Cerebral Palsy

Spastic Hemiplegia Type

2019KPBIA

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 HEMIPLEGIA
FULLTERM IN PRETERM
CHILDHOOD

Hypertonus, Poor Neck & Proximal

Lack of movement Dynamic Stability

ACQUIRED

Emotion, Psychological Problems

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 Consideration

• Vision and somatosensation

• Neck and spine movement
• Hand and foot movement, B.O.S
• Associated reaction and movement
• Developed Asymmetry from sensory to motor
• Internal Representation
• Seizure

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 Distribution of Postural Tone

More affected side Less affected side

`
High Tone when Moves
Hypertonus
Associated Movement
Associated Reaction
Mirroring

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Postural Tone in relation to Gestational age

Full – term Pre - term

Eye & Neck Near normal Low tone

Proximal part Near normal Low tone

Spasticity
Spasticity
Distal part Degree : Mild ~
Degree : Moderate
moderate

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 Procedure of transition of Postural Tone in
relation to Gestational age
Full - term Pre - term

Near normal on neck and proximal part Low tone on neck and proximal part

Lack of movement of Increased hypertonus on

extremities on affected side distal part than young age
due to damaged brain
 Sensory
 Hypertonus

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Postural Patterns based on PAC

• Low tone on proximal because of weak axis such as eye &

neck

• Low postural tone on more affected side

- Poor SCM, Upper Trapezius

- Poor movement of spine

- Poor Gleno-humeral rhythm, 3D pelvis movement

• Poor body scheme and cortical level of movement leads to

low postural tone

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 Postural Patterns based on PAC

• Weak eye movement

- Consideration on 2 parts of the problems of the eyes
- Optic problems and non-optic problems
- the children with C.P hemiplegia aren’t able to watch something with
two eyes in midline because of optic problems such as strabismus
and amblyopia etc.
- Even though there aren’t non-optic problems, the children with C.P
hemiplegia have difficulty in watching something by using two eyes
equally. Almost children with C.P. hemiplegia have difficulty in
watching something strongly through the eye on more affected side.
- Asymmetrical vision leads to more asymmetrical P.A.C.

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 Postural Patterns based on PAC

• Weak neck dynamic stability

- Fixed C1 & 2 suboccipital part

- Altered vestibular information

- Weak capital flexion

• Disappearance or weak of SCM, UPPER TRAPEZIUS on one

side

• Poor connective movement of the spine

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 Postural Patterns based on PAC

• Rib – cage
- One of the axis part that is altered shape more easily than other axis
part in C.P hemiplegia.
- Poor rib-cage movement leads to poor scapular & arm movement.
- Many more amount of breathing on less affected side than more
affected side leads to asymmetrical balance of core muscle group.

• Poor scapular movement with thoracic spine

• Poor Gleno-humeral rhythm of the arm

• Poor 3-dimensional pelvic movement

• Poor base of support / ankle and foot

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Postural Patterns based on PAC

• Poor voluntary movement of Hand & foot

- Due to Altered axis of hand and foot

- Poor quality and less amount of movement

- Due to weak signal of damaged hemisphere in the brain

- It leads to poor activation of the brain

• Asymmetrical activities in A.D.L

- Weak oromotor control on one side (etc. tongue movement,

munching, chewing, blowing, phonation, speech)

- Weak ocuollomotor control on one side (etc. monocular vision)

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Postural Patterns based on PAC

• Seizure due to hemisphere differences

• Associated reaction and movement

• Hyperkinetic behavior problem

• Short attention span and concentration

• Emotion control problem (frustration, depression)

• Growth of bone and muscle size (esp. weighted part such as hand &
foot)

• Changed Muscle properties

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Postural Patterns based on PAC

• We have to considerate 2 sensory parts when treating hemiplegia type.

Vision
- Limited range of lateralization of ocullomotor on more affected
side (narrow visual field)
- One eye rather than two eyes when watching something
- Depth and distance perception
- Visual pursuit movement (jerky tracking movement)
• Somatosensation
- Sensitivity (superficial and deep tactile, hyper or hypo sensitivity)
- Proprioception due to altered axis
- Discrimination problem

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 Postural Patterns
Eye, head & neck Abnormal development
Asymmetric asymmetric postural
information tone

Associated problems
Midline orientation - Visual field
Body scheme - Learning
Poor cortical level - Attention & distraction
of movement - Seizure

Increase tone more

Effort asymmtry compensation
more A.R , A.M

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Spastic Hemiplegia

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 Feature Principles of treatment

• Making the symmetrical neck and eyes axis with capital flexion movement

• Activating both side muscle of the neck and face

• Connective spine movement (esp. rotation from cervical to lumbar)

• Different scapular movement for increasing hand function(esp. grasping)

• Pelvis 3-dimensional movement for ankle and toe movement

• Increasing the somatosensation of affected side (esp. hand)

• Dynamical interaction between stability and mobility

• Encourage the aspects of both quality and quantity of movement

• Self security and modulation

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 Process of Spastic Hemiplegia

• Development Process

- 0-1 years : Basically low tone

- 1-3 years : Hyperkinetic as normal children

- 5-6 years : Clumsy

- 10-12 years : a lot of risk of contractures and

deformities

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 Process of Spastic Hemiplegia

• Intervention / Treatment Process

- 0-1 years : sensory intake in both side to get body scheme

- 1-3 years : bilateral play, motivation, stability & mobility

- 4-6 years : self-inhibition, with ADL

- 7 years : prevent further deformity/contracture

- 13-15 years : the whole management through

multidisciplinary approach

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 Treatment Principles based on PAC
POSTURAL
TONE
• Activation of Facial muscle on
affected side (frontalis,
massetor)
• Activation of neck muscle
(SCM, Upper trapezius)
• Activation of Oculo muscle
(lateral rectus)
• Activation of proximal muscle
ASSOCIATED
PROBLEMS
AXIS
• Right AXIS of neck and eye
(sub-occipital, C1,C2 )
• Right AXIS of spine and rib-cage
(spinal extension and segmental
rotation, deep breathing equally
on both side)
• Right AXIS of scapular and G.H
rhythm
• Right AXIS of the arm (Double
lock)
• 3D pelvic movement (reclination
of pelvis on more affected side)
• Right AXIS of calcaneal bone
(size of calcaneal bone)
VISION, PROPRIOCEPTION, TACTILE, STEREOGNOSIS, SEIZURE,
SHORT ATTENTION SPAN, PSYCHOLOGICAL PROBLEM(self esteem),
A/R, A/M
CONTRACTURE, DEFORMITIES
CORTICAL
MOVEMENT
• Activation of massetor and
tongue
• Voluntary movement of hand
(bimaual activity, fine movement
such as grasping, manipulation, etc)
• Voluntary movement of ankle and
foot
(making a circle by one self, acting
as a BOS )
• Watching with two eyes vision

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