Rehabilitation of Hemiparesis

Initial Assessment and Stabilization

The American Heart Association recommends urgent neuroimaging, preferably magnetic resonance imaging with diffusion or computed tomography, to determine the underlying cause of hemiparesis, with the most common cause being an ischemic stroke in the contralateral hemisphere 1
The American Heart Association suggests evaluating the patient's level of consciousness, specific neurological deficits, respiratory capacity, and oxygen saturation, as well as monitoring blood pressure and vital signs 1
The American Heart Association recommends maintaining a patent airway, monitoring oxygen saturation, and administering oxygen if saturation is less than 92%, with the patient's head elevated 15-30° if there is a risk of aspiration, and continuous cardiac monitoring for 24-72 hours, with blood pressure maintained between 110-220 mmHg systolic and 60-120 mmHg diastolic 2

The American Heart Association recommends evaluating the patient's eligibility for thrombolysis if they are within the therapeutic window, and initiating antithrombotics within the first 24 hours if there are no contraindications, with a strength of evidence level of A 2

The International Journal of Stroke suggests that physical therapy should include task-oriented training, muscle strengthening exercises, and balance and trunk control training, with the goal of improving motor function and mobility, and that occupational therapy should focus on activities of daily living, environmental adaptation, and the use of adaptive devices if necessary, with a moderate level of evidence 3
The International Journal of Stroke recommends considering repetitive transcranial magnetic stimulation (rTMS) or transcranial direct current stimulation (tDCS) as a complement to conventional therapy, as well as evaluating the use of dynamic functional orthotics to facilitate task-specific training, with a low level of evidence 3
Task-oriented interventions with balance training, trunk training, and seated balance exercises should be implemented in a progressive mobility program, particularly after stabilization, as recommended by the International Journal of Stroke and the American Academy of Physical Medicine and Rehabilitation 3, 4

The American Heart Association recommends monitoring respiratory function, performing breathing exercises, and using techniques to clear respiratory secretions, as well as preventing aspiration pneumonia, with a high level of evidence 2
The American Heart Association suggests evaluating the patient's swallowing capacity before initiating oral feeding, and maintaining NPO status until safe swallowing is confirmed, with a moderate level of evidence 2
The International Journal of Stroke recommends considering analgesics such as acetaminophen or ibuprofen for shoulder pain, as well as botulinum toxin injections for focal spasticity, with a moderate level of evidence 3
Gentle stretching and mobilization techniques, focusing on increasing external rotation and abduction, should be implemented to manage hemiplegic shoulder pain, as suggested by the International Journal of Stroke 3

The American Heart Association recommends regular visual and tactile inspections of high-risk areas for pressure ulcers, as well as using special mattresses and cushions to alleviate pressure, with a high level of evidence 2
The International Journal of Stroke suggests evaluating signs of depression, which has a prevalence of 25-79% in patients with post-stroke depression, and considering psychological and pharmacological interventions if necessary, with a moderate level of evidence 5
Perform visual and tactile checks of all risk areas at least once daily, repositioning every 2-4 hours with pressure zone checks, and use pressure-relieving tools (cushions, foam, pillows) and high-level prevention supports (air-loss mattress, dynamic mattress), as recommended by the National Pressure Injury Advisory Panel 4

The International Journal of Stroke suggests that significant functional recovery can occur during the first 6 months post-stroke, with continued improvements possible after this period, with a moderate level of evidence 3
The American Heart Association recommends regular assessments of functional progress, adjusting the rehabilitation plan as needed, educating the patient and family members on home management, and providing secondary prevention if the cause was a stroke, with a high level of evidence 2
Begin rehabilitation as soon as the patient is medically stable and stabilized, focusing on maintaining joint amplitudes, preventing and treating spasticity, and strengthening existing musculature, as recommended by the American Physical Therapy Association 4