What is hemiplegia?

12 mins read

Hemiplegia is a condition, caused by a brain injury, that results in a varying degree of weakness, stiffness and lack of control in one side of the body. On this page we explain how hemiplegia occurs, what its effects are, and how it is treated.

In this article

What is hemiplegia?

Watch our short animation to learn more about what causes hemiplegia, how it affects children, and what treatments and other support are available.

Childhood hemiplegia (sometimes called hemiparesis) is a condition caused by damage to the parts of the brain or spinal cord (the central nervous system) that control movements of the limbs, trunk, face, and so on. It affects one side of the body – the name comes from the Greek words hemi, which means half, and pleges, which means stricken. Because the nerves coming down from the brain to control the movement of the body cross sides, an injury to the left side of the brain will cause a right hemiplegia and an injury to the right side will cause a left hemiplegia.

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 (see below).

How common is Hemiplegia?

Hemiplegia is a relatively common condition, affecting up to one child in 1,000. About 80% of cases are congenital, and 20% acquired.

Will my child get worse?

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?

Congenital hemiplegia

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 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 congenital hemiplegia appears 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

This is the name given to hemiplegia which occurs later in childhood (or adulthood) as a result of injury or illness. 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. A health professional will talk you through any underlying cause.

What are the effects of hemiplegia?

It is difficult to generalise about the effects of hemiplegia because it affects each child differently.

The most obvious effect is the type of movement disorder that is visible. There may be a varying degree of weakness, stiffness (spasticity) and lack of fluid control (dystonia/dyskinesis) on the affected side of the body, rather like the effects of a stroke. In one child this may be very evident: 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.

The challenges children and young people with hemiplegia face means they can become very tired, which can affect their learning and their social interaction as well. It may also have a knock on effect on family life: tearfulness, silences, irritability and anger issues are all possible reactions to basic exhaustion, and your child may need time and space to chill out and recharge their batteries.

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.

What can be done to help?

Hemiplegia cannot be cured, but a lot can be done to minimise its effects and help children achieve their potential. The developing 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. Neuroplasticity means that with help from professionals, the brain may be able to ‘re-wire’.

Your child, once diagnosed, 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 will work in partnership with you to develop your child’s abilities as part of a wider network of professionals. This may include:

In children and young people with hemiplegia, the area of the brain affected does not necessarily predict which side of the body will be affected and which functions will be problematic.

How can I help my child?

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:

Parents have told us that it also helps to make a list of questions to ask before they go to appointments. It can also be helpful to have a friend or relative come along to appointments, as they can help make sure you ask all the questions on your list and take notes for you.

Find our more about how hemiplegia is treated.

Therapy your child may be offered

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 parents and carers, to agree a programme of management with specific goals that are tailored to the child’s development and needs.

The aim will be to improve the child’s participation in everyday activities, for example play, feeding, dressing, school life.

The therapists will work to develop the child’s skills, assessing posture and providing muscle stretching, and possibly strengthening activities. This will help prevent possible secondary consequences of hemiplegia such as pain or the development of abnormal shortening of the muscles (contractures).

Involving parents and children in therapy

Therapy goals could include improving function so that the child can grasp an object with the affected hand, or walk more confidently. They should take into account:

A therapy programme will probably include training parents/carers, and later the child him/herself, to carry out exercises or techniques which they should continue to use at home, for example during dressing or bathing, so that they become part of the child’s everyday life.

Other treatments your child may be offered

The child’s 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:

Are there other issues 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. Others are developmental and functional such as slower continence.

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 a 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.

Living with hemiplegia – what does the future hold?

It can be a huge shock to get a diagnosis of hemiplegia. 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. He or she will often adopt a ‘wait and see’ approach, which parents may find difficult to accept, since they may feel they are not being given all the facts.
Understanding hemiplegia and knowing how you can help your child achieve his or her potential is vital.

In general you should treat a child with hemiplegia 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.

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.

For children with hemiplegia school is much more tiring than for the average pupil. As the school day goes on, fatigue may have an effect on all activities, and may trigger tears or irritability. It’s helpful to talk to your child’s teacher so they are aware of this: you may be able to arrange for them to have somewhere to go for a short rest if they show signs of being tired.

Will my child be able to drive?

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.

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.

Support for people with hemiplegia and their families

Life can be a challenge 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 can share ideas and information.

We have lots of advice and support on our site, from finding a local support group, accessing social care services, benefits and money help, and more.

Download our factsheet What is Hemiplegia?