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STROKE AFTERMATH – Part 3: Weakness and Paralysis

In last month’s installment – “Late Effects,” I presented visual disturbance (aka visuomotor deficits). Readers may know that our eyes are a part of our brain and controlled by 4 of 12 Cranial Nerves and they are: CN2-Optic (visual acuity); CN3-Oculomotor; CN4-Trochlear; and CN6 - Abducens control the position of the eyeballs. Part 3 is about weakness and paralysis on half of the body due to a stroke on the opposite side of the brain called a hemisphere. We will begin from the top affecting the face, down to arm, hand, and the foot. In rehab, we refer to weakness and paralysis as Hemiparesis and Hemiplegia (respectively).

Hemiparesis is a slight weakness — such as mild loss of strength — in a leg, arm, or face. It can also be paralysis on one side of the body. Hemiplegia is a severe or complete loss of strength or paralysis on one side of the body.

When a stroke survivor is left with face palsy, the eye is often affected as is speech and chewing. We can know that cranial nerve 5 (Trigeminal) is involved so a neuro-rehab OT will work on is facial muscle control, visuomotor tracking, and symmetry exercises. A speech and language therapist (SLP) will address clarity of speech (articulation), voice volume, and swallowing issues (dysphagia and aspiration of food and liquids).

In cases of shoulder to hand hemiparesis and hemiplegia, Occupational therapists (OTs) are skilled at rehabilitating shoulder weakness that may cause the shoulder to dislocate (subluxation) and fine motor control in the hands for functional tasks such as grasping and releasing objects and manipulation of utensils as necessary for independence in self-care from self-feeding; hair and face grooming and hygiene; dressing and bathing; and toileting.

Sometimes stroke survivors outgrow their wheelchairs after returning home from rehab discharge. A poorly fitted wheelchair can not only halt progress, but it can cause musculoskeletal damage and skin breakdown which become permanent injuries. When walking is no longer an option, either OTs or PTs may work with a wheelchair vendor to provide an insurance-funded wheelchair and it is most often a standard folding, manually propelled wheelchair. If the person gains weight or if the seat is too high, the user is too weak to operate it independently.

OTs are focused on functional mobility training which means standing to transition from one surface to another such as from wheelchair to toilet, sofa, or bed. It may include walking short distances especially where the wheelchair is in the way such as in a tight bathroom space when they need to access toilet, tub, or shower. OTs are also specialized in recommending self-care aids (also called durable medical equipment – DME) such as a tub transfer bench, toilet rails and grab bars strategically placed for independence.

At Integrative Therapeutic Solutions, we help “late effects” stroke survivors resume rehabilitation even 3-4 years after their injury. We take our time to reassess and redesign the plan of care to stimulate and facilitate new neurorehabilitation because we treat THE WHOLE PERSON in body, home, and community. Don’t wait to rehabilitate,

Re-INTEGRATION IS STILL POSSIBLE and waiting to happen!


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