Pediatric Orthopedic Surgeons treating a Broken Wrist

HEMIPLEGIC GAIT

Hemiplegia is a symptom that involves one-sided paralysis and affects either the right or left side of the body. It happens because of brain or spinal cord injuries and conditions. Stroke is the primary cause and the result causes a Hemiplegic Gait.

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Hemiplegic Gait

Hemiplegia is a symptom that involves one-sided paralysis and affects either the right or left side of the body. It happens because of brain or spinal cord injuries and conditions. Depending on the cause, hemiplegia can last temporarily or permanently. The most common cause of hemiplegia is stroke, which damages the corticospinal tracts in one hemisphere of the brain. Hemiplegia patients show a spastic extension of the lower limb and flexion of the upper limb.

This gait is caused by ineffective flexor muscle control during the swing phase of walking. When combined with the stiffness of the extensor muscles, the gate is referred to as a hemiplegic gate. These muscles normally stretch the afflicted leg. Additionally, it causes an abnormal first point of contact during stance at the forefoot or lateral border of the foot. The knee is inflexible during the swing and hyperextended during the stance.

The normal hip and knee swing as well as leg circumduction are compromised in a hemiplegic gait. Hemiplegia causes reduced motor control and a changed range of motion at the joints because of paralysis, weakness, and spasticity. In addition to exhibiting weakness, the Gluteus maximus, quadriceps, and plantar flexors begin to exhibit spastic reactions to rapid stretching. In eight out of ten stroke survivors, hemiparesis is present. If your child has it, he or she could find it difficult to stand up, walk, or keep his or her balance. On their weaker side, your child might also experience numbness or tingling.

Analyzing the Hemiplegic Gait

Although doctors can identify hemiplegic gait abnormalities, quantifying these changes allows doctors to better understand stroke-related gait aberrations. Following a stroke, patients with hemiplegic gait often walk with slowed down and asymmetrical steps, shorter stance and single support times on the afflicted side, altered joint kinematics, and overall asymmetry in many of the quantifiable parameters. Insights on therapies that enhance gait quality, prevent possible joint injury, and reduce falling, will quantify these parameters.

To measure temporal-spatial metrics including gait speed, step length, and stance time, the Zeno Walkway System is frequently utilized. To determine dependence on the unaffected limb, doctors and scientists examine the center of pressure during stance and single support. Doctors can compute and quantify joint kinematics and dynamics during the gait cycle. Doctors use a 3-dimensional camera-based system to conduct the analysis.

These well-established gait metrics then compare data with normative data to determine the degree of impairment. Over time doctors will use the measurements to quantify treatment effects and compare walking settings to those previously collected. This method will identify the best treatments to improve walking, such as with or without an assistive device or brace.

QUESTIONS AND ANSWERS

What causes a hemiplegic gait in children?

Underlying neurological conditions will cause a hemiplegic gait in children and affect one side of the body. Some common causes include:

Cerebral Palsy: Hemiplegic cerebral palsy refers to a neurological disorder that results from damage to the brain’s motor control areas. It often leads to muscle weakness or paralysis on one side of the body, affecting walking patterns.
Stroke: Children can experience strokes, which can lead to hemiplegia and result in an abnormal gait pattern.
Brain Injuries: Traumatic brain injuries or other brain disorders may cause weakness or paralysis on one side of the body, leading to a hemiplegic gait.
Other Neurological Conditions: Some rare genetic or acquired neurological conditions can also result in hemiplegia and a corresponding gait abnormality.

How is a hemiplegic gait in children managed and treated?

- The management and treatment of a hemiplegic gait in children typically involve a multi-disciplinary approach that addresses both the underlying condition and functional mobility. Common approaches include:
  - Physical Therapy: Physical therapy plays a crucial role in improving mobility and gait patterns. Therapists work with children to strengthen muscles, improve balance, and teach compensatory strategies for walking.
  - Orthotic Devices: Some children may benefit from orthotic devices like braces or ankle-foot orthoses (AFOs) to provide support and stability during walking.
  - Assistive Devices: In some cases, doctors will recommend assistive devices such as canes, walkers, or crutches to help children maintain balance and reduce the risk of falls.
  - Constraint-Induced Movement Therapy (CIMT): Doctors will recommend this therapy to encourage the use of the affected limb by restraining the unaffected limb, promoting motor recovery and functional use.
  - Medications: Depending on the underlying cause of hemiplegia, doctors may prescribe medications to manage symptoms or reduce spasticity in the affected muscles.
  - Surgery: In certain cases, doctors will recommend surgical interventions such as tendon lengthening to improve muscle function or joint alignment.

The specific treatment plan will depend on the child’s age, the underlying condition, and the severity of the hemiplegic gait. It’s important for children with a hemiplegic gait to receive comprehensive care from a team of healthcare professionals, including physical therapists, occupational therapists, and pediatric specialists, to optimize their mobility and overall well-being.

What are the potential long-term effects and challenges for children with a hemiplegic gait?

