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class="vector-toc-numb">4.1</span> <span>Assessment tools</span> </div> </a> <ul id="toc-Assessment_tools-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Treatment" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Treatment"> <div class="vector-toc-text"> <span class="vector-toc-numb">5</span> <span>Treatment</span> </div> </a> <button aria-controls="toc-Treatment-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Treatment subsection</span> </button> <ul id="toc-Treatment-sublist" class="vector-toc-list"> <li id="toc-Medication" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Medication"> <div class="vector-toc-text"> <span class="vector-toc-numb">5.1</span> <span>Medication</span> </div> </a> <ul id="toc-Medication-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Surgery" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Surgery"> <div class="vector-toc-text"> <span class="vector-toc-numb">5.2</span> <span>Surgery</span> </div> </a> <ul id="toc-Surgery-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Rehabilitation" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Rehabilitation"> <div class="vector-toc-text"> <span class="vector-toc-numb">5.3</span> <span>Rehabilitation</span> </div> </a> <ul id="toc-Rehabilitation-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Physical_therapy" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Physical_therapy"> <div class="vector-toc-text"> <span class="vector-toc-numb">5.4</span> <span>Physical therapy</span> </div> </a> <ul id="toc-Physical_therapy-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Occupational_therapy" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Occupational_therapy"> <div class="vector-toc-text"> <span class="vector-toc-numb">5.5</span> <span>Occupational therapy</span> </div> </a> <ul id="toc-Occupational_therapy-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Orthotic_Intervention" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Orthotic_Intervention"> <div class="vector-toc-text"> <span class="vector-toc-numb">5.6</span> <span>Orthotic Intervention</span> </div> </a> <ul id="toc-Orthotic_Intervention-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Prognosis" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Prognosis"> <div class="vector-toc-text"> <span class="vector-toc-numb">6</span> <span>Prognosis</span> </div> </a> <ul id="toc-Prognosis-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Popular_culture" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Popular_culture"> <div class="vector-toc-text"> <span class="vector-toc-numb">7</span> <span>Popular culture</span> </div> </a> <ul id="toc-Popular_culture-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-See_also" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#See_also"> <div class="vector-toc-text"> <span class="vector-toc-numb">8</span> <span>See also</span> </div> </a> <ul id="toc-See_also-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-References" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#References"> <div class="vector-toc-text"> <span class="vector-toc-numb">9</span> <span>References</span> </div> </a> <ul id="toc-References-sublist" class="vector-toc-list"> </ul> </li> </ul> </div> </div> </nav> </div> </div> <div class="mw-content-container"> <main id="content" class="mw-body"> <header class="mw-body-header vector-page-titlebar"> <nav aria-label="Contents" class="vector-toc-landmark"> <div id="vector-page-titlebar-toc" class="vector-dropdown vector-page-titlebar-toc vector-button-flush-left" > <input type="checkbox" id="vector-page-titlebar-toc-checkbox" role="button" aria-haspopup="true" data-event-name="ui.dropdown-vector-page-titlebar-toc" class="vector-dropdown-checkbox " aria-label="Toggle the table of contents" > <label id="vector-page-titlebar-toc-label" for="vector-page-titlebar-toc-checkbox" class="vector-dropdown-label cdx-button cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--weight-quiet cdx-button--icon-only " aria-hidden="true" ><span class="vector-icon mw-ui-icon-listBullet mw-ui-icon-wikimedia-listBullet"></span> <span class="vector-dropdown-label-text">Toggle the table of contents</span> </label> <div class="vector-dropdown-content"> <div id="vector-page-titlebar-toc-unpinned-container" class="vector-unpinned-container"> </div> </div> </div> </nav> <h1 id="firstHeading" class="firstHeading mw-first-heading"><span class="mw-page-title-main">Hemiparesis</span></h1> <div id="p-lang-btn" class="vector-dropdown mw-portlet mw-portlet-lang" > <input type="checkbox" id="p-lang-btn-checkbox" role="button" aria-haspopup="true" data-event-name="ui.dropdown-p-lang-btn" class="vector-dropdown-checkbox mw-interlanguage-selector" aria-label="Go to an article in another language. Available in 23 languages" > <label id="p-lang-btn-label" for="p-lang-btn-checkbox" class="vector-dropdown-label cdx-button cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--weight-quiet cdx-button--action-progressive mw-portlet-lang-heading-23" aria-hidden="true" ><span class="vector-icon mw-ui-icon-language-progressive mw-ui-icon-wikimedia-language-progressive"></span> <span class="vector-dropdown-label-text">23 languages</span> </label> <div class="vector-dropdown-content"> <div class="vector-menu-content"> <ul class="vector-menu-content-list"> <li class="interlanguage-link interwiki-ar mw-list-item"><a href="https://ar.wikipedia.org/wiki/%D8%AE%D8%B2%D9%84_%D8%B4%D9%82%D9%8A" title="خزل شقي – Arabic" lang="ar" hreflang="ar" data-title="خزل شقي" data-language-autonym="العربية" data-language-local-name="Arabic" class="interlanguage-link-target"><span>العربية</span></a></li><li class="interlanguage-link interwiki-bn mw-list-item"><a href="https://bn.wikipedia.org/wiki/%E0%A6%85%E0%A6%B0%E0%A7%8D%E0%A6%A7_%E0%A6%AA%E0%A6%95%E0%A7%8D%E0%A6%B7%E0%A6%BE%E0%A6%98%E0%A6%BE%E0%A6%A4" title="অর্ধ পক্ষাঘাত – Bangla" lang="bn" hreflang="bn" data-title="অর্ধ পক্ষাঘাত" data-language-autonym="বাংলা" data-language-local-name="Bangla" class="interlanguage-link-target"><span>বাংলা</span></a></li><li class="interlanguage-link interwiki-ca mw-list-item"><a href="https://ca.wikipedia.org/wiki/Hemipar%C3%A8sia" title="Hemiparèsia – Catalan" lang="ca" hreflang="ca" data-title="Hemiparèsia" data-language-autonym="Català" data-language-local-name="Catalan" class="interlanguage-link-target"><span>Català</span></a></li><li class="interlanguage-link interwiki-cs mw-list-item"><a href="https://cs.wikipedia.org/wiki/Hemipar%C3%A9za" title="Hemiparéza – Czech" lang="cs" hreflang="cs" data-title="Hemiparéza" data-language-autonym="Čeština" data-language-local-name="Czech" class="interlanguage-link-target"><span>Čeština</span></a></li><li class="interlanguage-link interwiki-de badge-Q70894304 mw-list-item" title=""><a href="https://de.wikipedia.org/wiki/Hemiparese" title="Hemiparese – German" lang="de" hreflang="de" data-title="Hemiparese" data-language-autonym="Deutsch" data-language-local-name="German" class="interlanguage-link-target"><span>Deutsch</span></a></li><li class="interlanguage-link interwiki-et mw-list-item"><a href="https://et.wikipedia.org/wiki/Hemiparees" title="Hemiparees – Estonian" lang="et" hreflang="et" data-title="Hemiparees" data-language-autonym="Eesti" data-language-local-name="Estonian" class="interlanguage-link-target"><span>Eesti</span></a></li><li class="interlanguage-link interwiki-es mw-list-item"><a href="https://es.wikipedia.org/wiki/Hemiparesia" title="Hemiparesia – Spanish" lang="es" hreflang="es" data-title="Hemiparesia" data-language-autonym="Español" data-language-local-name="Spanish" class="interlanguage-link-target"><span>Español</span></a></li><li class="interlanguage-link interwiki-fa mw-list-item"><a href="https://fa.wikipedia.org/wiki/%D9%87%D9%85%DB%8C%E2%80%8C%D9%BE%D8%A7%D8%B1%D8%B2%DB%8C" title="همی‌پارزی – Persian" lang="fa" hreflang="fa" data-title="همی‌پارزی" data-language-autonym="فارسی" data-language-local-name="Persian" class="interlanguage-link-target"><span>فارسی</span></a></li><li class="interlanguage-link interwiki-fr mw-list-item"><a href="https://fr.wikipedia.org/wiki/H%C3%A9mipar%C3%A9sie" title="Hémiparésie – French" lang="fr" hreflang="fr" data-title="Hémiparésie" data-language-autonym="Français" data-language-local-name="French" class="interlanguage-link-target"><span>Français</span></a></li><li class="interlanguage-link interwiki-ko mw-list-item"><a href="https://ko.wikipedia.org/wiki/%ED%8E%B8%EC%B8%A1_%EB%B6%80%EC%A0%84_%EB%A7%88%EB%B9%84" title="편측 부전 마비 – Korean" lang="ko" hreflang="ko" data-title="편측 부전 마비" data-language-autonym="한국어" data-language-local-name="Korean" class="interlanguage-link-target"><span>한국어</span></a></li><li class="interlanguage-link interwiki-id mw-list-item"><a href="https://id.wikipedia.org/wiki/Hemiparesis" title="Hemiparesis – Indonesian" lang="id" hreflang="id" data-title="Hemiparesis" data-language-autonym="Bahasa Indonesia" data-language-local-name="Indonesian" class="interlanguage-link-target"><span>Bahasa Indonesia</span></a></li><li class="interlanguage-link interwiki-it mw-list-item"><a href="https://it.wikipedia.org/wiki/Emiparesi" title="Emiparesi – Italian" lang="it" hreflang="it" data-title="Emiparesi" data-language-autonym="Italiano" data-language-local-name="Italian" class="interlanguage-link-target"><span>Italiano</span></a></li><li class="interlanguage-link interwiki-ja badge-Q70894304 mw-list-item" title=""><a href="https://ja.wikipedia.org/wiki/%E4%B8%8D%E5%85%A8%E7%89%87%E9%BA%BB%E7%97%BA" title="不全片麻痺 – Japanese" lang="ja" hreflang="ja" data-title="不全片麻痺" data-language-autonym="日本語" data-language-local-name="Japanese" class="interlanguage-link-target"><span>日本語</span></a></li><li class="interlanguage-link interwiki-pl mw-list-item"><a href="https://pl.wikipedia.org/wiki/Hemipareza" title="Hemipareza – Polish" lang="pl" hreflang="pl" data-title="Hemipareza" data-language-autonym="Polski" data-language-local-name="Polish" class="interlanguage-link-target"><span>Polski</span></a></li><li class="interlanguage-link interwiki-pt mw-list-item"><a href="https://pt.wikipedia.org/wiki/Hemiparesia" title="Hemiparesia – Portuguese" lang="pt" hreflang="pt" data-title="Hemiparesia" data-language-autonym="Português" data-language-local-name="Portuguese" class="interlanguage-link-target"><span>Português</span></a></li><li class="interlanguage-link