Call our free helpline0808 808 3555
Call our free helpline
0808 808 3555
Hemiplegia is caused by injury to nerve tissue in the brain. This
leads to a loss of control, especially in the limbs on the side
affected by the injury. Currently it is not possible to repair the
injury within the brain, but this doesn't mean that motor control
can't be improved. Most current surgery is directed towards
relieving the physical effects of the brain injury.
Hemiplegia can often affect the way children's affected limbs
grow, particularly the way muscles develop and, to a lesser extent,
bones too. This is most obvious the further along the limb we look,
away from the torso. For example, we often see the calf muscle in
the leg becoming tighter with growth and the child increasingly
walking on their toes. This is often more marked in children whose
muscles work poorly at the front of the leg.
These effects can be reduced with the use of physiotherapy
and ankle or foot
orthoses (splints). More recently, treatment with botulinum
toxin has been effective in improving leg and arm function for many
children. But when these treatments aren't helpful, it might be
necessary to think about surgical correction for better
In the arm, issues tend to be more obvious towards the hand. A
number of things can happen, for example:
Unlike children with other types of cerebral palsy, children
with hemiplegia very rarely develop more central problems such as
scoliosis or dislocation of the hip.
The difficulties that occur vary from child to child, depending
on the effects of their impairment. The most frequently seen issues
in the leg are:
Although cosmetic surgery may not sound terribly rewarding, it
is the appearance of their leg which is often the most distressing
to children. This is especially the case once they reach
adolescence and particularly as most children with hemiplegia have
very good use of their lower limb.
The problems seen in the leg are very different from those in
the arm. It is necessary to use both legs for walking and running,
and as these are repetitive patterns of movement, it is often
possible to achieve a high level of functioning even with a lot of
Unlike the lower limb, each arm can act independently and do
very complex and varied tasks. This requires a lot of feedback and
perception of the limb. In many children with hemiplegia, the
unaffected arm is preferred very strongly, with the affected arm
either not used at all or relegated to very simple tasks such as
clasping. And so, even if issues are corrected it is very unlikely
that this will result in improved function.
This means that the potential for upper limb surgery is very
limited compared to lower limb surgery. Upper limb surgery is
largely used to improve the appearance of the arm and hand.
However, in rare instances issues in the upper limb can give rise
to problems, such as a thumb digging into the palm. In these cases
surgery can relieve the irritation.
The surgical procedures used in hemiplegia are generally quite
straightforward and involve:
The most difficult aspect of surgery is deciding what surgeries
to perform and the best time to perform surgery.
Nowadays most surgery of this type is performed by orthopaedic
surgeons who specialise in the management of children. Gait
analysis is often used to study walking patterns and help decide on
the appropriate surgery. This involves attaching sticky markers to
the skin and using cameras linked to a computer to build up a three
dimensional picture of the child's movements. It's similar
technology that filmmakers use for actors to 'animate' creatures in
films like King Kong, Lord of the Rings or Narnia. It also uses
instruments in the ground to measure the forces involved, and
electrodes can be used to measure the activity in the muscles.
Timing of surgery is important. If done at an early age when
there is a lot of growth left, the original issue can come back. If
the surgery is done when the child is mature, problems can be quite
difficult to correct and rehabilitation can be difficult.
Generally the best time is when the child is between six and 11
years old, but it might be necessary to perform surgery earlier
than this if impairments are quite severe. There is a large window
of opportunity, so the surgery can be timed to fit in best with
other considerations such as schooling and availability of
Orthopaedic surgery in hemiplegia usually requires an inpatient
stay in hospital, the length depending on the extent of surgery. In
recent years there have been considerable advances in the
management of pain, with the use of regional blocks (such as
epidurals) and the use of patient-controlled pumps for
post-operative pain. Most surgery can now be performed without any
After surgery, it is often necessary to immobilise the area in a
plaster cast, generally for about six weeks. It may then be
necessary to use splints to ensure that the correction that was
achieved at the time of surgery is maintained.
Rehabilitation after surgery is critical. Without good
physiotherapy, problems can come back. The rehabilitation period
often takes quite a long time, and it may be a year or longer
before the full benefits are seen.
This all means that before surgery your child's medical team
should make a plan to identify the resources that will be needed
for rehabilitation. There is not much point in doing surgery if it
is then going to take four or five months to get new splints or
there is no physiotherapist available.
Surgery will be very helpful for many children with hemiplegia
at some stage in their lives, but it needs to be part of a whole
package of care to ensure that they are able to achieve their full
See also HemiHelp's information sheets on
AFOs/DAFOs and Upper