What is hemiplegia?
Hemiplegia (sometimes called hemiparesis) is a condition that affects one side of the body (Greek 'hemi' = half). It is caused by injury to parts of the brain that control movements of the limbs, body, face, etc.
This injury may happen before, during or soon after birth (up to two years of age approximately), when it is known as congenital hemiplegia (or unilateral cerebral palsy). If this happens later in life as a result of injury or illness, it is called acquired hemiplegia. We also talk about a right or left hemiplegia, depending on the side affected. Generally, injury to the left side of the brain will cause a right hemiplegia and injury to the right side a left hemiplegia.
Hemiplegia is a relatively rare condition, affecting up to one child in 1,000. About 80% of cases are congenital, and 20% acquired. Hemiplegia affects each child differently.
You may be told that hemiplegia is a form of cerebral palsy, which is a descriptive name for a wider group of conditions in which movement and posture are affected owing to injury to the brain. These conditions are lifelong and non-progressive, which means they do not get worse. They may look different over time, partly because the child is growing and developing.
How does hemiplegia occur?
The causes of congenital hemiplegia are mostly unknown. Usually parents only become aware of their child's hemiplegia during infancy or early childhood as the child's difficulty with movement on one side gradually becomes obvious.
There is a higher risk in very premature babies and with multiple pregnancies, and it is unclear whether a difficult birth may be an occasional factor. But in most cases the injury occurs at some point during pregnancy, and researchers have, as yet, been unable to isolate any contributory factors. Some studies suggest that there could be an increased risk in communities where marriage between close relatives is common.
Parents often worry that they may be somehow to blame, but this is not the case as it would appear to be mostly a matter of chance. A research study on twins, where one twin has hemiplegia, suggests that nothing the mother (or father) did or didn't do during the pregnancy affected the child's hemiplegia.
Acquired hemiplegia results from brain injury. The most common cause is a stroke (when a bleed or blood clot damages part of the brain), but it can also result from a head injury or infection.
Hemiplegia and having another child
If your child has acquired hemiplegia, which results from damage to the brain during childhood, you have exactly the same risk as any other person of another child having hemiplegia - approximately one in 1,000. If, however, your child has congenital hemiplegia, your risk is slightly increased, although it is still extremely unlikely to occur. You can ask for a genetic test to determine whether there is any genetic reason for your child to have had a bleed, but there is only a 1-2% chance of this.
What are the effects of hemiplegia?
It is difficult to generalise: hemiplegia affects each child differently. The most obvious result is a varying degree of weakness, stiffness (spasticity) and lack of control in the affected side of the body, rather like the effects of a stroke.
In one child this may be very obvious (he or she may have little use of one hand, may limp or have poor balance); in another child it will be so slight that it only shows when attempting specific physical activities.
What does it feel like to have hemiplegia?
Most children say that their affected hand feels heavy, tense or tired and stiffer than the other side and that these feelings greatly intensify after exercise. Many feel hot or cold temperatures more acutely with the affected hand, although in others the feeling is so impaired that the child cannot tell the difference between the two temperatures.
Children sometimes say that when they touch something with their affected hand, it is as though that hand is wearing a very thin glove. Most children say that they forget their hand is there - which is when their hand closes into a tight fist. Very few, if any, children complain of pain, tingling or numbness in the affected limb.
Are there other problems associated with hemiplegia ?
Yes, there may be. Because hemiplegia is caused by injury to the brain, it is not just motor pathways and motor development that may be affected. And despite the developing brain's effort to relocate functions to undamaged areas, approximately half of children do have additional diagnoses.
Some of these additional diagnoses are medical in nature, such as epilepsy, visual impairment or speech difficulties. Many children have less obvious additional challenges, such as perceptual problems, specific learning difficulties or emotional and behavioural problems. Each child should be fully assessed and regularly monitored to identify if any of these associated problems are present.
As the child grows these difficulties may become more frustrating and disabling than the more obvious physical ones, but with multidisciplinary management their effects can be reduced.
Find out more about problems associated with hemiplegia.
How is hemiplegia treated?
Hemiplegia cannot be cured, but a lot can be done to minimise its effects and help children achieve their potential. Understanding hemiplegia and knowing how you can help your child achieve his or her potential is vital.
Make good use of the specialists dealing with your child's hemiplegia. Do ask them questions and make sure you understand their replies, if necessary asking them to repeat them using non- specialist terms.
Find our more about how hemiplegia is treated.
What does the future hold?
The most common questions we are asked are:
Will my child walk and talk?
Nearly all children with hemiplegia will eventually walk and talk, although they may be a little later than their peers. Many children with hemiplegia do a kind of 'bottom shuffle' instead of crawling, but this is very normal and just means trouser bottoms wear out instead of trouser knees!
Some children have other problems in addition to their hemiplegia, which may have an impact on walking and speech.
Will the hemiplegia get worse?
No, although as your child grows you may find that their hemiplegia affects more aspects of their development than is immediately obvious. Nor will it get better. Hemiplegia as a condition does not change much. However, its effects can be minimised with appropriate therapy.
Will my child go to a mainstream nursery and school?
Most children and young people with hemiplegia attend mainstream schools, with or without some extra support. It is essential to give teachers as much information as possible about your child and how best to help him or her.
Find out more about support in education.
In general, all children with hemiplegia have full bladder control but it might be slightly later than average. However, because of the difficulty some children have with undressing, they might have a lot of 'accidents' at the beginning. Trousers with elasticated waists make life easier for a child - see our information on dressing.
Many people with hemiplegia are able to drive a car, although they usually need automatic gears, power steering and steering and indicator adapters. They will not, however, be able to obtain a licence if they have epilepsy or severe eye problems. See our driving page for more information.
Support for your family
Life can be difficult for children and young people with hemiplegia who want to do the same things as other children. They tire more easily and the effort involved in simple tasks can be considerable. They need all the help and encouragement you can give them. And you need support in your turn - ideally from other parents and carers who understand how you feel and with whom you can also share ideas and information.