Right hemiplegia is a consequence of stroke that can be distinguished from left hemiplegia not only by the side on which the paralysis manifests itself, but also by its specific characteristics.
Right hemiplegia is the result of the damage suffered by the brain's left hemisphere following a stroke (since the body's controls are criss-crossed), although the repercussions are even broader, as we shall see later in the sections on Apraxia.
The mistake that's often made in stroke rehabilitation is to offer therapies that are not specifically designed for right hemiplegia and left hemiplegia. What's more, after becoming more familiar with the Perfetti method, you'll find that every patient with hemiplegia requires their OWN specific type of rehabilitation.
What do Right and Left Hemiplegia have in common?
At first glance, the most significant common element between right and left hemiplegia might appear to be spasticity. That which is less apparent, however, is that the hemiparesis originates from a different alteration of the cognitive processes. In fact, it should be noted that our movements are made possible thanks to the complex organization of our mental processes.
The movement and the behaviour should only be seen as the tip of the iceberg, below which lies a veritable submerged mountain of well-organized mental and cognitive processes that allow for their expression. By damaging the brain, a stroke impairs the patient's ability to organize the cognitive processes that allow for movement. We often hear about the different tasks assigned to the right and left hemispheres, which make different contributions to our overall motor skills, our behaviour, and our language. Therefore, even if they do have certain common features, there are a number of major differences between right hemiplegia and left hemiplegia.
What are the differences between Right and Left Hemiplegia?
You may have heard that our capacity for language lies in the left hemisphere of the brain. While this is true to some extent, not all of our ability to communicate resides in the activities of the left hemisphere, even if some of the most obvious effects of a lesion to the left hemisphere would lead us to assume its dominance over the properties of language. It is precisely language disorders (the so-called aphasias) that are often associated with right hemiplegia.
We must keep in mind that language and movement share many cognitive processes, and aphasia can therefore be defined as the inability to organize communication.
Aphasia is a complex problem for those involved in rehabilitation and speech therapy. In fact, it is often confused with amnesia of words, and right hemiplegic patients are often erroneously asked to continuously repeat certain words in the hope that they will be able to learn and remember them.
What I often find is that in most cases aphasia does not consist of a problem with words (just as hemiplegia does not consist of a problem with muscle contractions), but rather the difficulty to access certain linguistic forms and rules at a given time and within a given context.
Apraxia is a frequent characteristic of right hemiplegia, and is caused by the alteration of certain cognitive processes, such as attention, learning and the ability to perform transformations between different information channels, including language, vision and perception. While this last step may seem less clear, it is a reflection of the complexity associated with the problem of apraxia, which in fact is often diagnosed with difficulty and is rarely treated using specific and targeted therapies. Apraxia is an extremely complex clinical matter, and while there are a number of tests that allow us to highlight certain aspects of apraxia, I personally use the test developed by De Renzi, which consists of asking the patient to imitate a number of gestures. Based on the quality with which these gestures are imitated with the upper limb, the practitioner can select the specific characteristics of the apraxia displayed by the right hemiplegic patient. The peculiarity of this test lies in the fact that the imitation itself is performed using the left arm, or rather the "healthy" limb, which is generally believed not to suffer from any movement problems, but may actually show signs of numerous problems linked to the spatial organization of movements, such as the omission of certain joints involved in the gesture, and the replacement or changes of orientation, all of which are essential for correct motor behaviour. This aspect makes us once again consider how a stroke does not affect the arms or legs themselves, but rather our ability to organize movements in a manner that's appropriate for the context, since these disturbances can also be seen on the left side, where it is not generally believed that problems of this sort should arise.