Children with a hemiplegic gait may face several long-term effects and challenges, depending on the underlying cause and the effectiveness of their treatment. Some common considerations include:

- Muscle Imbalance: Prolonged muscle weakness or spasticity on one side of the body can lead to muscle imbalances and joint contractures, which may require ongoing management to prevent deformities.
- Functional Limitations: Depending on the severity of the hemiplegic gait, children may have difficulty performing certain tasks, including activities of daily living, recreational activities, or participation in sports.
- Social and Psychological Impact: Living with a hemiplegic gait can have a social and psychological impact on children. They may face challenges related to self-esteem, body image, and peer interactions.
- Educational Needs: Some children with hemiplegic gait may require educational support and accommodations to address any physical limitations in the classroom.
- Transition to Adulthood: As children with hemiplegic gait transition into adulthood, they may need continued medical and rehabilitative care to maintain mobility and independence.

Early intervention, ongoing therapy, and a supportive environment can help mitigate some of these long-term challenges and improve the overall quality of life for children with a hemiplegic gait. Parents should regularly follow up with healthcare providers and specialists to monitor progress and adjust treatment plans as needed.

Walking differently can indicate a medical indication that something is wrong. Make an appointment with one of our pediatric orthopedists to ensure everything is fine.

Hemiplegia — Does it Go Away?

Furthermore, hemiplegia can result in medical issues including seizures, speech difficulty, and vision impairment. Unfortunately, a cure for hemiplegia does not exist, but it doesn’t get worse over time, and undamaged parts of the brain often can take over many of the functions of the damaged parts. Basically, it does not progress — with assistance, symptoms of the affliction can get better.

Hemiplegia a Complex Condition

Hemiplegia is more than just a physical condition, which makes the situation complex. With newborns, It occurs because of brain damage, typically before or shortly after birth. The side of the body opposite the affected side of the brain experiences weakness and loss of control, similar to the symptoms of a stroke.

Hemiplegic Treatments

The treatment plan for a child with hemiplegic gait is multifaceted and doctors will tailor treatment to the individual child’s needs. Hemiplegic gait is often associated with neurological conditions such as cerebral palsy or the after-effects of a stroke. The primary goals of treatment are to improve mobility, functional independence, and overall quality of life. Here is a detailed report outlining the treatment components for a child with hemiplegic gait:

Diagnosis and Assessment:

The treatment process begins with a comprehensive evaluation and diagnosis by a team of healthcare professionals, including pediatric neurologists, physical therapists, and occupational therapists.
Medical imaging such as MRI or CT scans will assess the extent of brain damage or identify the underlying cause.
The child’s medical history, developmental milestones, and any associated medical conditions are thoroughly reviewed to create a personalized treatment plan.

Physical Therapy:

Physical therapy is a cornerstone of treatment and focuses on improving the child’s physical abilities and mobility.
Therapists work to strengthen weakened muscles on the affected side and improve balance and coordination.
Gait training is a crucial component of physical therapy, with the goal of achieving a more natural and functional walking pattern.
Range of motion exercises and stretching help prevent muscle contractures and joint stiffness.
The use of assistive devices such as orthotic braces or specialized shoes may improve stability and gait.

Occupational Therapy:

Occupational therapists focus on improving the child’s ability to perform daily activities and tasks, such as dressing, feeding, and fine motor skills.
Adaptive techniques and strategies are taught to promote independence.
Upper extremity function is addressed to enhance the child’s ability to use the affected arm and hand effectively.

Speech Therapy (if needed):

For children with speech and language difficulties due to their underlying condition, speech therapy may improve communication skills.

Constraint-Induced Movement Therapy (CIMT):

Doctors may recommend CIMT in some cases to encourage the use of the affected limb by restricting the unaffected limb. This promotes motor recovery and functional use.

Medication Management (if necessary):

In cases where spasticity or muscle tightness is a significant issue, doctors may prescribe medications like muscle relaxants or botulinum toxin injections to manage symptoms.

Surgical Interventions (in selected cases):

For severe muscle contractures or joint deformities that do not respond to conservative treatments, doctors may suggest surgical interventions like tendon lengthening or releases.

Assistive Devices and Orthotics:

The child may benefit from using assistive devices such as canes, walkers, or crutches to improve balance and mobility.
Custom orthotic devices, including ankle-foot orthoses (AFOs), may provide support and stability.

Psychosocial Support and Counseling:

Children and their families may benefit from psychological support to address the emotional and social challenges associated with the condition.
Support groups and counseling services can provide valuable resources and a sense of community.

Ongoing Monitoring and Adjustments:

Treatment plans are dynamic and may need adjustments as the child grows and develops. – Regular follow-up appointments with the healthcare team are essential to assess progress, make necessary modifications, and provide ongoing care.

In summary, the treatment of a child with hemiplegic gait is comprehensive and multidisciplinary, involving physical therapy, occupational therapy, medical management, and potentially surgical interventions. The primary goal is to improve the child’s mobility, independence, and overall well-being while addressing the specific challenges associated with their condition. A personalized and coordinated approach is essential to achieve the best possible outcomes. Our doctors treat Hemiplegic Gait at the Medical City Children’s Orthopedics and Spine Specialists medical practice, and for the convenience of our patients, we have offices in Arlington, Dallas, Flower Mound, Frisco, and McKinney, TX. We accept new patients and patients seeking a second opinion. We invite you to call and make an appointment.

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Footnote:

Science Direct: Hemiplegic Gait

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