Flexion and Spastic Hemiplegia after Cerebral Apoplexy

Abstract

Impairments of the lower limbs, observed in patients with hemiplegia after cerebral apoplexy, are mainly caused by the inhibitive factors such as loose-type and spastic-type hemiplegia, sensory impairments, or articular contracture. Among these factors, spastic hemiplegia is the major target of physical therapy in this disease. There is atendency to show a typical position of the limbs peculiar to cerebral apoplexy, with flexion of the upper limb and extension of the lower limb, this being called Wernicke-Mann. In the standing position, however, some cases were observed where the lower limb was flexed, and the patients were unable to walk dre to the superiority of the flexor muscle. A study of this inexplicable phenomenon suggested that it was different to the knee-flexion involved in the loose-type hemiplegia in its mechanism of onset, as well as its difference from foot flexion and spastic paraplegia. The authors therefore evaluated six patients during the period from July 1977 to December 1982 (four male and two female patients), included were four patients with right hemiplegia and two with left hemiplegia. As a result, symptoms such as decrease in the will to move (with normal conversation and symptom different from akinetic mutism), nervousness upon movement (a sense of anxiety), acceleration of tendon reflex, contracture and sensory impairment. These patients received dynamic, long ower-limb orthoses (including Type-PP LLB), with knee pads to help them walk with the assistance of a T-cane. However, only one case could reduce the short lower-limb orthosis or Walk without assistance. All other patients showed poor results.