Editing Hemiparesis (section)

==Diagnosis==
Hemiplegia is identified by clinical examination by a health professional, such as a [[physiotherapist]] or doctor. [[Radiological]] studies like a [[Full-body CT scan|CT scan]] or [[magnetic resonance imaging]] of the brain should be used to confirm injury in the brain and spinal cord, but alone cannot be used to identify movement disorders. Individuals who develop [[seizure]]s may undergo tests to determine where the focus of excess electrical activity is.<ref>{{cite web |url=http://www.originsofcerebralpalsy.com/02-forms/06-hemiplegia.html |title=Spastic Hemiplegia : Cerebral Palsy |publisher=OriginsOfCerebralPalsy.com |access-date=2013-03-08 |archive-date=2018-01-26 |archive-url=https://web.archive.org/web/20180126162320/http://www.originsofcerebralpalsy.com/02-forms/06-hemiplegia.html |url-status=dead }}</ref>

Hemiplegia patients usually show a characteristic gait.  The leg on the affected side is extended and internally rotated and is swung in a wide, lateral arc rather than lifted in order to move it forward.  The upper limb on the same side is also adducted at the shoulder, flexed at the elbow, and pronated at the wrist with the thumb tucked into the palm and the fingers curled around it.<ref>{{cite web | title = Gait Abnormalities | work = The Stanford 25 | url = http://stanford25.wordpress.com/gait-abnormalities/ | archive-url = https://web.archive.org/web/20101011002705/http://stanford25.wordpress.com/gait-abnormalities/ | archive-date=October 11, 2010 }}</ref>

===Assessment tools===
There are a variety of standardized assessment scales available to [[physiotherapists]] and other [[health care professionals]] for use in the ongoing evaluation of the status of a patient's hemiplegia. The use of standardized assessment scales may help physiotherapists and other health care professionals during the course of their treatment plant to:{{citation needed|date=August 2021}}
* Prioritize treatment interventions based on specific identifiable motor and sensory deficits
* Create appropriate short- and long-term goals for treatment based on the outcome of the scales, their professional expertise and the desires of the patient
* Evaluate the potential burden of care and monitor any changes based on either improving or declining scores

Some of the most commonly used scales in the assessment of hemiplegia are:
* The [[Fugl-Meyer Assessment of sensorimotor function]] (FMA)<ref>{{cite journal | vauthors = Fugl-Meyer AR, Jääskö L, Leyman I, Olsson S, Steglind S | title = The post-stroke hemiplegic patient. 1. a method for evaluation of physical performance | journal = Scandinavian Journal of Rehabilitation Medicine | volume = 7 | issue = 1 | pages = 13–31 | year = 1975 | doi = 10.2340/1650197771331 | pmid = 1135616 | s2cid = 19245788 | doi-access = free }}</ref>