interwiki-sr mw-list-item"><a href="https://sr.wikipedia.org/wiki/%D0%A5%D0%B5%D0%BC%D0%B8%D0%BF%D0%B0%D1%80%D0%B5%D0%B7%D0%B0" title="Хемипареза – Serbian" lang="sr" hreflang="sr" data-title="Хемипареза" data-language-autonym="Српски / srpski" data-language-local-name="Serbian" class="interlanguage-link-target"><span>Српски / srpski</span></a></li><li class="interlanguage-link interwiki-sv mw-list-item"><a href="https://sv.wikipedia.org/wiki/Hemipares" title="Hemipares – Swedish" lang="sv" hreflang="sv" data-title="Hemipares" data-language-autonym="Svenska" data-language-local-name="Swedish" class="interlanguage-link-target"><span>Svenska</span></a></li><li class="interlanguage-link interwiki-th mw-list-item"><a href="https://th.wikipedia.org/wiki/%E0%B8%AD%E0%B8%B1%E0%B8%A1%E0%B8%9E%E0%B8%A4%E0%B8%81%E0%B8%A9%E0%B9%8C%E0%B8%84%E0%B8%A3%E0%B8%B6%E0%B9%88%E0%B8%87%E0%B8%8B%E0%B8%B5%E0%B8%81" title="อัมพฤกษ์ครึ่งซีก – Thai" lang="th" hreflang="th" data-title="อัมพฤกษ์ครึ่งซีก" data-language-autonym="ไทย" data-language-local-name="Thai" class="interlanguage-link-target"><span>ไทย</span></a></li><li class="interlanguage-link interwiki-tr mw-list-item"><a href="https://tr.wikipedia.org/wiki/Hemiparezi" title="Hemiparezi – Turkish" lang="tr" hreflang="tr" data-title="Hemiparezi" data-language-autonym="Türkçe" data-language-local-name="Turkish" class="interlanguage-link-target"><span>Türkçe</span></a></li><li class="interlanguage-link interwiki-uk mw-list-item"><a href="https://uk.wikipedia.org/wiki/%D0%93%D0%B5%D0%BC%D1%96%D0%BF%D0%B0%D1%80%D0%B5%D0%B7" title="Геміпарез – Ukrainian" lang="uk" hreflang="uk" data-title="Геміпарез" data-language-autonym="Українська" data-language-local-name="Ukrainian" class="interlanguage-link-target"><span>Українська</span></a></li><li class="interlanguage-link interwiki-za mw-list-item"><a href="https://za.wikipedia.org/wiki/Mazmbiengj" title="Mazmbiengj – Zhuang" lang="za" hreflang="za" data-title="Mazmbiengj" data-language-autonym="Vahcuengh" data-language-local-name="Zhuang" class="interlanguage-link-target"><span>Vahcuengh</span></a></li><li class="interlanguage-link interwiki-zh-yue mw-list-item"><a href="https://zh-yue.wikipedia.org/wiki/%E5%8D%8A%E8%BA%AB%E4%B8%8D%E9%81%82" title="半身不遂 – Cantonese" lang="yue" hreflang="yue" data-title="半身不遂" data-language-autonym="粵語" data-language-local-name="Cantonese" class="interlanguage-link-target"><span>粵語</span></a></li><li class="interlanguage-link interwiki-zh mw-list-item"><a href="https://zh.wikipedia.org/wiki/%E8%BC%95%E5%81%8F%E7%99%B1" title="輕偏癱 – Chinese" lang="zh" hreflang="zh" data-title="輕偏癱" data-language-autonym="中文" data-language-local-name="Chinese" class="interlanguage-link-target"><span>中文</span></a></li> </ul> <div class="after-portlet after-portlet-lang"><span class="wb-langlinks-edit wb-langlinks-link"><a href="https://www.wikidata.org/wiki/Special:EntityPage/Q2291130#sitelinks-wikipedia" title="Edit interlanguage links" class="wbc-editpage">Edit links</a></span></div> </div> </div> </div> </header> <div class="vector-page-toolbar"> <div class="vector-page-toolbar-container"> <div id="left-navigation"> <nav 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div.hatnote{padding-left:1.6em;margin-bottom:0.5em}.mw-parser-output .hatnote i{font-style:normal}.mw-parser-output .hatnote+link+.hatnote{margin-top:-0.5em}@media print{body.ns-0 .mw-parser-output .hatnote{display:none!important}}</style><div role="note" class="hatnote navigation-not-searchable">Not to be confused with <a href="/wiki/Spastic_hemiplegia" title="Spastic hemiplegia">Spastic hemiplegia</a>.</div> <div class="shortdescription nomobile noexcerpt noprint searchaux" style="display:none">Medical condition</div><style data-mw-deduplicate="TemplateStyles:r1257001546">.mw-parser-output .infobox-subbox{padding:0;border:none;margin:-3px;width:auto;min-width:100%;font-size:100%;clear:none;float:none;background-color:transparent}.mw-parser-output .infobox-3cols-child{margin:auto}.mw-parser-output .infobox .navbar{font-size:100%}@media screen{html.skin-theme-clientpref-night .mw-parser-output .infobox-full-data:not(.notheme)>div:not(.notheme)[style]{background:#1f1f23!important;color:#f8f9fa}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .infobox-full-data:not(.notheme) div:not(.notheme){background:#1f1f23!important;color:#f8f9fa}}@media(min-width:640px){body.skin--responsive .mw-parser-output .infobox-table{display:table!important}body.skin--responsive .mw-parser-output .infobox-table>caption{display:table-caption!important}body.skin--responsive .mw-parser-output .infobox-table>tbody{display:table-row-group}body.skin--responsive .mw-parser-output .infobox-table tr{display:table-row!important}body.skin--responsive .mw-parser-output .infobox-table th,body.skin--responsive .mw-parser-output .infobox-table td{padding-left:inherit;padding-right:inherit}}</style><table class="infobox ib-medical-condition"><tbody><tr><th colspan="2" class="infobox-above" style="background:#ccc">Hemiparesis</th></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Medical_specialty" title="Medical specialty">Specialty</a></th><td class="infobox-data"><a href="/wiki/Neurology" title="Neurology">Neurology</a></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Signs_and_symptoms" title="Signs and symptoms">Symptoms</a></th><td class="infobox-data">Loss of motor skills on one side of body</td></tr><tr><th scope="row" class="infobox-label">Causes</th><td class="infobox-data"><a href="/wiki/Stroke" title="Stroke">Stroke</a></td></tr></tbody></table> <p><b>Hemiparesis</b>, also called unilateral <a href="/wiki/Paresis" title="Paresis">paresis</a>, is the weakness of one entire side of the body (<i><a href="https://en.wiktionary.org/wiki/hemi-#Prefix" class="extiw" title="wikt:hemi-">hemi-</a></i> means "half"). <b>Hemiplegia</b>, in its most severe form, is the complete <a href="/wiki/Paralysis" title="Paralysis">paralysis</a> of one entire side of the body. Either hemiparesis or hemiplegia can result from a variety of medical causes, including congenital conditions, trauma, tumors, <a href="/wiki/Traumatic_brain_injury" title="Traumatic brain injury">traumatic brain injury</a> and stroke.<sup id="cite_ref-FactsInfo_1-0" class="reference"><a href="#cite_note-FactsInfo-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> </p> <meta property="mw:PageProp/toc" /> <div class="mw-heading mw-heading2"><h2 id="Signs_and_symptoms">Signs and symptoms</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hemiparesis&action=edit&section=1" title="Edit section: Signs and symptoms"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Different types of hemiparesis can impair different bodily functions. Some effects, such as weakness or partial paralysis of a limb on the affected side, are generally always to be expected. Other impairments can appear, upon external examination, to be unrelated to the limb weakness, but are nevertheless also caused by damage to the affected side of the brain.<sup id="cite_ref-FactsInfo_1-1" class="reference"><a href="#cite_note-FactsInfo-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Loss_of_motor_skills">Loss of motor skills</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hemiparesis&action=edit&section=2" title="Edit section: Loss of motor skills"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>People with hemiparesis often have difficulties maintaining their balance due to limb paralysis, leading to an inability to properly shift body weight. This makes performing everyday activities, such as dressing, eating, grasping objects, or using the bathroom, more difficult. Hemiparesis with origin in the lower section of the brain creates a condition known as <a href="/wiki/Ataxia" title="Ataxia">ataxia</a>, a loss of both gross and fine motor skills, which often manifests as a staggering and stumbling gait. Pure motor hemiparesis, a form of hemiparesis characterized by one-sided weakness in the leg, arm, and face, is the most commonly diagnosed form of hemiparesis.<sup id="cite_ref-FactsInfo_1-2" class="reference"><a href="#cite_note-FactsInfo-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Pusher_syndrome">Pusher syndrome</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hemiparesis&action=edit&section=3" title="Edit section: Pusher syndrome"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">Main article: <a href="/wiki/Pusher_syndrome" title="Pusher syndrome">Pusher syndrome</a></div> <p>Pusher syndrome is a clinical disorder following left- or right-sided brain damage, in which patients actively push their weight away from the non-hemiparetic side to the hemiparetic side. This is in contrast to most <a href="/wiki/Stroke" title="Stroke">stroke</a> patients, who typically prefer to bear more weight on their nonhemiparetic side. Pusher syndrome can vary in severity and leads to a loss of postural balance.<sup id="cite_ref-Karnath03_2-0" class="reference"><a href="#cite_note-Karnath03-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> The lesion involved in this syndrome is thought to be in the posterior <a href="/wiki/Thalamus" title="Thalamus">thalamus</a> on either side, or in multiple areas of the right <a href="/wiki/Cerebral_hemisphere" title="Cerebral hemisphere">cerebral hemisphere</a>.<sup id="cite_ref-3" class="reference"><a href="#cite_note-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-4" class="reference"><a href="#cite_note-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> </p><p>A diagnosis of pusher syndrome includes observation of three behaviours. The most obvious one is the patient's regularly occurring (not just occasional) tendency to spontaneously hold a body posture in which the torso is longitudinally tilted toward the paretic side of the body. The second is the patient's use of the nonparetic extremities including abduction and extension of the extremities of the non-affected side, to help in the push toward the affected (paretic) side, resulting in an abnormal lateral tilt of the body axis. The third is that, when a care provider tries to realign the patient's body to an upright posture, the patient spontaneously pushes back against the attempt, feeling this normal posture to be off balance.