Friday, November 18, 2016

Hemiplegia & the OT role

There are several types of paralysis that can happen in the body, hemiplegia being one of them. Hemiplegia is a paralysis of one side of the body and includes the upper limb, one side of the trunk, and the lower limb (Snell, p. 168). "Hemi": half, "plegia": paralysis or stroke.
According to the CHASA (Children's hemiplegia and stroke association), hemiplegia is a type of Cerebral Palsy which comes from damage to the part of the brain that controls muscle movements. Causes include but are not limited to CVA's or a stroke, TIA's, head trauma, intraventricular hemorrhage of the newborn, infections, brain tumor, Todd's paralysis, and many more.

*Cerebral Palsy: a condition caused by injury to the parts of the brain that control our ability to use our muscles and bodies. It often happens before birth, during delivery, or soon after being born. CP can be mild, moderate, or severe. According to the CDC< CP occurs in 1 in every 300 children. 
Symptoms of Hemiplegia in a child: they could have stiffness/weakness in muscles on ONE side of the body, only using one hand during play or favoring one hand before the age of 3 years old, keeping on hand in a fist, difficulty with balance and walking, difficulty with fine motor tasks, delay in developmental milestones. 
There is currently no cure for hemiplegia however therapies can help tremendously to support the functions of a person. The occupational therapy role for children with hemiplegia: to help improve their ability to perform tasks in their everyday life activities which include school activities, play, dressing skills, and so on. Specifically OT's can help with hand function/strengthening for the affected limb, modifying equipment in the classroom or at home, and splinting. 

A lot of children may have problems with their finger movements, and grasping and releasing objects on the affected hand, and possibly atrophy of the hand/arm. I currently have a child on my caseload with hemiplegia and wanted to research different wants to support him to use his affected hand and develop the skills to grasp and release toys on a functional level. 

1. Stretching is important to improve and support movement in the upper extremity to prevent further stiffness. 
-Unilateral reaching to support lengthening of affected side 
-Passive range of motion exercises: "the benefits of mobilization include maintenance of joint lubrication, prevention of secondary orthopedic problems, maintenance of soft-tissue length, and possible reduction of spasticity by acting on the nonneural components of spasticity (Gillen, p. 460)."

2. Sensory activities to the affected upper extremity 
-Weight bearing activities 
-Refrigerated cookie dough: child has to make a ball with both hands and (grasping) and then release it onto baking sheet 
-Waving bubble wands 
-Stirring with affected hand (e.g. stirring in a sensory bin)

3. Support bilateral play so that the child has to use both hands 
-Opening boxes, bags of food/toys/candy 
-Scrunching paper together with both hands
-Pushing something with both hands (e.g. a box, laundry basket, a scooter)
Teeter Popper: support bilateral integration and coordination, grasp, balance, and sensory input (popping noise, rocking movement). Found for $34.95 on Amazon. 

*A short video I found helpful on hemiplegia made by to address what hemiplegia is and how it may affect a person's life. 

Gillen, Glen. Stroke Rehabilitation. A Function-Based Approach. 4th ed., St. Louis, Elsevier, 2016, p. 460. 
Snell, Richard S. Clinical Neuroanatomy. 7th ed., Baltimore, Lippincott Williams & Wilkins, 2010 p. 198. 

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