Hemiplegic/Hemiparetic Cerebral Palsy

Hemiplegic cerebral palsy affects motor abilities and muscle tone on one side of the body. It is a form of paralysis. About 33 – 39% of children with cerebral palsy have hemiplegic cerebral palsy. Other terms for hemiplegic cerebral palsy include hemiplegia, unilateral cerebral palsy, or hemiparetic cerebral palsy (which refers to milder cases).

The most common cause of hemiplegic cerebral palsy is a fetal or neonatal stroke. Common causes of stroke in babies include hypoxic-ischemic encephalopathy (HIE), birth trauma, and preeclampsia. In some cases, strokes are preventable and occur as the result of medical negligence.

Sixty percent of infants who develop hemiplegic cerebral palsy have seizures in the neonatal period. Therefore, the presence of seizures can serve as an early warning sign of hemiplegic cerebral palsy. Seizures should also be promptly treated, because they can worsen existing brain damage. Other signs of hemiplegic CP, which may present in the first 18 months of life, include the following:

• A preference for using one hand over the other; the baby may keep the affected hand coiled into a fist
• Asymmetrical movements when crawling or standing (with assistance)
• Delays in milestones such as rolling over, sitting upright, crawling, walking, etc.
• Stiff muscles on one side
• Difficulty with balance

Diagnosing Hemiplegic Cerebral Palsy

Once signs of hemiplegic cerebral palsy emerge, diagnosis can be confirmed with an MRI (magnetic resonance imaging). Cranial ultrasounds may also be performed.

Although some children with hemiplegic cerebral palsy are seriously affected by paralysis, 88% are classified as GMFCS level 1. This means that they are able to move without assistance, and by age six should be able to do activities such as:

• Walk on uneven surfaces
• Climb stairs without a handrail
• Sit or stand without using their hands for support

However, they may have the following challenges:

• Difficulty using their affected arm; for example, they may be unable to pick up small objects or turn their hand over.
• Uneven gait, which can cause tripping
• Vision problems or other sensory loss on one side.
• Epilepsy is very common, affecting an estimated 44-67% of children with hemiparesis.
• Cognitive impairments or behavioral issues
• Speech and language problems
• Muscular atrophy on the affected side
• Scoliosis

Like other forms of cerebral palsy, there is no “cure” for hemiplegia. However, there are medications that can help, such as those prescribed to control seizures. Children with hemiplegic cerebral palsy may also benefit from orthotics and braces to make walking easier. Finally, various types of therapy – such as physical therapy, occupational therapy, speech and language therapy, or cognitive behavioral therapy – may help to minimize discomfort and maximize function.