<sup id="cite_ref-Karnath03_2-1" class="reference"><a href="#cite_note-Karnath03-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> </p><p>The pusher syndrome is present in 10.4% of patients with acute stroke and hemiparesis,<sup id="cite_ref-Pedersen96_5-0" class="reference"><a href="#cite_note-Pedersen96-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> and may increase the time needed for physical rehabilitation. The Copenhagen Stroke Study found that patients who presented with <a href="/wiki/Ipsilateral" class="mw-redirect" title="Ipsilateral">ipsilateral</a> pushing took an average of 3.6 additional weeks to reach the same functional outcome, as measured by the <a href="/wiki/Barthel_Index" class="mw-redirect" title="Barthel Index">Barthel Index</a>, compared with acute-stroke and hemiparesis patients who did not engage in ipsilateral pushing.<sup id="cite_ref-Pedersen96_5-1" class="reference"><a href="#cite_note-Pedersen96-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> </p><p>Pushing behaviour demonstrates that these patients’ perception of their body <a href="/wiki/Human_position" class="mw-redirect" title="Human position">posture</a> in relation to gravity has been altered. They experience their body as oriented "upright" when the body is actually tilted to the side of the brain lesion. At the same time, their processing of visual and vestibular inputs when determining the <a href="/wiki/Subjective_visual_vertical" title="Subjective visual vertical">subjective visual vertical</a> seems to be normal. When they are sitting, the pushing presents as a strong lateral lean toward the affected side. When they stand up, the pushing creates a highly unstable situation as they are unable to support their body weight on the weakened lower extremity. The resulting increased risk of falls must be addressed with therapy aimed at correcting their altered proprioceptive perception of vertical.<sup id="cite_ref-Karnath03_2-2" class="reference"><a href="#cite_note-Karnath03-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> </p><p>Pusher syndrome is sometimes confused with <a href="/wiki/Hemispatial_neglect" title="Hemispatial neglect">hemispatial neglect</a>, and the two terms are sometimes (incorrectly) used interchangeably. Some older theories suggested that hemispatial neglect is what leads to pusher syndrome.<sup id="cite_ref-Karnath03_2-3" class="reference"><a href="#cite_note-Karnath03-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> However, hemispatial neglect occurs mostly when there is a right-hemisphere lesion, and one study found that pusher syndrome is also present in patients with left hemisphere lesions (which generally also lead to <a href="/wiki/Aphasia" title="Aphasia">aphasia</a>).<sup id="cite_ref-6" class="reference"><a href="#cite_note-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> </p><p>Neglect and aphasia are not the cause of pusher syndrome, although both are highly correlated with it (possibly because the brain structures associated with these syndromes are close to each other).<sup id="cite_ref-Karnath03_2-4" class="reference"><a href="#cite_note-Karnath03-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> </p><p>Physical therapists treating patients with pusher syndrome focus on <a href="/wiki/Motor_learning" title="Motor learning">motor learning</a> strategies that reduce its ill effects, such as the use of verbal cues, consistent feedback, and practice correcting orientation and shifting weight,<sup id="cite_ref-7" class="reference"><a href="#cite_note-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> for example sitting with their stronger side next to a wall and repeatedly leaning towards the wall, thus gradually re-training the brain to recognize true vertical.<sup id="cite_ref-Karnath03_2-5" class="reference"><a href="#cite_note-Karnath03-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> </p><p>A physical-therapy approach for patients with pusher syndrome debuted in 2003 suggests that the visual control of vertical upright orientation, which is undisturbed in these patients, is the most important intervention. In sequential order, treatment is designed to enable patients to realize their altered perception of vertical, use visual aids for feedback about body orientation, learn the movements necessary to reach proper vertical position, and maintain vertical body position while performing other activities.<sup id="cite_ref-Karnath03_2-6" class="reference"><a href="#cite_note-Karnath03-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Classification_of_pusher_syndrome">Classification of pusher syndrome</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hemiparesis&action=edit&section=4" title="Edit section: Classification of pusher syndrome"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Individuals who present with pusher syndrome or lateropulsion, as defined by Davies, vary in their degree and severity of this condition and therefore appropriate measures need to be implemented in order to evaluate the level of "pushing". There has been a shift towards early diagnosis and evaluation of functional status for individuals who have had a <a href="/wiki/Stroke" title="Stroke">stroke</a> and presenting with pusher syndrome in order to decrease the time spent as an in-patient at hospitals and promote the return to function as early as possible.<sup id="cite_ref-Lagerqvist_&_Skargren_8-0" class="reference"><a href="#cite_note-Lagerqvist_&_Skargren-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup> Moreover, in order to assist therapists in the classification of pusher syndrome, specific scales have been developed with validity that coincides with the criteria set out by Davies' definition of "pusher syndrome".<sup id="cite_ref-Babyar09_9-0" class="reference"><a href="#cite_note-Babyar09-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> In a study by Babyar <i>et al.</i>, an examination of such scales helped determine the relevance, practical aspects and clinimetric properties of three specific scales existing today for lateropulsion.<sup id="cite_ref-Babyar09_9-1" class="reference"><a href="#cite_note-Babyar09-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> The three scales examined were the Clinical Scale of Contraversive Pushing, Modified Scale of Contraversive Pushing, and the Burke Lateropulsion Scale.<sup id="cite_ref-Babyar09_9-2" class="reference"><a href="#cite_note-Babyar09-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> The results of the study show that reliability for each scale is good; moreover, the Scale of Contraversive Pushing was determined to have acceptable clinimetric properties, and the other two scales addressed more functional positions that will help therapists with clinical decisions and research.<sup id="cite_ref-Babyar09_9-3" class="reference"><a href="#cite_note-Babyar09-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Causes">Causes</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hemiparesis&action=edit&section=5" title="Edit section: Causes"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The most common cause of hemiparesis and hemiplegia is <a href="/wiki/Stroke" title="Stroke">stroke</a>. Strokes can cause a variety of movement disorders, depending on the location and severity of the <a href="/wiki/Lesion" title="Lesion">lesion</a>. Hemiplegia is common when the stroke affects the <a href="/wiki/Corticospinal_tract" title="Corticospinal tract">corticospinal tract</a>. Other causes of hemiplegia include <a href="/wiki/Spinal_cord_injury" title="Spinal cord injury">spinal cord injury</a>, specifically <a href="/wiki/Brown-S%C3%A9quard_syndrome" title="Brown-Séquard syndrome">Brown-Séquard syndrome</a>, <a href="/wiki/Traumatic_brain_injury" title="Traumatic brain injury">traumatic brain injury</a>, or disease affecting the <a href="/wiki/Brain" title="Brain">brain</a>. A permanent brain injury that occurs during the intrauterine life, during delivery or early in life can lead to hemiplegic <a href="/wiki/Cerebral_palsy" title="Cerebral palsy">cerebral palsy</a>. As a <a href="/wiki/Lesion" title="Lesion">lesion</a> that results in hemiplegia occurs in the brain or spinal cord, hemiplegic muscles display features of the <a href="/wiki/Upper_motor_neuron_syndrome" title="Upper motor neuron syndrome">upper motor neuron syndrome</a>. Features other than weakness include decreased movement control, <a href="/wiki/Clonus" title="Clonus">clonus</a> (a series of involuntary rapid muscle contractions), <a href="/wiki/Spasticity" title="Spasticity">spasticity</a>, exaggerated deep tendon reflexes and decreased endurance.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (August 2021)">citation needed</span></a></i>]</sup> </p><p>The incidence of hemiplegia is much higher in premature babies than term babies. There is also a high incidence of hemiplegia during <a href="/wiki/Pregnancy" title="Pregnancy">pregnancy</a> and experts believe that this may be related to either a traumatic delivery, use of <a href="/wiki/Forceps" title="Forceps">forceps</a> or some event which causes brain injury.<sup id="cite_ref-10" class="reference"><a href="#cite_note-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup> There is tentative evidence of an association with undiagnosed <a href="/wiki/Celiac_disease" class="mw-redirect" title="Celiac disease">celiac disease</a> and improvement after withdrawal of <a href="/wiki/Gluten" title="Gluten">gluten</a> from the diet.<sup id="cite_ref-ShapiroBlanco2017_11-0" class="reference"><a href="#cite_note-ShapiroBlanco2017-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup> </p><p>Other causes of hemiplegia in adults include <a href="/wiki/Physical_trauma" class="mw-redirect" title="Physical trauma">trauma</a>, <a href="/wiki/Bleeding" title="Bleeding">bleeding</a>, brain <a href="/wiki/Infection" title="Infection">infections</a> and <a href="/wiki/Cancer" title="Cancer">cancers</a>. Individuals who have uncontrolled <a href="/wiki/Diabetes_mellitus" class="mw-redirect" title="Diabetes mellitus">diabetes</a>, <a href="/wiki/Hypertension" title="Hypertension">hypertension</a> or those who smoke have a higher chance of developing a stroke. Weakness on one side of the face may occur and may be due to a viral infection, stroke or a cancer.