Right Hemiplegia - Any Suggestions?

[David J West]

I would be very interested in learning anything more about my hemiplegia - 
particularly any suggestions from the medical profession. Alternatively, I 
would like to hear from people who are in a similar position to myself.

In September, 1984 and at the age of 17, I had a car accident in which I 
suffered a right hemiplegia. All details of my resultant disabilities and an 
account since the accident are listed below.

I have limited functional movement of my right shoulder, arm and elbow, 
since they are quite spastic. My hand has the ability to grasp, while my arm 
has some distinct uses that involve acting on resistive forces. Examples 
being, lifting weights, chin-ups, push-ups, holding and carrying bulky 
objects, etc. For anything involving fine coordinated movements, they are of 
little functional use. My leg has also been partially affected. While these 
exercises do maintain my right side's mobility, I do not feel they are 
helping in the long term.

It is also interesting to note that my right side totally relaxes whilst 
asleep.

A report written upon discharge from hospital diagnosed that I had received 
a deep intra-cerebral haematoma. Quoting the report: 'C.T. Scans showed an 
area of haemorrhage in the left thalamus surrounded by oedema. There were 
separate areas of punctate haemorrhage, more superiorly placed within the 
same hemisphere and the ventricular system was quite small. Repeat CAT scans 
showed the  haematoma to be resolving and there was a moderately large 
infarct on the left internal capsule with encroachment upon the left 
thalamus at the site of the previously described haematoma.' 

A report written by a rehabilitation doctor 6 months after the accident 
said: The residua from this accident are in the form of bilateral upper 
motor neurone lesions affecting all four limbs, with increased tone, 
positive Hoffmann and extensor Babinski signs. The right side is by far the 
worst and this is his dominant side"

In April, 1985, as an inpatient of  the Royal Perth Rehabilitation Hospital, 
I was expected to swim in the hydrotherapy pool. I had lost all of my 
confidence in water (this being a side-effect of the accident) and I was 
literally terrified of the thought of my head being submerged in water. When 
the time came to swim, panic set in and both my arms and hands started the 
motions of "dog-paddle". 

This function of my right arm was caused by - according to my instincts - a 
life-threatening situation and only lasted until I realised that I wasn't 
going to drown. I couldn't understand why I wasn't able to swim or even put 
my head underwater (without breathing in) especially when being confident in 
water was of second nature before the accident. Many months were spent 
trying regain my confidence in water and now, I would only panic if I was 
actually drowning. To this day, I still cannot confidently put my head 
underwater.

Also, on the rarest of occasions, from impulse and for an instant, my right 
hand and arm have displayed reflex-action type movements. eg. stopping a 
glass jar from falling off a shelf, jumping when startled by anything, and 
my whole arm has withdrawn my hand from painful situations. I would have 
doubts, though, about these rare instances leading to anything, if not for 
the day in the hydrotherapy pool. 

Regrettably, there were no residual effects resulting from these 
experiences. It just seems very irregular that my arm and hand have the 
potential to function normally but can only do so in extreme circumstances.

It has been 12 years since the accident and during this time, I have seen 
several specialists. A physiotherapist found that by constant and vigorous 
shaking of the fingers and hand made them relax. My physiotherapist has also 
tried interferential treatment on the right forearm. This didn't have the 
desired effect and for the time that it was being tried, increased my hand 
and finger's spasticity. Soon after the accident my physiotherapist in 
hospital tried limited biofeedback but this too was also unrewarding.

Prior to being discharged from hospital in 1985, I had a condition known as 
"drop-foot" and tenotomies were performed on both Achilles tendons Plus, my 
right forearm was flexed against my throat so a tendon release was also 
performed. In the years after being discharged, I had several minor 
orthopaedic operations to improve my function.  Not being critical to this 
kind of treatment but it has inherent limitations in that it can only do so 
much.

Neurologists and Doctors have tried many drugs including: Sinemet-M, Valium, 
Baclofen, Rivitrol, Tegretol, Artane and Epilim. The Doctors involved with 
prescribing Sinemet-M explained that this drug is usually used on people who 
suffer from Parkinson's disease.

With people who suffer from this disorder, the brain sometimes lacks the 
drug. Two symptoms of this deficiency are the relaxation of the spastic 
limb(s) whilst asleep and the spastic limb(s) being able to move more 
readily against resistance. In my case, these symptoms were true and since 
the nature of my head-injury was uncertain, it was possible that Sinemet-M 
may help.

At any rate, Epilim was the only agent that seemed to help and I am now 
taking a daily dosage of 3 x 500mg. Although Epilim hasn't affected my hand 
and arm's usefulness, it has however, lessened the spasticity of my right 
side thus making it more comfortable for me. My Neurologist said that 
relaxation of my (R) side was the maximum benefit of trying all the drugs 
and agents because the brain was affected in the accident.

In the past, I have also seen a hypnotherapist. It was my theory that if I 
could be induced into a panic situation - under hypnosis - then, I could not 
see any problem in getting my hand and arm to "work". If my hand and arm had 
performed differently under certain circumstances, then prolonging the 
effects into everyday situations might be possible. I asked a rehabilitation 
doctor about hypnotherapy. He said: 'He would have to be a good hypnotist!'. 
Realistically, I could see his point.

About a year later I asked my GP if I could be referred to a hypnotherapist. 
He had no hesitation in obliging me because he said that he was going to 
refer me anyway. I was relieved - he actually took me seriously.

Among other things, the hypnotherapist tried regression - taking me back 
with hypnosis to the hydrotherapy pool. This didn't work although he only 
tried because I wanted him to. In summary, I was not surprised at the 
failure of hypnotherapy but was somewhat annoyed with the hypnotherapist's 
pessimistic attitude. It was like all things: if I didn't try, I would never 
know.

I initially thought it was the panic involved with my head going underwater 
that made my hand and arm function. However, in September, 1988, to try and 
arouse the panic situation, I went skydiving - Deluxe Tandem. 

We tried free-falling from 10,000ft at 120mph, for 45 seconds by firstly 
doing two forward rolls. This didn't work and not too disappointingly 
either. To be quite honest, I was doing it just for the thrill with an 
ulterior motive in mind; I'll be the first to admit that my methods were a 
little excessive but by all accounts, it was feasible. All the exercise did 
accomplish was to make me feel decidedly ill and quite arguably, it was the 
wrong way to approach the problem.