The FMA is often used as a measure of functional or physical impairment following a [[cerebrovascular accident]] (CVA).'''<ref>{{cite journal | vauthors = Sullivan KJ, Tilson JK, Cen SY, Rose DK, Hershberg J, Correa A, Gallichio J, McLeod M, Moore C, Wu SS, Duncan PW | display-authors = 6 | title = Fugl-Meyer assessment of sensorimotor function after stroke: standardized training procedure for clinical practice and clinical trials | journal = Stroke | volume = 42 | issue = 2 | pages = 427–32 | date = February 2011 | pmid = 21164120 | doi = 10.1161/STROKEAHA.110.592766 | doi-access = free }}</ref> '''It measures sensory and motor impairment of the upper and lower extremities, balance in several positions, range of motion, and pain. This test is a reliable and valid measure in measuring post-stroke impairments related to [[stroke recovery]]. A lower score in each component of the test indicates higher impairment and a lower functional level for that area. The maximum score for each component is 66 for the upper extremities, 34 for the lower extremities, and 14 for balance'''. '''<ref>{{cite book | vauthors = Sullivan SB |chapter=Stroke | veditors = O'Sullivan SB, Schmitz TJ |title=Physical Rehabilitation |publisher=F.A. Davis |location=Philadelphia PA |year=2007 |edition=5th}}</ref>  Administration of the FMA should be done after reviewing a training manual.<ref>{{cite web|url=http://www.rehabmeasures.org/lists/rehabmeasures/dispform.aspx?id=908 |title=Fugl-Meyer Assessment of Motor Recovery after |publisher=Rehab Measures |access-date=2013-03-08 |url-status=dead |archive-url=https://web.archive.org/web/20160924083300/http://www.rehabmeasures.org/lists/rehabmeasures/dispform.aspx?id=908 |archive-date=2016-09-24 }}</ref>
* The [[Chedoke-McMaster Stroke Assessment]] (CMSA)<ref>{{cite journal | vauthors = Gowland C, Stratford P, Ward M, Moreland J, Torresin W, Van Hullenaar S, Sanford J, Barreca S, Vanspall B, Plews N | display-authors = 6 | title = Measuring physical impairment and disability with the Chedoke-McMaster Stroke Assessment | journal = Stroke | volume = 24 | issue = 1 | pages = 58–63 | date = January 1993 | pmid = 8418551 | doi = 10.1161/01.STR.24.1.58 | doi-access =  }}</ref>
This test is a reliable measure of two separate components evaluating both motor impairment and [[disability]].<ref>{{cite journal | vauthors = Valach L, Signer S, Hartmeier A, Hofer K, Steck GC | title = Chedoke-McMaster stroke assessment and modified Barthel Index self-assessment in patients with vascular brain damage | journal = International Journal of Rehabilitation Research | volume = 26 | issue = 2 | pages = 93–9 | date = June 2003 | pmid = 12799602 | doi = 10.1097/00004356-200306000-00003 }}</ref> The disability component assesses any changes in physical function including gross motor function and walking ability. The disability inventory can have a maximum score of 100 with 70 from the gross motor index and 30 from the walking index. Each task in this inventory has a maximum score of seven except for the 2 minute walk test which is out of two. The impairment component of the test evaluates the upper and lower extremities, postural control and pain. The impairment inventory focuses on the seven stages of recovery from stroke from [[flaccid paralysis]] to normal motor functioning.  A training workshop is recommended if the measure is being utilized for the purpose of data collection.<ref>{{cite web |url=http://www.rehabmeasures.org/Lists/RehabMeasures/DispForm.aspx?ID=918&Source=http%3A%2F%2Fwww%2Erehabmeasures%2Eorg%2FLists%2FRehabMeasures%2FAdmin%2Easpx |title=Chedoke-McMaster Stroke Assessment Measure |publisher=Rehab Measures |access-date=2013-03-08 |archive-url=https://web.archive.org/web/20141006184204/http://www.rehabmeasures.org/Lists/RehabMeasures/DispForm.aspx?ID=918&Source=http%3A%2F%2Fwww%2Erehabmeasures%2Eorg%2FLists%2FRehabMeasures%2FAdmin%2Easpx |archive-date=2014-10-06 |url-status=dead }}</ref>
* The [[Stroke Rehabilitation Assessment of Movement]] (STREAM)<ref>{{cite journal | vauthors = Daley K, Mayo N, Wood-Dauphinée S | title = Reliability of scores on the Stroke Rehabilitation Assessment of Movement (STREAM) measure | journal = Physical Therapy | volume = 79 | issue = 1 | pages = 8–19; quiz 20–3 | date = January 1999 | doi = 10.1093/ptj/79.1.8 | pmid = 9920188 | url = http://www.ptjournal.org/cgi/pmidlookup?view=long&pmid=9920188 | doi-access = free }}</ref>

The STREAM consists of 30 test items involving upper-limb movements, lower-limb movements, and basic mobility items. It is a clinical measure of voluntary movements and general mobility (rolling, bridging, sit-to-stand, standing, stepping, walking and stairs) following a stroke. The voluntary movement part of the assessment is measured using a 3-point ordinal scale (unable to perform, partial performance, and complete performance) and the mobility part of the assessment uses a 4-point ordinal scale (unable, partial, complete with aid, complete no aid). The maximum score one can receive on the STREAM is a 70 (20 for each limb score and 30 for mobility score).  The higher the score, the better movement and mobility is available for the individual being scored.<ref>{{cite book | vauthors = O'sullivan S, Schmitz T | title = Physical Rehabilitation |edition= 5th  | publisher = F.A. Davis | year = 2007 | location = Philadelphia PA | page = 736 }}</ref>