How is hemiplegia treated?
When a child is first diagnosed, it is often difficult for a doctor to predict whether problems will be mild or severe later in life. They will often adopt a 'wait and see' approach, which parents can find difficult to accept if feel they are not being given all the facts.
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.
You just been told your child has hemiplegia
Once diagnosed, your child 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.
Your GP will of course continue to deal with your child's normal, ailments, but more specialised care will be provided by paediatricians at the CDC. Some CDCs run parents groups where you can meet and share experiences with other families.
The multidisciplinary approach
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 you to agree a programme of management with specific goals that are tailored to your child's development and needs.
The aim will be to improve your child's participation in everyday activities e.g. play, feeding, dressing, school life. The therapists will work to develop your child's skills, assessing posture and providing muscle stretching, and possibly strengthening activities. This will help prevent possible secondary consequences of the condition such as pain or the development of contractures (abnormal shortening of the muscles).
Goals could include improving function so that, for example, your child can grasp an object with the affected hand, or walk better. They should take into account you and your child's views, the time and effort involved in carrying out therapy activities, the impact on the child and his or her family and how effective the activities might be.
A therapy programme will probably include training you, and later your child him/herself, to carry out exercises or techniques which they should continue to use at home, e.g. during dressing or bathing, so that they become part of their everyday life. Their progress should be reviewed regularly to assess how well the therapy programme is working and consider whether there is a need for other treatments as well. These might include orthoses (devices, such as splints, fitted to the body to improve posture and/or function); drugs such as baclofen; Botulinum Toxin injections or orthopaedic surgery.
Children with hemiplegia often have difficulties with speech and communication. Speech and language therapists work with people to maximize the ability to communicate.
In general a child with hemiplegia should be treated as normally as possible. It is essential to involve the affected side in play and everyday activities, to make your child as "two-sided" as he or she can be. As they get older, many children and young people with hemiplegia can be encouraged to develop more use of their affected side through involvement in their chosen sports and hobbies.
Find out more about hemiplegia treatments
Receiving a diagnosis that your child has hemiplegia is a critical event.
Physiotherapists work on balance, weightbearing on the affected side and developing sensitivity in the affected hand.
Occupational therapy uses play, adaptive and work activities to develop children's motor, cognitive, perceptual and self care skills.
Foot Splints or Orthoses (AFOs)
Splints, or orthoses, can help to manage walking patterns in children with hemiplegia.
Splinting of the arm, shoudler, elbow, wrist or hand.
Surgery can correct some of the physical effects of neurological damage in children with hemiplegia.
Botulinum Toxin injections can be used to treat hemiplegia as part of a movement therapy programme.