<sup id="cite_ref-12" class="reference"><a href="#cite_note-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Common">Common</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hemiparesis&action=edit&section=6" title="Edit section: Common"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <ul><li><b>Vascular</b>: <a href="/wiki/Cerebral_hemorrhage" class="mw-redirect" title="Cerebral hemorrhage">cerebral hemorrhage</a>, <a href="/wiki/Stroke" title="Stroke">stroke</a>, <a href="/wiki/Cerebral_palsy" title="Cerebral palsy">cerebral palsy</a></li> <li><b>Infective</b>: <a href="/wiki/Encephalitis" title="Encephalitis">encephalitis</a>, <a href="/wiki/Meningitis" title="Meningitis">meningitis</a>, <a href="/wiki/Brain_abscess" title="Brain abscess">brain abscess</a>, <a href="/wiki/Cerebral_palsy" title="Cerebral palsy">cerebral palsy</a>, <a href="/wiki/Spinal_epidural_abscess" class="mw-redirect" title="Spinal epidural abscess">spinal epidural abscess</a></li> <li><b>Neoplastic</b>: <a href="/wiki/Glioma" title="Glioma">glioma</a>, <a href="/wiki/Meningioma" title="Meningioma">meningioma</a>, <a href="/wiki/Brain_tumors" class="mw-redirect" title="Brain tumors">brain tumors</a>, <a href="/wiki/Spinal_cord_tumors" class="mw-redirect" title="Spinal cord tumors">spinal cord tumors</a></li> <li><b>Demyelination</b>: <a href="/wiki/Multiple_sclerosis" title="Multiple sclerosis">multiple sclerosis</a>, <a href="/wiki/Disseminated_sclerosis" class="mw-redirect" title="Disseminated sclerosis">disseminated sclerosis</a>, <a href="/wiki/Acute_disseminated_encephalomyelitis" title="Acute disseminated encephalomyelitis">ADEM</a>, <a href="/wiki/Neuromyelitis_optica" class="mw-redirect" title="Neuromyelitis optica">neuromyelitis optica</a></li> <li><b>Traumatic</b>: cerebral lacerations, <a href="/wiki/Subdural_hematoma" title="Subdural hematoma">subdural hematoma</a>, <a href="/wiki/Epidural_hematoma" title="Epidural hematoma">epidural hematoma</a>, <a href="/wiki/Cerebral_palsy" title="Cerebral palsy">cerebral palsy</a>, <a href="/wiki/Vertebral_compression_fracture" title="Vertebral compression fracture">vertebral compression fracture</a></li> <li><b>Iatrogenic</b>: local anaesthetic injections given intra-arterially rapidly, instead of given in a nerve branch.</li> <li><b>Ictal</b>: <a href="/wiki/Seizure" title="Seizure">seizure</a>, <a href="/wiki/Todd%27s_paralysis" class="mw-redirect" title="Todd's paralysis">Todd's paralysis</a></li> <li><b>Congenital</b>: <a href="/wiki/Cerebral_palsy" title="Cerebral palsy">cerebral palsy</a>, Neonatal-Onset Multisystem Inflammatory Disease (NOMID)</li> <li><b>Degenerative</b>: <a href="/wiki/ALS" title="ALS">ALS</a>, <a href="/wiki/Corticobasal_degeneration" title="Corticobasal degeneration">corticobasal degeneration</a></li> <li><b>Parasomnia</b>: <a href="/wiki/Sleep_paralysis" title="Sleep paralysis">sleep paralysis</a><sup id="cite_ref-13" class="reference"><a href="#cite_note-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup></li></ul> <div class="mw-heading mw-heading2"><h2 id="Mechanism">Mechanism</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hemiparesis&action=edit&section=7" title="Edit section: Mechanism"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Movement of the body is primarily controlled by the <a href="/wiki/Pyramidal_tract" class="mw-redirect" title="Pyramidal tract">pyramidal (or corticospinal) tract</a>, a pathway of neurons that begins in the <a href="/wiki/Motor_cortex" title="Motor cortex">motor areas of the brain</a>, projects down through the <a href="/wiki/Internal_capsule" title="Internal capsule">internal capsule</a>, continues through the <a href="/wiki/Brainstem" title="Brainstem">brainstem</a>, decussates (or cross midline) at the <b>lower</b> <a href="/wiki/Medulla_oblongata" title="Medulla oblongata">medulla</a>, then travels down the spinal cord into the <a href="/wiki/Motor_neuron" title="Motor neuron">motor neurons</a> that control each muscle. In addition to this main pathway, there are smaller contributing pathways (including the <a href="/wiki/Anterior_corticospinal_tract" title="Anterior corticospinal tract">anterior corticospinal tract</a>), some portions of which do not cross the midline.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (August 2021)">citation needed</span></a></i>]</sup> </p><p>Because of this anatomy, injuries to the pyramidal tract above the medulla generally cause <b><a href="/wiki/Contralateral" class="mw-redirect" title="Contralateral">contralateral</a> hemiparesis</b> (weakness on the opposite side as the injury). Injuries at the lower medulla, spinal cord, and peripheral nerves result in <b><a href="/wiki/Ipsilateral" class="mw-redirect" title="Ipsilateral">ipsilateral</a> hemiparesis</b>.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (August 2021)">citation needed</span></a></i>]</sup> </p><p>In a few cases, lesions above the medulla have resulted in ipsilateral hemiparesis: </p> <ul><li>In several reported cases, patients with hemiparesis from an old <i>contralateral</i> brain injury subsequently experienced worsening of their hemiparesis when hit with a second stroke in the <i>ipsilateral</i> brain.<sup id="cite_ref-Ago2003_14-0" class="reference"><a href="#cite_note-Ago2003-14"><span class="cite-bracket">[</span>14<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Song2005_15-0" class="reference"><a href="#cite_note-Song2005-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Yamamoto2007_16-0" class="reference"><a href="#cite_note-Yamamoto2007-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup> The authors hypothesize that brain reorganization after the initial injury led to more reliance on uncrossed motor pathways, and when these compensatory pathways were damaged by a second stroke, motor function worsened further.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (July 2021)">citation needed</span></a></i>]</sup></li> <li>A case report describes a patient with a congenitally uncrossed pyramidal tract, who developed right-sided hemiparesis after a hemorrhage in the right brain.<sup id="cite_ref-Terakawa2000_17-0" class="reference"><a href="#cite_note-Terakawa2000-17"><span class="cite-bracket">[</span>17<span class="cite-bracket">]</span></a></sup></li></ul> <div class="mw-heading mw-heading2"><h2 id="Diagnosis">Diagnosis</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hemiparesis&action=edit&section=8" title="Edit section: Diagnosis"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Hemiplegia is identified by clinical examination by a health professional, such as a <a href="/wiki/Physiotherapist" class="mw-redirect" title="Physiotherapist">physiotherapist</a> or doctor. <a href="/wiki/Radiological" class="mw-redirect" title="Radiological">Radiological</a> studies like a <a href="/wiki/Full-body_CT_scan" title="Full-body CT scan">CT scan</a> or <a href="/wiki/Magnetic_resonance_imaging" title="Magnetic resonance imaging">magnetic resonance imaging</a> 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 <a href="/wiki/Seizure" title="Seizure">seizures</a> may undergo tests to determine where the focus of excess electrical activity is.<sup id="cite_ref-18" class="reference"><a href="#cite_note-18"><span class="cite-bracket">[</span>18<span class="cite-bracket">]</span></a></sup> </p><p>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.<sup id="cite_ref-19" class="reference"><a href="#cite_note-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Assessment_tools">Assessment tools</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hemiparesis&action=edit&section=9" title="Edit section: Assessment tools"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>There are a variety of standardized assessment scales available to <a href="/wiki/Physiotherapists" class="mw-redirect" title="Physiotherapists">physiotherapists</a> and other <a href="/wiki/Health_care_professionals" class="mw-redirect" title="Health care professionals">health care professionals</a> 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:<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (August 2021)">citation needed</span></a></i>]</sup> </p> <ul><li>Prioritize treatment interventions based on specific identifiable motor and sensory deficits</li> <li>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</li> <li>Evaluate the potential burden of care and monitor any changes based on either improving or declining scores</li></ul> <p>Some of the most commonly used scales in the assessment of hemiplegia are: </p> <ul><li>The <a href="/wiki/Fugl-Meyer_Assessment_of_sensorimotor_function" title="Fugl-Meyer Assessment of sensorimotor function">Fugl-Meyer Assessment of sensorimotor function</a> (FMA)<sup id="cite_ref-20" class="reference"><a href="#cite_note-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup></li></ul> <p>The FMA is often used as a measure of functional or physical impairment following a <a href="/wiki/Cerebrovascular_accident" class="mw-redirect" title="Cerebrovascular accident">cerebrovascular accident</a> (CVA).<b><sup id="cite_ref-21" class="reference"><a href="#cite_note-21"><span class="cite-bracket">[</span>21<span class="cite-bracket">]</span></a></sup> </b>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 <a href="/wiki/Stroke_recovery" title="Stroke recovery">stroke recovery</a>. 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<b>. </b><sup id="cite_ref-22" class="reference"><a href="#cite_note-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup> Administration of the FMA should be done after reviewing a training manual.<sup id="cite_ref-23" class="reference"><a href="#cite_note-23"><span class="cite-bracket">[</span>23<span class="cite-bracket">]</span></a></sup> </p> <ul><li>The <a href="/w/index.php?title=Chedoke-McMaster_Stroke_Assessment&action=edit&redlink=1" class="new" title="Chedoke-McMaster Stroke Assessment (page does not exist)">Chedoke-McMaster Stroke Assessment</a> (CMSA)<sup id="cite_ref-24" class="reference"><a href="#cite_note-24"><span class="cite-bracket">[</span>24<span class="cite-bracket">]</span></a></sup></li></ul> <p>This test is a reliable measure of two separate components evaluating both motor impairment and <a href="/wiki/Disability" title="Disability">disability</a>.<sup id="cite_ref-25" class="reference"><a href="#cite_note-25"><span class="cite-bracket">[</span>25<span class="cite-bracket">]</span></a></sup> 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 <a href="/wiki/Flaccid_paralysis" title="Flaccid paralysis">flaccid paralysis</a> to normal motor functioning. A training workshop is recommended if the measure is being utilized for the purpose of data collection.