Right Hemiplegia

David J West djwest at iinet.net.au
Sat Nov 30 21:31:39 EST 1996


In the beginning I wrote this article to distribute to specialists
worldwide and kept on updating it as the specialists replied. You may
find certain information relevant to your situation or things
contained herein that you may find useful. Please keep me informed
Many thanks - David (djwest at iinet.net.au)
****************** 
In September, 1984 and at the age of 17, I had a car accident in which
I suffered a right hemiplegia. The final result being a partial loss
of the dexterous use of my right hand and arm. The freedom of use is
restricted in the leg. Below is a description of my problems:

	Hand - very spastic its only real use is for grasping objects.
	Wrist - its usual position is fully extended with approx 15° voluntary
flexion - this movement is of little or no functional use.
	Forearm - a difficulty moving to a supinated position.
	Elbow - a full range of voluntary flexion and extension but smooth
movement is restricted to resistive forces.
	Shoulder - comparatively good
	Leg - freedom of movement is restricted
	The sensation is normal down my right side
	It is also interesting to note that my right side totally relaxes
whilst asleep
.
A report written upon discharge from hospital concluded 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. Being confident in water
meant more to me than having the temporary use of my right arm.
(Nothing short of another head trauma would make me loose my
confidence to such an extent I would be as terrified as I was on that
day in April, 1985.) I have since taken up waterskiing and am
sufficiently confident enough in water albeit with the aid of a
life-jacket! To this day, I still cannot put my head underwater and be
assured I won’t swallow any water.
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 many 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 since 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. Most of these
drugs were intended to reduce spasticity. 
The Doctors involved with prescribing Sinemet-M explained the drug is
usually prescribed for people who suffer from Parkinson’s disease.
Sinemet occurs naturally in the brain but it 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 right 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.


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