trained caregiver.

Even though the individual is not actively creating this movement, the passive movement helps stimulate the brain and spark neuroplasticity, particularly when attention is paid to the movement. If an individual performs passive exercise while watching television, for example, it won’t have the desired effect.

Physical therapy

Physical therapists specialize in restoring movement in the body. Individuals with hemiplegia can greatly benefit from working with a physical therapist to practice specific rehabilitation exercises that target their unique needs.

Occupational therapy

Occupational therapists specialize in improving a person’s ability to perform the activities of daily living such as feeding and getting dressed. Occupational therapy can help individuals with hemiplegia learn adaptive techniques to accomplish daily activities as well as exercises that help target those movements.

Assistive devices

Individuals with hemiplegia are at a greater risk of falling, particularly if leg function and balance is affected. It’s always a good idea to consult with a physical and/or occupational therapist to get recommendations for assistive devices such as canes, walkers, or wheelchairs to help improve your safety as you carry out daily activities.

Mental practice

Mental practice, or mental imagery, involves visualizing yourself practicing the activity that you want to improve. Studies have shown that visualizing movement sparks changes in the areas of the brain that contribute to movement such as the motor and premotor areas.

Mental practice can be done anytime and anywhere, even from your bed. The accessibility of this therapy makes it a great fit for individuals with hemiplegia. To see the best results, individuals can mentally rehearse their rehabilitation exercises before actually practicing them. Studies have found that combining mental practice with physical practice leads to better results than physical practice alone.

Electrical stimulation

When hemiplegia makes voluntary movement difficult, electrical stimulation can help bring movement into the affected muscles. It works by applying electricity to the affected muscles through pads affixed to the skin. Never attempt to do electrical stimulation by yourself without first consulting with a therapist and receiving training, if appropriate.

Electrical stimulation makes a great treatment for hemiplegia because it helps bring movement into the affected side, which helps spark neuroplasticity. As with all hemiplegia treatments, use this therapy in conjunction with rehabilitation exercises for the best results.

Electrical acupuncture

Acupuncture is an alternative treatment that involves inserting thin needles into specific “acupoints” on the body. Sometimes electrical stimulation can be applied to these needles after they are inserted; and sometimes electrical stimulation pads can be affixed to the specific acupoint instead of a needle.

One study found that electrical acupuncture helped improve hemiplegia when using the latter technique (applying e-stim through pads affixed to specific acupoints) combined with traditional rehabilitation exercises.

Sensory retraining

If an individual with hemiplegia also struggles with sensory changes, like numbness or “pins-and-needles” sensations, they may benefit from a rehabilitation technique called sensory retraining. This therapy attempts to retrain the brain to improve its ability to process sensation by practicing different exercises that stimulate sensation.

Modified constraint-induced movement therapy

Modified constraint-induced movement therapy (mCIMT) involves restraining the non-affected side to encourage use of the affected side. For example, an oven mitt can be placed on the non-affected hand to encourage use of the affected hand.

This type of therapy is considered aggressive and potentially frustrating to the person with hemiplegia. Therefore, it’s important to use this therapy to the point of challenge but not frustration.

One study found that mCIMT led to better results than traditional therapy alone. It’s worth noting that each individual participated in nearly 6 hours of therapy per day, which is twice the amount of therapy given during inpatient rehabilitation.

Exercises for Hemiplegia

As you can see, every treatment for hemiplegia involves some form of exercise because it’s the key to improving movement after neurological injury. Here are some types of hemiplegia exercises your therapist may recommend:

Passive exercises

Passive exercises can be accomplished in a variety of ways. For hand exercises, for example, individuals can use their non-affected hand to assist their affected hand through the exercise. However, heavier limbs like the leg require help from a therapist or caregiver to passively practice rehab exercises.

hand palm-down on a table for passive hemiplegia exercise
hand flipped over for passive hemiplegia exercise

One example of a passive exercise for the hand is “palm up and down.” During this exercise, you can place your affected hand on a table and then use your non-affected hand to turn your palm up and down. Pay close attention to the movement to maximize neuroplasticity.

See more hand therapy exercises »

Strengthening exercises

Individuals with hemiplegia are at greater risk of muscle atrophy (when the muscles shrink and waste away) due to nonuse. Therefore, individuals with hemiplegia can try weight-bearing exercises to help strengthen the muscles on the affected side.

OT in starting position for cane lean stretch
OT leaning to the left with the cane

One example is the “cane lean” exercise. Start by placing your affected hand on a cane and then place your non-affected hand on top for stability. Then, gently and safely lean into the affected side. This weight bearing helps stimulate the affected side.

Stretching exercises

Individuals with hemiplegia can also benefit from stretching exercises, especially if spasticity is involved. Some examples include a forearm stretch and wrist stretch.

occupational therapist demonstrating forearm stretch

During the forearm stretch, place your hands in your lap and then interlace your fingers. Then bend your wrist to stretch your affected arm palm-side up.

occupational therapist demonstrating wrist stretch for hemiplegia

For the wrist stretch, keep your fingers interlaced and then gently bend your affected wrist. Never stretch to the point of pain.

If you’re looking for suitable exercises for hemiplegia, your therapist is a great resource. They know how to choose suitable exercises that target your unique needs.

You can also browse through our library of rehabilitation exercises and adapt them for hemiplegia by practicing them passively. It’s a good idea to get one-on-one time with a therapist and then practice specific exercises on your own at home.

Improving Movement with Hemiplegia

Hemiplegia involves paralysis on the right or left side of the body, often after injury to the brain or spinal cord. Treatment involves rewiring the brain through repetitive exercises.

While exercise is one of the best rehabilitation methods, you can enhance your results by combining traditional therapy with other modalities such as electrical stimulation and mental practice.

Every neurological injury is unique, which means that every individual can benefit from a unique therapy plan. Work closely with your therapists and try to be as consistent as possible with your exercises. This will help maximize chances of regaining movement with hemiplegia.

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Get Inspired with This Stroke Survivor Story

Mom gets better every day!

When my 84-year-old Mom had a stoke on May 2, the right side of her body was rendered useless. In the past six months, she has been blessed with a supportive medical team, therapy team, and family team that has worked together to gain remarkable results.

While she still struggles with her right side, she can walk (with assistance) and is beginning to get her right arm and hand more functional. We invested in the FitMi + MusicGlove + Tablet bundle for her at the beginning of August.

She lights up when we bring it out and enjoys using it for about 20 to 30 minutes at a time. While she still doesn’t have enough strength to perform some of the exercises, she rocks the ones she can do!

Thanks for creating such powerful tools to help those of us caring for stroke patients. What you do really matters!

David M. Holt’s review of FitMi home therapy, 11/09/2020

5 stars

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