<sup id="cite_ref-26" class="reference"><a href="#cite_note-26"><span class="cite-bracket">[</span>26<span class="cite-bracket">]</span></a></sup> </p> <ul><li>The <a href="/w/index.php?title=Stroke_Rehabilitation_Assessment_of_Movement&action=edit&redlink=1" class="new" title="Stroke Rehabilitation Assessment of Movement (page does not exist)">Stroke Rehabilitation Assessment of Movement</a> (STREAM)<sup id="cite_ref-27" class="reference"><a href="#cite_note-27"><span class="cite-bracket">[</span>27<span class="cite-bracket">]</span></a></sup></li></ul> <p>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.<sup id="cite_ref-28" class="reference"><a href="#cite_note-28"><span class="cite-bracket">[</span>28<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Treatment">Treatment</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hemiparesis&action=edit&section=10" title="Edit section: Treatment"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Treatment for hemiparesis is the same treatment given to those recovering from strokes or brain injuries.<sup id="cite_ref-FactsInfo_1-3" class="reference"><a href="#cite_note-FactsInfo-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> Health care professionals such as <a href="/wiki/Physical_therapists" class="mw-redirect" title="Physical therapists">physical therapists</a> and <a href="/wiki/Occupational_therapists" class="mw-redirect" title="Occupational therapists">occupational therapists</a> play a large role in assisting these patients in their recovery. Treatment is focused on improving sensation and motor abilities, allowing the patient to better manage their activities of daily living. Some strategies used for treatment include promoting the use of the hemiparetic limb during functional tasks, maintaining range of motion, and using <a href="/wiki/Neuromuscular_electrical_stimulation" class="mw-redirect" title="Neuromuscular electrical stimulation">neuromuscular electrical stimulation</a> to decrease <a href="/wiki/Spasticity" title="Spasticity">spasticity</a> and increase awareness of the limb.<sup id="cite_ref-29" class="reference"><a href="#cite_note-29"><span class="cite-bracket">[</span>29<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-30" class="reference"><a href="#cite_note-30"><span class="cite-bracket">[</span>30<span class="cite-bracket">]</span></a></sup> </p><p>At the more advanced level, using <a href="/wiki/Constraint-induced_movement_therapy" title="Constraint-induced movement therapy">constraint-induced movement therapy</a> will encourage overall function and use of the affected limb.<sup id="cite_ref-31" class="reference"><a href="#cite_note-31"><span class="cite-bracket">[</span>31<span class="cite-bracket">]</span></a></sup> <a href="/wiki/Mirror_box" class="mw-redirect" title="Mirror box">Mirror Therapy</a> (MT) has also been used early in stroke rehabilitation and involves using the unaffected limb to stimulate motor function of the hemiparetic limb. Results from a study on patients with severe hemiparesis concluded that MT was successful in improving motor and sensory function of the distal hemiparetic upper limb.<sup id="cite_ref-32" class="reference"><a href="#cite_note-32"><span class="cite-bracket">[</span>32<span class="cite-bracket">]</span></a></sup> Active participation is critical to the motor learning and recovery process, therefore it's important to keep these individuals motivated so they can make continual improvements.<sup id="cite_ref-33" class="reference"><a href="#cite_note-33"><span class="cite-bracket">[</span>33<span class="cite-bracket">]</span></a></sup><br /> Also speech pathologists may work to increase function for people with hemiparesis.<sup id="cite_ref-34" class="reference"><a href="#cite_note-34"><span class="cite-bracket">[</span>34<span class="cite-bracket">]</span></a></sup> </p><p>Treatment should be based on assessment by the relevant health professionals, including <a href="/wiki/Physiotherapists" class="mw-redirect" title="Physiotherapists">physiotherapists</a>, doctors and <a href="/wiki/Occupational_therapists" class="mw-redirect" title="Occupational therapists">occupational therapists</a>. Muscles with severe motor impairment including weakness need these therapists to assist them with specific exercise, and are likely to require help to do this.<sup id="cite_ref-35" class="reference"><a href="#cite_note-35"><span class="cite-bracket">[</span>35<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Medication">Medication</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hemiparesis&action=edit&section=11" title="Edit section: Medication"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Drugs can be used to treat issues related to the Upper Motor Neuron Syndrome. Drugs like <a href="/wiki/Chlordiazepoxide" title="Chlordiazepoxide">Librium</a> or <a href="/wiki/Diazepam" title="Diazepam">Valium</a> could be used as a relaxant. Drugs are also given to individuals who have recurrent seizures, which may be a separate but related problem after <a href="/wiki/Brain_injury" title="Brain injury">brain injury</a>.<sup id="cite_ref-mcgill_36-0" class="reference"><a href="#cite_note-mcgill-36"><span class="cite-bracket">[</span>36<span class="cite-bracket">]</span></a></sup> Intra-muscular injection of <a href="/wiki/Botulinum_toxin" title="Botulinum toxin">botulinum toxin</a> A is used to treat spasticity that is associated with hemiparesis both in cerebral palsy children and stroke in adults. It can be injected into a muscle or more commonly muscle groups of the upper or lower extremities. Botulinum toxin A induces temporary muscle paralysis or relaxation. The main goal of botulinum toxin A is to maintain the range of motion of affected joints and to prevent the occurrence of fixed joint contractures or stiffness.<sup id="cite_ref-37" class="reference"><a href="#cite_note-37"><span class="cite-bracket">[</span>37<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-38" class="reference"><a href="#cite_note-38"><span class="cite-bracket">[</span>38<span class="cite-bracket">]</span></a></sup> A randomized trial pointed out that individualized homeopathic medication in addition to the standard physiotherapy might have some effect in post-stroke hemiparesis.<sup id="cite_ref-39" class="reference"><a href="#cite_note-39"><span class="cite-bracket">[</span>39<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Surgery">Surgery</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hemiparesis&action=edit&section=12" title="Edit section: Surgery"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Surgery may be used if the individual develops a secondary issue of <a href="/wiki/Contracture" title="Contracture">contracture</a>, from a severe imbalance of muscle activity. In such cases the <a href="/wiki/Surgeon" title="Surgeon">surgeon</a> may cut the <a href="/wiki/Ligament" title="Ligament">ligaments</a> and relieve joint contractures. Individuals who are unable to swallow may have a tube inserted into the stomach. This allows food to be given directly into the stomach. The food is in liquid form and instilled at low rates. Some individuals with hemiplegia will benefit from some type of <a href="/wiki/Prosthesis" title="Prosthesis">prosthetic</a> device. There are many types of braces and splints available to stabilize a joint, assist with walking and keep the upper body erect.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (June 2022)">citation needed</span></a></i>]</sup> </p> <div class="mw-heading mw-heading3"><h3 id="Rehabilitation">Rehabilitation</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hemiparesis&action=edit&section=13" title="Edit section: Rehabilitation"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Rehabilitation is the main treatment of individuals with hemiplegia. In all cases, the major aim of rehabilitation is to regain maximum function and quality of life. Both physical and <a href="/wiki/Occupational_therapy" title="Occupational therapy">occupational therapy</a> can significantly improve the quality of life. </p> <div class="mw-heading mw-heading3"><h3 id="Physical_therapy">Physical therapy</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hemiparesis&action=edit&section=14" title="Edit section: Physical therapy"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p><a href="/wiki/Physical_therapy" title="Physical therapy">Physical therapy</a> (PT) can help improve muscle strength & coordination, mobility (such as standing and walking), and other physical function using different sensorimotor techniques.<sup id="cite_ref-40" class="reference"><a href="#cite_note-40"><span class="cite-bracket">[</span>40<span class="cite-bracket">]</span></a></sup> Physiotherapists can also help reduce shoulder pain by maintaining shoulder range of motion, as well as using <a href="/wiki/Functional_electrical_stimulation" title="Functional electrical stimulation">Functional electrical stimulation</a>.<sup id="cite_ref-41" class="reference"><a href="#cite_note-41"><span class="cite-bracket">[</span>41<span class="cite-bracket">]</span></a></sup> Supportive devices, such as braces or slings, can be used to help prevent or treat shoulder subluxation<sup id="cite_ref-42" class="reference"><a href="#cite_note-42"><span class="cite-bracket">[</span>42<span class="cite-bracket">]</span></a></sup> in the hopes to minimize disability and pain. Although many individuals with stroke experience both shoulder pain and shoulder subluxation, the two are mutually exclusive.<sup id="cite_ref-43" class="reference"><a href="#cite_note-43"><span class="cite-bracket">[</span>43<span class="cite-bracket">]</span></a></sup> A treatment method that can be implemented with the goal of helping to regain motor function in the affected limb is <a href="/wiki/Constraint-induced_movement_therapy" title="Constraint-induced movement therapy">constraint-induced movement therapy</a>. This consists of constraining the unaffected limb, forcing the affected limb to accomplish tasks of daily living.