Left Hemiplegia and the characteristics of left hemiplegic patients: these are key topics for understanding the problems of those who have suffered a stroke in the right hemisphere of the brain.
Getting to know the characteristics of Left Hemiplegia helps us better understand the behaviour of left hemiplegic patients, and allows us to identify the best rehabilitative treatment method.
While right hemiplegic patients commonly experience speech disorders (aphasia) and apraxia, for left hemiplegic patients the disorders tend to be more complex and difficult to detect.
It is precisely for this reason that specific attention has never been applied to the treatment of Left Hemiplegia. The main characteristics that are often associated with left hemiplegia include:
Neglect, also known as hemi-attention or hemispatial neglect, is a phenomenon that's commonly attributed to the difficulty of exploring the left visual space. It's not a visual impairment, but can rather be understood as a deficit in focusing attention and awareness on the left side of space.
This disorder also partially explains the movement difficulties encountered by left hemiplegic patients, which are linked to their difficulties in focusing attention upon the "world on the left", including their own body, and with it the surrounding environment.
Anosognosia: This is another distinctive characteristic that's often associated with left hemiplegia, and consists of a lack of awareness of one's own pathology.
When combined, these two disorders give rise to a series of alterations and difficulties, which the left hemiplegic patient encounters on a daily basis, but all too often only become the object of curious anecdotes and misunderstandings. Those who are involved in rehabilitation must translate these "anecdotes" into rehabilitative data that can be used to create the best possible rehabilitation strategies for left hemiplegia recovery.
In fact, attention and awareness disorders have obvious effects upon the left hemiplegic patient's movements and behaviour, and they must therefore be addressed and recovered through the rehabilitation process.
It has been mentioned multiple times that movement is the result of complex organization activities, in which the cognitive processes play a fundamental role.
Once simple example of how the alteration of the cognitive processes (and the patient's attention in particular) can result in movement alterations is that of children with Attention Deficit Disorder.
They're extremely lively and hyperactive children who are always on the move due to their inability to focus their attention, if not only for a few moments.
Even in patients suffering from left hemiplegia, movement alterations are not only caused by an alteration of the muscles, but rather by a combination of cognitive alterations, including attention deficit, which is the most debilitating.
In particular, the attention-related difficulties associated with left hemiplegia involve the ability to focus the attention upon the most significant point of a problem, and the ability to divide the attention among multiple aspects of the body simultaneously.
Learning difficulties can also be quite pronounced in certain cases, especially when combined with attention disorders, and it should be noted that the recovery will depend on the therapist's ability to teach, and the patient's ability to learn the more advanced movements.
Therefore, the perception disorders encountered in left hemiplegic patients are not only caused by direct damage to the primary sensory areas, but are also the result of complex difficulties encountered in acquiring information regarding the surrounding environment through one's own body.
It therefore follows that the rehabilitation of left hemiplegic patients should not be focused upon strengthening the muscles, and since spasticity should not be considered as a muscular problem drugs like botulinum toxin (which among other things is counter-productive to rehabilitation) should not be administered. Rather, the post-stroke and left hemiplegia rehabilitation efforts should simultaneously focus upon: the body, the altered functions (like walking and the ability to grasp and manipulate objects), and the cognitive/emotional and informational processes.
Neurocognitive Rehabilitation (or the Perfetti method) has been recognized as the hemiplegia recovery method of choice for years, because in addition to the recovery of muscle contraction, it also takes the cognitive processes into account.
And when it comes down to it, a stroke is actually a brain injury: it doesn't directly affect the muscles, but rather our ability to organize movements through cognitive processes like attention, learning, memory and perception.
In short: While the disorders associated with left hemiplegia manifest themselves as motor deficits (spasticity, hypertonicity, difficulties walking and moving the arm and hand), these visible expressions are merely the result of the brain injury that has impaired the patient's ability to organize their cognitive processes.
Therefore, in order to obtain the best possible recovery in cases of left hemiplegia, the mental functions that we understand to be the basis for movement must be the focus of our care and rehabilitation efforts.
As a result, left hemiplegia rehabilitation requires a form of therapeutic treatment that focuses upon the recovery of these cognitive abilities.
The family plays a role of fundamental importance to the patient's recovery process, and if well-instructed the family members can actively participate in their loved one's recovery through the neurocognitive rehabilitation exercises. Personally, I rarely encounter patients who intend to undergo treatment without the involvement of a family member or caregiver, and it's hard to imagine obtaining a good level of recovery with only the work carried out at the clinic or treatment centre, without the family's contribution.
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