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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.
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.
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.
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
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
& 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.