<sup id="cite_ref-44" class="reference"><a href="#cite_note-44"><span class="cite-bracket">[</span>44<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Occupational_therapy">Occupational therapy</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hemiparesis&action=edit&section=15" title="Edit section: Occupational therapy"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p><a href="/wiki/Occupational_therapy" title="Occupational therapy">Occupational therapists</a> may specifically help with hemiplegia with tasks such as improving hand function, strengthening hand, shoulder and torso, and participating in activities of daily living (ADLs), such as eating and dressing. Therapists may also recommend a hand splint for active use or for stretching at night. Some therapists actually make the splint; others may measure your child's hand and order a splint. OTs educate patients and family on compensatory techniques to continue participating in daily living, fostering independence for the individual - which may include, environmental modification, use of adaptive equipment, sensory integration, etc.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (August 2021)">citation needed</span></a></i>]</sup> </p> <div class="mw-heading mw-heading3"><h3 id="Orthotic_Intervention">Orthotic Intervention</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hemiparesis&action=edit&section=16" title="Edit section: Orthotic Intervention"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Orthotic devices are one type of intervention for relieving symptoms of hemiparesis. Commonly called braces, orthotics range from 'off the shelf' to custom fabricated solutions, but their main goal is alike, to supplement diminished or missing muscle function and joint laxity. A wide range of orthotic treatment can be designed by a Certified Orthotist (C.O.) or Certified Prosthetist Orthotist (C.P.O). Orthotics may be made of metal, plastic, or composite material (such as fiberglass, dyneema (<a href="/wiki/UHMWPE" class="mw-redirect" title="UHMWPE">UHMWPE</a>,) carbon fiber; etc.) and design may be changed to address many different conditions.<sup id="cite_ref-45" class="reference"><a href="#cite_note-45"><span class="cite-bracket">[</span>45<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Prognosis">Prognosis</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hemiparesis&action=edit&section=17" title="Edit section: Prognosis"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Hemiplegia is not a progressive disorder, except in progressive conditions like a growing brain tumour. Once the injury has occurred, the symptoms should not worsen. However, because of lack of mobility, other complications can occur. Complications may include muscle and joint stiffness, loss of aerobic fitness, muscle spasms, bed sores, pressure ulcers and <a href="/wiki/Thrombus" title="Thrombus">blood clots</a>.<sup id="cite_ref-healthopedia_46-0" class="reference"><a href="#cite_note-healthopedia-46"><span class="cite-bracket">[</span>46<span class="cite-bracket">]</span></a></sup> </p><p>Sudden recovery from hemiplegia is very rare. Many of the individuals will have limited recovery, but the majority will improve from intensive, specialised rehabilitation. Potential to progress may differ in cerebral palsy, compared to adult acquired brain injury. It is vital to integrate the hemiplegic child into society and encourage them in their daily living activities. With time, some individuals may make remarkable progress.<sup id="cite_ref-healthopedia_46-1" class="reference"><a href="#cite_note-healthopedia-46"><span class="cite-bracket">[</span>46<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Popular_culture">Popular culture</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hemiparesis&action=edit&section=18" title="Edit section: Popular culture"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <ul><li>In <a href="/wiki/Barbara_Kingsolver" title="Barbara Kingsolver">Barbara Kingsolver</a>'s novel, <i><a href="/wiki/The_Poisonwood_Bible" title="The Poisonwood Bible">The Poisonwood Bible</a></i>, the character Adah is incorrectly diagnosed, in childhood, as having hemiplegia.<sup id="cite_ref-47" class="reference"><a href="#cite_note-47"><span class="cite-bracket">[</span>47<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-48" class="reference"><a href="#cite_note-48"><span class="cite-bracket">[</span>48<span class="cite-bracket">]</span></a></sup></li> <li>Rock band <a href="/wiki/HAERTS" class="mw-redirect" title="HAERTS">HAERTS</a> released an EP called <i>Hemiplegia</i> via <a href="/wiki/Columbia_Records" title="Columbia Records">Columbia Records</a> in 2013.<sup id="cite_ref-49" class="reference"><a href="#cite_note-49"><span class="cite-bracket">[</span>49<span class="cite-bracket">]</span></a></sup></li> <li>In the 1994 <a href="/wiki/Jodie_Foster" title="Jodie Foster">Jodie Foster</a> film <i><a href="/wiki/Nell_(film)" title="Nell (film)">Nell</a></i>, the title character portrayed by Foster has developed her own language (<a href="/wiki/Idioglossia" title="Idioglossia">idioglossia</a>), developed in part due to the distinct speech patterns of her mother, caused by her hemiplegia due to a stroke.</li> <li>In the <a href="/wiki/Anime" title="Anime">anime</a> series <i><a href="/wiki/Mobile_Suit_Gundam:_Iron-Blooded_Orphans" title="Mobile Suit Gundam: Iron-Blooded Orphans">Mobile Suit Gundam: Iron-Blooded Orphans</a></i>, the protagonist Mikazuki Augus is paralyzed in the entire right half of his body after a fierce battle with the Mobile Armor Hashmal. In order to defeat the Mobile Armor, he was forced to deactivate the safety limiter on his Gundam's neural interface and overloading the connection between him and the Mobile Suit for the necessary power.</li> <li>In the game <a href="/wiki/Identity_V" title="Identity V">Identity V</a> the hunter "Sculptor" / Galatea Claude is paralysed on the left side of her body.</li></ul> <div class="mw-heading mw-heading2"><h2 id="See_also">See also</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hemiparesis&action=edit&section=19" title="Edit section: See also"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <ul><li><a href="/wiki/Alternating_hemiplegia" title="Alternating hemiplegia">Alternating hemiplegia</a></li> <li><a href="/wiki/Brunnstrom_Approach" title="Brunnstrom Approach">Brunnstrom Approach</a></li> <li><a href="/wiki/Hemiplegic_migraine" title="Hemiplegic migraine">Hemiplegic migraine</a></li> <li><a href="/wiki/Laryngeal_paralysis" title="Laryngeal paralysis">Laryngeal paralysis</a></li> <li><a href="/wiki/Paraplegia" title="Paraplegia">Paraplegia</a></li> <li><a href="/wiki/Paresis" title="Paresis">Paresis</a></li></ul> <div class="mw-heading mw-heading2"><h2 id="References">References</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hemiparesis&action=edit&section=20" title="Edit section: References"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r1239543626">.mw-parser-output .reflist{margin-bottom:0.5em;list-style-type:decimal}@media screen{.mw-parser-output .reflist{font-size:90%}}.mw-parser-output .reflist .references{font-size:100%;margin-bottom:0;list-style-type:inherit}.mw-parser-output .reflist-columns-2{column-width:30em}.mw-parser-output .reflist-columns-3{column-width:25em}.mw-parser-output .reflist-columns{margin-top:0.3em}.mw-parser-output .reflist-columns ol{margin-top:0}.mw-parser-output .reflist-columns li{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .reflist-upper-alpha{list-style-type:upper-alpha}.mw-parser-output .reflist-upper-roman{list-style-type:upper-roman}.mw-parser-output .reflist-lower-alpha{list-style-type:lower-alpha}.mw-parser-output .reflist-lower-greek{list-style-type:lower-greek}.mw-parser-output .reflist-lower-roman{list-style-type:lower-roman}</style><div class="reflist"> <div class="mw-references-wrap mw-references-columns"><ol class="references"> <li id="cite_note-FactsInfo-1"><span class="mw-cite-backlink">^ <a href="#cite_ref-FactsInfo_1-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-FactsInfo_1-1"><sup><i><b>b</b></i></sup></a> <a href="#cite_ref-FactsInfo_1-2"><sup><i><b>c</b></i></sup></a> <a href="#cite_ref-FactsInfo_1-3"><sup><i><b>d</b></i></sup></a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://www.disabled-world.com/health/neurology/hemiparesis.php">Detailed article about hemiparesis</a> <a rel="nofollow" class="external text" href="https://web.archive.org/web/20220202003438/https://www.disabled-world.com/health/neurology/hemiparesis.php">Archived</a> 2022-02-02 at the <a href="/wiki/Wayback_Machine" title="Wayback Machine">Wayback Machine</a> at Disabled-World.com</span> </li> <li id="cite_note-Karnath03-2"><span class="mw-cite-backlink">^ <a href="#cite_ref-Karnath03_2-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-Karnath03_2-1"><sup><i><b>b</b></i></sup></a> <a href="#cite_ref-Karnath03_2-2"><sup><i><b>c</b></i></sup></a> <a href="#cite_ref-Karnath03_2-3"><sup><i><b>d</b></i></sup></a> <a href="#cite_ref-Karnath03_2-4"><sup><i><b>e</b></i></sup></a> <a href="#cite_ref-Karnath03_2-5"><sup><i><b>f</b></i></sup></a> <a href="#cite_ref-Karnath03_2-6"><sup><i><b>g</b></i></sup></a></span> <span class="reference-text"><style data-mw-deduplicate="TemplateStyles:r1238218222">.mw-parser-output cite.citation{font-style:inherit;word-wrap:break-word}.mw-parser-output .citation q{quotes:"\"""\"""'""'"}.mw-parser-output .citation:target{background-color:rgba(0,127,255,0.133)}.mw-parser-output .id-lock-free.id-lock-free a{background:url("//upload.wikimedia.org/wikipedia/commons/6/65/Lock-green.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-limited.id-lock-limited a,.mw-parser-output .id-lock-registration.id-lock-registration a{background:url("//upload.wikimedia.org/wikipedia/commons/d/d6/Lock-gray-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-subscription.id-lock-subscription a{background:url("//upload.wikimedia.org/wikipedia/commons/a/aa/Lock-red-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .cs1-ws-icon a{background:url("//upload.wikimedia.org/wikipedia/commons/4/4c/Wikisource-logo.svg")right 0.1em center/12px no-repeat}body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-free a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-limited a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-registration a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-subscription a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .cs1-ws-icon a{background-size:contain;padding:0 1em 0 0}.mw-parser-output .cs1-code{color:inherit;background:inherit;border:none;padding:inherit}.mw-parser-output .cs1-hidden-error{display:none;color:var(--color-error,#d33)}.mw-parser-output .cs1-visible-error{color:var(--color-error,#d33)}.mw-parser-output .cs1-maint{display:none;color:#085;margin-left:0.3em}.mw-parser-output .cs1-kern-left{padding-left:0.2em}.mw-parser-output .cs1-kern-right{padding-right:0.2em}.mw-parser-output .citation .mw-selflink{font-weight:inherit}@media screen{.mw-parser-output .cs1-format{font-size:95%}html.skin-theme-clientpref-night .mw-parser-output .cs1-maint{color:#18911f}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .cs1-maint{color:#18911f}}</style><cite id="CITEREFKarnathBroetz2003" class="citation journal cs1">Karnath HO, Broetz D (December 2003). <a rel="nofollow" class="external text" href="https://doi.org/10.1093%2Fptj%2F83.12.1119">"Understanding and treating "pusher syndrome"<span class="cs1-kern-right"></span>"</a>. <i>Phys Ther</i>. <b>83</b> (12): 1119–25. