hemiplegia: prognosis

[maithili85]

hello to all.
i am a physiotherapy student.
i just want to know the prognosis of patients with hemiplegia having more of upper limb involvement with moderate spasticity ( ashw. gr.2).
i also want to know what are the goals practically possible to achieve after regular physiotherapy in such patients.
thank you.

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[thabiso]

Hi,
I am normally careful with a prognosis especially for neuro cases. Too many things contribute. Roughly I work with period from cva to onset of increased tone. The shorter that is the better the prognosis(i.e. the period in which the patient's tone is floppy. I also check the current rate of recovery, patient cognitive functions (are they able to understand and follow instructions). Also their age and absence of any complicating medical conditions. Here in Zim I have seen HIV & Aids as an underlying medical condition and in the absence of ARVs I have seen cases with relatively "good prognosis" depreciate over time.

Dont have any literature at hand but I hope this helps..

[Aisha_kb]

Maithili, you need to be more elaborate on the patients condition. How long since the physiotherapy treatment started and when did it start? What are you doing for the patient and how in your short course have you felt is the condition?
With Neuro cases there is alot of factors that come into play, and most of it is how much of carry over of advice and exercises is being done at home? If the patient or his/her attendents are playing a major role in doing the exercises, proper positioning, for the patient, that CAN ADD to a better prognosis.
There is never a sure fixed range for improvement. Regardless what the literature says. Practically, each patient should be dealt with individually and only with experience after treating as many of that same condition can you develop a sense of whether the patient has scope of a quick / better improvement or not.
I have not been in this field for that long, but it is how i feel regarding Neurological cases.

Can a more expereinced physio comment on this please?

[asha]

Your examination findings have to be more elaborate. Is there any sensory problem? What is the onset? What is the area of brain involved? You have mentioned that there is more of UL problem. That means there has been some LL affection. How's the trunk? If the trunk is not good, it would definitely affect the UL. Personally I believe in the plasticity of the brain. It is capable of giving much more than what is written about. Reasons why there is no reliable or validated technique in neuro rehab. I have worked extensively with hemi's for the last 17 yrs. If there is no much of sensory issues to tackle, I think the patient could regain complete function if tackled rightly.
asha

[junior_physiotherapist]

Your examination findings have to be more elaborate. Is there any sensory problem? What is the onset? What is the area of brain involved? You have mentioned that there is more of UL problem. That means there has been some LL affection. How's the trunk? If the trunk is not good, it would definitely affect the UL. Personally I believe in the plasticity of the brain. It is capable of giving much more than what is written about. Reasons why there is no reliable or validated technique in neuro rehab. I have worked extensively with hemi's for the last 17 yrs. If there is no much of sensory issues to tackle, I think the patient could regain complete function if tackled rightly.
asha

would u plz feed us more about ur opinions regarding brain platicity,along with what referrences u depend on!!
i know there is brain elasticity & plasticity ,the first one with childern while the second with adult ..is it true!!
i'll still ur response

regards

[bsgandhi01]

hello to all.
i am a physiotherapy student.
i just want to know the prognosis of patients with hemiplegia having more of upper limb involvement with moderate spasticity ( ashw. gr.2).
i also want to know what are the goals practically possible to achieve after regular physiotherapy in such patients.
thank you.

hey friend.......
u dont tell since how long patient is having stroke......
prognosis is dependend on age,his medical histrory,and many othere factor.
please keep doin work if he is havin stroke in last three month ...........
keep workin .......