Hemiparesis | Training And Re-education Of Muscle Weakness By Physiotherapy

Hemiparesis is a condition, in which there is weakness on one side of the body that can occur due to the secondary effect of injury to the central nervous system. Because of this, the treatment of this condition involves engaging the central nervous system's natural ability to heal itself. For this process, the neural pathways are created, reorganized, and strengthened. This blog helps to explain how this technique works through physiotherapy. The physiotherapist helps individuals with hemiparesis to improve their movements by doing repetitive and consistent exercises on their weakened sides. We have discussed below, the effect of physiotherapy exercises on the central nervous system.

Hemiparesis

Hemiparesis is most commonly caused by a stroke, in which, the supply of blood in the brain becomes disrupted, which causes brain cells to die. This process can affect the areas of the brain responsible for movement, it can cause issues with motor control such as hemiparesis (weakness on one side of the body) or hemiplegia (paralysis on one side of the body).

Each hemisphere of the brain controls the movement of the body on the opposite. Therefore, hemiparesis typically affects the side of the body opposite to the side of the stroke, whereas some strokes or brain injuries can cause muscle weakness on the same side as the injury, which is called ipsilateral hemiparesis. Movement is not only controlled by the motor cortex but other areas of the brain, such as the cerebellum, that play a role in the ability to move. As a result, there is an increased risk of a stroke or brain injury affecting an area of the brain that contributes to the movement. Other conditions that can cause hemiparesis are cerebral palsy, brain injury, or other diseases that affect the nervous system or brain such as cancers or tumors. Though these causes are less common but still are prevalent.

Effect of Physical Therapy Exercises on Neuroplasticity

The central nervous system has the capability to heal itself through the phenomenon of neuroplasticity.

Neuroplasticity occurs based on demand ie the task that is practiced most frequently are the neural pathways that will be the strongest. This is why everyday tasks like combing, eating, tying shoes eventually become thoughtless. Because of practicing the task a thousand times, the neural pathways for that skill become very strong.

Hemiparesis involves neuroplasticity which helps the brain to create and strengthen new pathways that control movement. The stronger these pathways become, the more strengthened and coordinated movement the individual will have with their affected side.

Physiotherapy is such therapy that focuses on neuroplasticity and is crucial for helping survivors regain movement. This is important to regain independence and therefore helps to accomplish the daily activities.

Physiotherapy for Hemiparesis

Physiotherapy aims to rehabilitate the nervous system, though hemiparesis recovery is a long process. Neuroplasticity does not occur overnight, it requires repetitive training and a consistent rehabilitation program to keep the recovery going. Physiotherapy helps to restore optimal functioning. The physiotherapist understands how to design exercises with an optimum challenge for patients with hemiparesis to target their affected limbs.

Physiotherapy helps to retrain the affected limbs by repetitive exercises. The more the individual moves their affected side, the more neuroplasticity occurs in response.

As a result the individual gains independence for daily activities like eating, dressing, bathing, etc. Functional training is given such as lifting a spoon, holding things, and placing them back down. Compensation techniques are also taught to the individual to accomplish difficult tasks by using shortcuts and to help him/her navigate their new life. If the individual continues to exercise their affected side regularly, only then they can continue to maximize their chances of motor recovery.

Repetitive Practice

Neuroplasticity occurs based on frequency and consistency. For engaging neuroplasticity repeating skilled movements with the weakened side is essential.  The more the task is being practiced, the better the movement becomes. This is referred to as massed practice and it's essential for hemiparesis recovery.

Home Exercise Programs

Home exercise programs become important, as they can help individuals to improve by practicing exercises with massed practice at home.

Depending on the frequency of the physiotherapy sessions, physiotherapists suggest practicing home exercise programs to build upon the skills that have been learned in physiotherapy sessions. To optimize neuroplasticity and functional recovery, it is essential to continue practicing outside of therapy sessions.

Constraint-Induced Movement Therapy

Constraint-Induced Movement Therapy (CIMT) is a treatment that involves restraining the unaffected side while exercising the affected side for10-15 consecutive weekdays each day the exercises are done for several hours. CIMT is most commonly used for affected arms/hands and involves the affected lower extremities as well. Being more aggressive therapy in the volume, it shows great improvement.

Mirror Therapy

This therapy uses a mirror that is placed over the hemiparetic arm or leg. Then, the individual performs exercises with the stronger arm or leg while watching the moving image in the mirror. This image in the mirror tricks the brain into thinking both arms or legs are moving, which helps spark neuroplasticity.

Electrical Stimulation

Electrical stimulations are applied to the muscles through pads on the skin, this stimulates movement on the weakened muscles. For example, if an individual has a weak hand or wrist movement, the physiotherapist can apply electrical stimulation, which helps flex and extend the wrist, depending on the placement. For maximum results, these stimulations can be combined with task-related training.

Mental Practice

Mental practice is a cognitive treatment that requires no movement at all it helps activate neuroplasticity. It involves mentally rehearsing specific activities to improve the performance of those activities. An individual with hemiparesis is asked to spend time mentally rehearsing their exercises before actually performing them.

There is no specific time period for recovery, it can be challenging to predict neurological recovery time, as each person's brain is wired differently, which makes recovery after every neurological injury unique.