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://doi.org/10.1093%2Fptj%2F83.12.1119">10.1093/ptj/83.12.1119</a></span>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/14640870">14640870</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Phys+Ther&rft.atitle=Understanding+and+treating+%22pusher+syndrome%22&rft.volume=83&rft.issue=12&rft.pages=1119-25&rft.date=2003-12&rft_id=info%3Adoi%2F10.1093%2Fptj%2F83.12.1119&rft_id=info%3Apmid%2F14640870&rft.aulast=Karnath&rft.aufirst=HO&rft.au=Broetz%2C+D&rft_id=https%3A%2F%2Fdoi.org%2F10.1093%252Fptj%252F83.12.1119&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHemiparesis" class="Z3988"></span></span> </li> <li id="cite_note-3"><span class="mw-cite-backlink"><b><a href="#cite_ref-3">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFKarnathFerberDichgans2000" class="citation journal cs1">Karnath HO, Ferber S, Dichgans J (November 2000). "The origin of contraversive pushing: evidence for a second graviceptive system in humans". <i>Neurology</i>. <b>55</b> (9): 1298–304. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1212%2Fwnl.55.9.1298">10.1212/wnl.55.9.1298</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/11087771">11087771</a>. <a href="/wiki/S2CID_(identifier)" class="mw-redirect" title="S2CID (identifier)">S2CID</a> <a rel="nofollow" class="external text" href="https://api.semanticscholar.org/CorpusID:19399616">19399616</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Neurology&rft.atitle=The+origin+of+contraversive+pushing%3A+evidence+for+a+second+graviceptive+system+in+humans&rft.volume=55&rft.issue=9&rft.pages=1298-304&rft.date=2000-11&rft_id=https%3A%2F%2Fapi.semanticscholar.org%2FCorpusID%3A19399616%23id-name%3DS2CID&rft_id=info%3Apmid%2F11087771&rft_id=info%3Adoi%2F10.1212%2Fwnl.55.9.1298&rft.aulast=Karnath&rft.aufirst=HO&rft.au=Ferber%2C+S&rft.au=Dichgans%2C+J&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHemiparesis" class="Z3988"></span></span> </li> <li id="cite_note-4"><span class="mw-cite-backlink"><b><a href="#cite_ref-4">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFKarnathFerberDichgans2000" class="citation journal cs1">Karnath HO, Ferber S, Dichgans J (December 2000). <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC17678">"The neural representation of postural control in humans"</a>. <i>Proceedings of the National Academy of Sciences of the United States of America</i>. <b>97</b> (25): 13931–6. <a href="/wiki/Bibcode_(identifier)" class="mw-redirect" title="Bibcode (identifier)">Bibcode</a>:<a rel="nofollow" class="external text" href="https://ui.adsabs.harvard.edu/abs/2000PNAS...9713931K">2000PNAS...9713931K</a>. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://doi.org/10.1073%2Fpnas.240279997">10.1073/pnas.240279997</a></span>. <a href="/wiki/PMC_(identifier)" class="mw-redirect" title="PMC (identifier)">PMC</a> <span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC17678">17678</a></span>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/11087818">11087818</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Proceedings+of+the+National+Academy+of+Sciences+of+the+United+States+of+America&rft.atitle=The+neural+representation+of+postural+control+in+humans&rft.volume=97&rft.issue=25&rft.pages=13931-6&rft.date=2000-12&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC17678%23id-name%3DPMC&rft_id=info%3Apmid%2F11087818&rft_id=info%3Adoi%2F10.1073%2Fpnas.240279997&rft_id=info%3Abibcode%2F2000PNAS...9713931K&rft.aulast=Karnath&rft.aufirst=HO&rft.au=Ferber%2C+S&rft.au=Dichgans%2C+J&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC17678&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHemiparesis" class="Z3988"></span></span> </li> <li id="cite_note-Pedersen96-5"><span class="mw-cite-backlink">^ <a href="#cite_ref-Pedersen96_5-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-Pedersen96_5-1"><sup><i><b>b</b></i></sup></a></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFPedersenWandelJørgensenNakayama1996" class="citation journal cs1">Pedersen PM, Wandel A, Jørgensen HS, Nakayama H, Raaschou HO, Olsen TS (January 1996). "Ipsilateral pushing in stroke: incidence, relation to neuropsychological symptoms, and impact on rehabilitation. The Copenhagen Stroke Study". <i>Archives of Physical Medicine and Rehabilitation</i>. <b>77</b> (1): 25–8. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1016%2Fs0003-9993%2896%2990215-4">10.1016/s0003-9993(96)90215-4</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/8554469">8554469</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Archives+of+Physical+Medicine+and+Rehabilitation&rft.atitle=Ipsilateral+pushing+in+stroke%3A+incidence%2C+relation+to+neuropsychological+symptoms%2C+and+impact+on+rehabilitation.+The+Copenhagen+Stroke+Study&rft.volume=77&rft.issue=1&rft.pages=25-8&rft.date=1996-01&rft_id=info%3Adoi%2F10.1016%2Fs0003-9993%2896%2990215-4&rft_id=info%3Apmid%2F8554469&rft.aulast=Pedersen&rft.aufirst=PM&rft.au=Wandel%2C+A&rft.au=J%C3%B8rgensen%2C+HS&rft.au=Nakayama%2C+H&rft.au=Raaschou%2C+HO&rft.au=Olsen%2C+TS&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHemiparesis" class="Z3988"></span></span> </li> <li id="cite_note-6"><span class="mw-cite-backlink"><b><a href="#cite_ref-6">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFDavies1985" class="citation book cs1">Davies PM (1985). <i>Steps to follow: A guide to the treatment of adult hemiplegia : Based on the concept of K. and B. 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dd:first-child::before,.mw-parser-output .hlist dt dt:first-child::before,.mw-parser-output .hlist dt li:first-child::before,.mw-parser-output .hlist li dd:first-child::before,.mw-parser-output .hlist li dt:first-child::before,.mw-parser-output .hlist li li:first-child::before{content:" (";font-weight:normal}.mw-parser-output .hlist dd dd:last-child::after,.mw-parser-output .hlist dd dt:last-child::after,.mw-parser-output .hlist dd li:last-child::after,.mw-parser-output .hlist dt dd:last-child::after,.mw-parser-output .hlist dt dt:last-child::after,.mw-parser-output .hlist dt li:last-child::after,.mw-parser-output .hlist li dd:last-child::after,.mw-parser-output .hlist li dt:last-child::after,.mw-parser-output .hlist li li:last-child::after{content:")";font-weight:normal}.mw-parser-output .hlist ol{counter-reset:listitem}.mw-parser-output .hlist ol>li{counter-increment:listitem}.mw-parser-output .hlist ol>li::before{content:" "counter(listitem)"\a0 "}.mw-parser-output .hlist dd ol>li:first-child::before,.mw-parser-output .hlist dt ol>li:first-child::before,.mw-parser-output .hlist li ol>li:first-child::before{content:" ("counter(listitem)"\a0 "}</style></div><div role="navigation" class="navbox" aria-label="Navbox" style="width:100%; margin:0.5em 0 0.5em 0;;padding:3px"><table class="nowraplinks navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="row" class="navbox-group" style="width:1%;background: #EAECF0;color:black;">Classification</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"><div style="position:relative; float:right; font-size:0.8em;"><a href="https://www.wikidata.org/wiki/Q2291130" class="extiw" title="d:Q2291130">D</a></div><div class="hlist" style="text-align:left;"><ul><li><b><a href="/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems" class="mw-redirect" title="International Statistical Classification of Diseases and Related Health Problems">ICD</a>-<a href="/wiki/ICD-11" title="ICD-11">11</a></b>: <a rel="nofollow" class="external text" href="https://icd.who.int/browse/latest-release/mms/en#1641958762%2Funspecified">MB53.Z</a>, <a rel="nofollow" class="external text" href="https://icd.who.int/browse/latest-release/mms/en#1367613958">6B60.6</a></li><li><b><a href="/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems" class="mw-redirect" title="International Statistical Classification of Diseases and Related Health Problems">ICD</a>-<a href="/wiki/ICD-10" title="ICD-10">10</a></b>: <a rel="nofollow" class="external text" href="https://icd.who.int/browse10/2019/en#/G81.9">G81.9</a></li><li><b><a href="/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems" class="mw-redirect" title="International Statistical Classification of Diseases and Related Health Problems">ICD</a>-<a href="/wiki/List_of_ICD-9_codes" title="List of ICD-9 codes">9-CM</a></b>: <a rel="nofollow" class="external text" href="http://www.icd9data.com/getICD9Code.ashx?icd9=342.9">342.9</a>, <a rel="nofollow" class="external text" href="http://www.icd9data.com/getICD9Code.ashx?icd9=094.89">094.89</a>, <a rel="nofollow" class="external text" href="http://www.icd9data.com/getICD9Code.ashx?icd9=438.2">438.2</a></li><li><b><a href="/wiki/Medical_Subject_Headings" title="Medical Subject Headings">MeSH</a></b>: <a rel="nofollow" class="external text" href="https://meshb.nlm.nih.gov/record/ui?ui=D006429">D006429</a></li></ul></div></div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"></div><div role="navigation" class="navbox" aria-labelledby="Signs_and_symptoms_relating_to_movement_and_gait" style="padding:3px"><table 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href="/wiki/Special:EditPage/Template:Movement_and_gait_symptoms_and_signs" title="Special:EditPage/Template:Movement and gait symptoms and signs"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="Signs_and_symptoms_relating_to_movement_and_gait" style="font-size:114%;margin:0 4em"><a href="/wiki/Signs_and_symptoms" title="Signs and symptoms">Signs