Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Hemiplegia

hemiplegia in русский (Россия)

Related Terms

  • Hemiparalysis
  • Hemiparesis

Differential Diagnosis

Specialists

  • Internal Medicine Physician
  • Neurologist
  • Neurosurgeon
  • Occupational Therapist
  • Physical Therapist
  • Psychiatrist

Comorbid Conditions

Factors Influencing Duration

Disability duration will be influenced by the cause of the hemiplegia, the severity and area of the paralysis, the duties or activity level required of the individual, and which side of the body was affected. An individual who has a job that involves moderate to heavy physical activity would be considered permanently disabled. Duties that are more sedentary might not present as many problems if the individual still has the intellectual capacity to perform the work.

Medical Codes

ICD-9-CM:
342.00 - Hemiplegia, Flaccid, Affecting Unspecified Side
342.01 - Hemiplegia, Flaccid, Affecting Dominant Side
342.02 - Hemiplegia, Flaccid, Affecting Nondominant Side
342.10 - Hemiplegia, Spastic, Affecting Unspecified Side
342.11 - Hemiplegia, Spastic, Affecting Dominant Side
342.12 - Hemiplegia, Spastic, Affecting Nondominant Side
342.80 - Hemiplegia, Other Specified, Affecting Unspecified Side
342.81 - Hemiplegia, Other Specified, Affecting Dominant Side
342.82 - Hemiplegia, Other Specified, Affecting Nondominant Side
342.90 - Hemiplegia, Unspecified, Affecting Unspecified Side
342.91 - Hemiplegia, Unspecified, Affecting Dominant Side
342.92 - Hemiplegia, Unspecified, Affecting Nondominant Side

Overview

Hemiplegia is the complete paralysis of one side of the body. It involves the arm, the leg, and sometimes the face of the affected side. A related term, hemiparesis, refers to a partial loss of motor function, and is far more common.

The main causes of hemiplegia are brain hemorrhage (hemorrhagic stroke) and diseases of the blood vessels of the cerebrum and brain stem that cause interruption of blood supply to the brain (ischemic stroke). Trauma (brain injury) is another cause of hemiplegia. Other important causes that are less acute in onset include brain tumor or lesion, brain abscess, diseases that destroy the sheath surrounding nerve cells (e.g., multiple sclerosis), blood vessel (vascular) complications of viral or bacterial infection (meningitis), and inflammation of the brain (encephalitis). When a brain lesion causes hemiplegia, the lesion is most likely on the side of the brain opposite to the paralysis. In rare cases it results from infectious disease caused by the poliovirus (poliomyelitis) or a disorder of motor nerve cells (neurons) in the spinal cord, brainstem, and motor cortex (motor system disease).

Brain stem lesions in the medulla, can cause paralysis of other parts of the body, including the tongue and sometimes the pharynx and larynx on one side and the arm and leg on the other. These are called "crossed paralyses," and are typical of brain stem lesions. A lesion in the spinal cord is rare and more often these lesions induce paralysis on both sides of the body. A paralysis that spares the face, combined with a loss of vibratory and position sense on the same side, and a loss of pain and temperature sensation on the opposite side, signifies disease of one side of the spinal cord (Brown-Séquard syndrome).

Incidence and Prevalence: Hemiplegia occurs in 88% of individuals who have suffered a stroke (Bruno). Overall incidence, which includes causes other than stroke, is difficult to predict.

Source: Medical Disability Advisor



Diagnosis

History: Individuals report weakness or paralysis on one side of the body, which may include the arms, legs, facial muscles, tongue, and swallowing muscles. There may be defects in speech (aphasia) or difficulty in swallowing (dysphagia).

Physical exam: Muscle weakness is evaluated during the physical and neurological examination. Identifying the pattern of muscle weakness or paralysis can help the physician identify where the damage has occurred in the nervous system. Muscle atrophy may be seen in the limbs or trunk of one side of the body. The face, an arm, a leg, or the entire side of the body may be affected. Individuals with hemiplegia may have difficulty walking or grasping objects. A loss of ability to coordinate movement (ataxia) may be evident and may manifest as problems with body posture, walking, and balance. Examination may also reveal a loss of sensation (sensory deficit).

Tests: MRI, CT scan, and cerebral angiogram are the most useful diagnostic tests to confirm the cause of hemiplegia and the area of brain injury.

Source: Medical Disability Advisor



Treatment

Medication to lower blood pressure and blood cholesterol levels may be used in individuals with hemiplegia caused by stroke who have risk factors for stroke recurrence, such as high blood pressure (hypertension) and heart disease. Drug therapy to reduce the swelling of the brain and emergency brain surgery to relieve pressure (decompression) may be necessary in cases of head injury, brain hemorrhage, brain tumors, or brain abscess. Surgery may also be used to repair blockage of the blood vessels (carotid endarterectomy) or malformations in and around the brain (total surgical excision or tumor resection). Treatment to prevent formation of blood clots in the bedridden individual should be immediate, or complications can occur.

As soon as the individual has stabilized, physical therapy may begin to prevent stiffening (contractures) of the arms and legs. In many cases, there can be a return of some function of affected areas within 1 to 2 years. The individual must be taught exercises to maintain body alignment. Assessment of mental status should be made to determine the presence and degree of mental impairment and depression. Treatment with antidepressant drugs may be required.

Source: Medical Disability Advisor



Prognosis

Hemiplegia that results from lesions of the brain and spinal cord can be severe and permanent. The distribution of the paralysis due to these lesions varies with the location of the lesion and always affects a group of muscles, never individual muscles. The paralysis never involves all of the muscles on one side of the body, even in the most severe forms of hemiplegia.