and symptoms</a> relating to movement and <a href="/wiki/Gait" title="Gait">gait</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%">Gait</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Gait_abnormality" title="Gait abnormality">Gait abnormality</a></li> <li>CNS <ul><li><a href="/wiki/Scissor_gait" title="Scissor gait">Scissor gait</a></li> <li><a href="/wiki/Cerebellar_ataxia" title="Cerebellar ataxia">Cerebellar ataxia</a></li> <li><a href="/wiki/Chorea" title="Chorea">Choreic gait</a></li> <li><a href="/wiki/Parkinsonian_gait" title="Parkinsonian gait">Festinating gait/Parkinsonian gait</a></li> <li><a href="/wiki/Magnetic_gait" title="Magnetic gait">Magnetic gait</a></li> <li><a href="/wiki/Marche_%C3%A0_petit_pas" title="Marche à petit pas">Marche à petit pas</a></li> <li><a href="/wiki/Propulsive_gait" title="Propulsive gait">Propulsive gait</a></li> <li><a href="/wiki/Stomping_gait" title="Stomping gait">Stomping gait</a></li> <li><a href="/wiki/Spastic_gait" title="Spastic gait">Spastic gait</a></li> <li><a href="/wiki/Truncal_ataxia" title="Truncal ataxia">Truncal ataxia</a></li> <li><a href="/wiki/Balance_disorder" title="Balance disorder">Vestibular gait</a></li></ul></li> <li>Muscular <ul><li><a href="/wiki/Myopathic_gait" title="Myopathic gait">Myopathic gait/Waddling gait</a></li> <li><a href="/wiki/Trendelenburg_gait" title="Trendelenburg gait">Trendelenburg gait</a></li> <li><a href="/wiki/Pigeon_gait" title="Pigeon gait">Pigeon gait</a></li></ul></li> <li><a href="/wiki/Foot_drop" title="Foot drop">Foot drop</a> <ul><li><a href="/wiki/Steppage_gait" title="Steppage gait">Steppage gait</a></li> <li><a href="/wiki/Toe_walking" title="Toe walking">Toe walking</a></li></ul></li> <li>Asymmetric gait <ul><li><a href="/wiki/Gait#Variables" title="Gait">Leaping gait</a></li></ul></li> <li>Asynchronous gait <ul><li><a href="/wiki/Gunslinger%27s_gait" title="Gunslinger's gait">Gunslinger's gait</a></li> <li><a class="mw-selflink selflink">Hemiparetic gait</a></li> <li><a href="/wiki/Limp" title="Limp">Limp</a></li> <li><a href="/wiki/Antalgic_gait" title="Antalgic gait">Antalgic gait</a></li></ul></li> <li>Deformity <ul><li><a href="/wiki/Lotus_gait" class="mw-redirect" title="Lotus gait">Lotus gait</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Interlimb_coordination" title="Interlimb coordination">Coordination</a></th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Ataxia" title="Ataxia">Ataxia</a></li> <li><a href="/wiki/Cerebellar_ataxia" title="Cerebellar ataxia">Cerebellar ataxia</a> <ul><li><a href="/wiki/Dysmetria" title="Dysmetria">Dysmetria</a></li> <li><a href="/wiki/Dysdiadochokinesia" title="Dysdiadochokinesia">Dysdiadochokinesia</a></li> <li><a href="/wiki/Pronator_drift" title="Pronator drift">Pronator drift</a></li> <li><a href="/wiki/Dyssynergia" title="Dyssynergia">Dyssynergia</a></li></ul></li> <li><a href="/wiki/Sensory_ataxia" title="Sensory ataxia">Sensory ataxia</a></li> <li><a href="/wiki/Asterixis" title="Asterixis">Asterixis</a></li> <li><a href="/wiki/Abasia" title="Abasia">Abasia</a></li> <li><a href="/wiki/Hemimotor_neglect" title="Hemimotor neglect">Hemimotor neglect</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Dyskinesia" title="Dyskinesia">Abnormal movement</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Athetosis" title="Athetosis">Athetosis</a></li> <li><a href="/wiki/Chorea" title="Chorea">Chorea</a></li> <li><a href="/wiki/Tremor" title="Tremor">Tremor</a></li> <li><a href="/wiki/Fasciculation" title="Fasciculation">Fasciculation</a></li> <li><a href="/wiki/Fibrillation" title="Fibrillation">Fibrillation</a></li> <li><a href="/wiki/Myokymia" title="Myokymia">Myokymia</a></li> <li><a href="/wiki/Myoclonus" title="Myoclonus">Myoclonus</a></li> <li><a href="/wiki/Hyperkinesia" title="Hyperkinesia">Hyperkinesia</a> / <a href="/wiki/Hypokinesia" title="Hypokinesia">Hypokinesia</a></li> <li><a href="/wiki/Myotonia" title="Myotonia">Myotonia / Pseudomyotonia</a></li> <li><a href="/wiki/Hypotonia" title="Hypotonia">Hypotonia</a></li> <li><a href="/wiki/Stereotypy" title="Stereotypy">Stereotypy</a></li> <li><a href="/wiki/Akathisia" title="Akathisia">Akathisia</a></li> <li><a href="/wiki/Echopraxia" title="Echopraxia">Echopraxia</a></li> <li><a href="/wiki/Echolalia" title="Echolalia">Echolalia</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Posturing</th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Abnormal_posturing" title="Abnormal posturing">Abnormal posturing</a></li> <li>Stooped posture <ul><li><a href="/wiki/Camptocormia" title="Camptocormia">Camptocormia</a></li> <li><a href="/wiki/Osteoporosis" title="Osteoporosis">Osteoporosis</a></li></ul></li> <li><a href="/wiki/Opisthotonus" title="Opisthotonus">Opisthotonus</a></li> <li><a href="/wiki/Spasm" title="Spasm">Spasm</a></li> <li><a href="/wiki/Trismus" title="Trismus">Trismus</a></li> <li><a href="/wiki/Cramp" title="Cramp">Cramp</a></li> <li><a href="/wiki/Tetany" title="Tetany">Tetany</a></li> <li><a href="/wiki/Hypertonia" title="Hypertonia">Hypertonia</a></li> <li><a href="/wiki/Joint_locking_(symptom)" class="mw-redirect" title="Joint locking (symptom)">Joint locking</a></li> <li><a href="/wiki/Catalepsy" title="Catalepsy">Catalepsy</a></li> <li><a href="/wiki/Waxy_flexibility" title="Waxy flexibility">Waxy flexibility</a></li> <li>Grimacing</li> <li><a href="/wiki/Apparent_death#Humans" title="Apparent death">Tonic immobility</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Paralysis" title="Paralysis">Paralysis</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Flaccid_paralysis" title="Flaccid paralysis">Flaccid paralysis</a></li> <li><a href="/wiki/Periodic_paralysis" title="Periodic paralysis">Periodic paralysis</a></li> <li><a href="/wiki/Spastic_paraplegia" class="mw-redirect" title="Spastic paraplegia">Spastic paraplegia</a> <ul><li><a href="/wiki/Spastic_diplegia" title="Spastic diplegia">Spastic diplegia</a></li> <li><a href="/wiki/Spastic_paraplegia" class="mw-redirect" title="Spastic paraplegia">Spastic paraplegia</a></li></ul></li> <li>Syndromes <ul><li><a href="/wiki/Monoplegia" title="Monoplegia">Monoplegia</a></li> <li><a href="/wiki/Diplegia" title="Diplegia">Diplegia</a> / <a href="/wiki/Paraplegia" title="Paraplegia">Paraplegia</a></li> <li><a href="/wiki/Hemiplegia" class="mw-redirect" title="Hemiplegia">Hemiplegia</a></li> <li><a href="/wiki/Triplegia" title="Triplegia">Triplegia</a></li> <li><a href="/wiki/Tetraplegia" title="Tetraplegia">Tetraplegia</a> / <a href="/wiki/Quadruplegia" class="mw-redirect" title="Quadruplegia">Quadruplegia</a></li></ul></li> <li>General causes <ul><li><a href="/wiki/Upper_motor_neuron_lesion" title="Upper motor neuron lesion">Upper motor neuron lesion</a></li> <li><a href="/wiki/Lower_motor_neuron_lesion" title="Lower motor neuron lesion">Lower motor neuron lesion</a></li></ul></li> <li><a href="/wiki/Sleep_paralysis" title="Sleep paralysis">Sleep paralysis</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Muscle_weakness" title="Muscle weakness">Weakness</a></th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a class="mw-selflink selflink">Hemiparesis</a></li> <li><a href="/wiki/Gowers%27_sign" class="mw-redirect" title="Gowers' sign">Gowers' sign</a></li> <li><a href="/wiki/Locomotive_syndrome" title="Locomotive syndrome">Locomotive syndrome</a></li> <li><a href="/wiki/Ptosis_(eyelid)" title="Ptosis (eyelid)">Ptosis</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Range_of_motion" title="Range of motion">Range of motion</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Contracture" title="Contracture">Contracture</a> <ul><li><a href="/wiki/Bethlem_myopathy" title="Bethlem myopathy">Bethlem sign</a></li> <li><a href="/wiki/Club_foot" class="mw-redirect" title="Club foot">Club foot</a></li></ul></li> <li><a href="/wiki/Joint_stiffness" title="Joint stiffness">Joint stiffness</a></li> <li><a href="/wiki/Ankylosis" title="Ankylosis">Ankylosis</a></li> <li><a href="/wiki/Hypermobility_(joints)" title="Hypermobility (joints)">Hypermobility</a> <ul><li><a href="/wiki/Gorlin_sign" title="Gorlin sign">Gorlin sign</a></li> <li><a href="/wiki/Ehlers-Danlos_syndromes" class="mw-redirect" title="Ehlers-Danlos syndromes">EDS</a></li> <li><a href="/wiki/Hypermobility_spectrum_disorder" title="Hypermobility spectrum disorder">HSD</a></li></ul></li> <li><a href="/wiki/Boutonniere_deformity" title="Boutonniere deformity">Boutonniere deformity</a></li> <li><a href="/wiki/Swan_neck_deformity" title="Swan neck deformity">Swan neck deformity</a></li> <li><a href="/wiki/Scoliosis" title="Scoliosis">Scoliosis</a></li> <li><a href="/wiki/Kyphosis" title="Kyphosis">Kyphosis</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Other</th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Rachitic_rosary" title="Rachitic rosary">Rachitic rosary</a></li> <li><a href="/wiki/Flat_feet" title="Flat feet">Flat feet</a></li> <li><a href="/wiki/Pronation_of_the_foot#overpronation" title="Pronation of the foot">Overpronation/Flexible flat feet</a></li> <li><a href="/wiki/Knock-knee" class="mw-redirect" title="Knock-knee">Knock-knee</a></li> <li><a href="/wiki/Bow-leggedness" class="mw-redirect" title="Bow-leggedness">Bow-leggedness</a></li> <li><a href="/wiki/Back_knee" class="mw-redirect" title="Back knee">Back knee</a></li> <li><a href="/wiki/Hyporeflexia" title="Hyporeflexia">Hyporeflexia</a></li> <li><a href="/wiki/Hyperreflexia" title="Hyperreflexia">Hyperreflexia</a> <ul><li><a href="/wiki/Clasp-knife_response" title="Clasp-knife response">Clasp-knife response</a></li></ul></li> <li><a href="/wiki/Shivering" title="Shivering">Shivering</a></li> <li><a href="/wiki/Hypnic_jerk" title="Hypnic jerk">Hypnic jerk</a></li> <li><a href="/wiki/Astasia-abasia" title="Astasia-abasia">Astasia-abasia</a></li> <li><a href="/wiki/Vertigo" title="Vertigo">Vertigo</a></li> <li><a href="/wiki/Motion_sickness" title="Motion sickness">Motion sickness</a></li> <li><a href="/wiki/Conversion_disorder" title="Conversion disorder">Conversion disorder</a></li> <li><a href="/wiki/Shell_shock" title="Shell shock">Shell shock</a></li> <li><a href="/wiki/Stupor" title="Stupor">Stupor</a></li> <li><a href="/wiki/Catatonia" title="Catatonia">Catatonia</a></li> <li><a href="/wiki/Dancing_mania" title="Dancing mania">Dancing mania</a></li></ul> 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