Hemiplegia resulting from stroke is usually permanent. Roughly 70% of individuals are able to regain some function of the hand in physical therapy (Bruno). In cases of head injury, there may be partial or near complete recovery. In other causes less acute in onset, recovery may be possible if the condition is treated promptly (removal of a brain tumor or treatment of a viral infection). The degree of recovery depends on the extent of the damage to the brain or spinal cord. In all cases, there is the possibility of some degree of recovery with appropriate rehabilitation (physical therapy).

In addition to physical limitations, the mental status of the individual is an essential element of recovery. Brain damage can cause loss of normal thought processes (cognitive disorders), and balance may be impaired. Even if the individual can think and speak clearly, the devastating loss of normal control of the body affects each individual differently, and a reactive depression is not uncommon. Sometimes control of emotions and behavior are impaired. Speech and behavioral therapies can result in some degree of recovery.

Source: Medical Disability Advisor



Rehabilitation

Individuals who suffer from hemiplegia may require various rehabilitation services, including physical therapy, occupational therapy, speech therapy, and orthotic management. Rehabilitation services should occur at a frequency of 2 to 3 times a week for 8 weeks.

Occupational therapy focuses on regaining the ability to perform activities of daily living. Individuals learn to perform tasks while sitting down on a kitchen stool. By instructing individuals in tasks such as these, occupational therapists also engage in balance retraining. Individuals also learn dressing and bathing techniques. Occupational therapists may order equipment to assist individuals.

Occupational therapists also promote the return of upper extremity and hand function through a variety of activities. Often the upper arm separates (subluxes) from the shoulder girdle because of a loss of muscle tone. Occupational therapy may use neuromuscular electrical stimulation (NMES), in which electrodes provide external stimulation to the muscles to counteract this symptom. More frequently, individuals wear a hemi-sling that helps support the arm to prevent subluxation. Occupational therapists may stretch the upper extremities and teach self-stretching techniques so that the arm can regain maximum potential. Individuals also learn strengthening exercises and practice tasks that require the affected hand to bear weight, thus sending nerve impulses to the brain so that damaged neural paths can begin to heal. Individuals engage in tasks that require both hands, such as holding a cup with the hemiplegic hand while pouring a drink using the good hand. As function returns, individuals may engage in fine motor tasks such as handwriting.

Occupational therapists also are instrumental in helping an individual perform activities of daily living, such as housecleaning, gardening, and practicing arts and crafts. They also help individuals learn how to adapt to driving and provide on-road training, which may be an important consideration in returning to work.

Physical therapy focuses on stretching and strengthening the hemiplegic side. Therapists may passively stretch the affected side. Individuals and their family members learn to perform a stretching and strengthening program for the legs. Physical therapy also focuses on transfer training. The therapist teaches the individual to bear weight evenly when sitting and standing so that the individual is aware of the hemiplegic side. Individuals also learn mobility techniques such as walking and climbing stairs while using a pyramid cane or 4-pronged cane. For those individuals who cannot walk, the physical therapist may order a special wheelchair, called a hemi-chair, which can be propelled using only the good arm because a special axle connects the wheels.

Orthotic management may also be required for individuals to regain function. Occupational therapists may make an individual a night splint, which positions the thumb and fingers so that the hand forms the letter "C." This position places the hand in a functional position, allowing for full use of the hand if strength returns. An orthotist, who custom-fits braces and splints, may make an individual a leg splint to promote better control of the ankle and knee during ambulation.

Speech therapy may be required to strengthen the muscles of the face for improved speech and swallowing. Individuals learn to move the facial muscles in a balanced manner, both by manual assistance and visual cueing through the use of a mirror. Individuals perform tongue exercises to allow for better speech and eating. Activities such as sustained vocal expressions help individuals learn to speak with greater clarity. Individuals begin eating semi-moist, pureed food, which is easier to swallow, and progress to eating food rich in taste, smell, and texture to assist in the swallowing reflex. Individuals also learn to achieve sucking control and saliva production.

Vocational therapists may help an individual with hemiplegia identify vocational strengths and develop resumes that highlight those strengths. Stroke vocational rehabilitation agencies may help an individual find a job that is tailored to his or her specific needs and appropriate for the degree of disability.

Individuals may need counseling by a psychologist or psychiatrist to help them adjust to their altered functional abilities and body image.

Source: Medical Disability Advisor



Complications

Muscles can become permanently contracted if a physical therapy program with specific exercises to increase range of motion is not instituted. Skin can break down due to increased pressure and form pressure (decubitus) ulcers if position changes and skin care are not done regularly to relieve pressure. Pneumonia and blood clots (deep vein thrombosis) are other complications.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Work restrictions and accommodations will depend on job requirements and the level of activity involved. Wheelchair accessibility in and out of buildings and handicapped facilities may be needed. Although only one side of the body is affected in hemiplegia, activities that require coordination and balance are affected and may limit the individual's ability to perform physical work.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Has diagnosis of hemiplegia been confirmed?
  • Has there been psychiatric evaluation?
  • Was a complete neurological evaluation performed with appropriate imaging studies to ascertain the area of brain involvement?

Regarding treatment:

  • If individual has hypertension, high blood cholesterol, or heart disease as a cause of stroke, was medication prescribed to control these conditions?
  • Did individual receive appropriate treatment for a causative condition such as encephalitis, meningitis, or brain abscess?
  • Was surgery required to repair blockage to the blood vessels (carotid endarterectomy) or malformations in and around the brain (total surgical excision or tumor resection)? With what success?
  • Has individual complied with a physical therapy program for rehabilitation?
  • Has mental status been assessed?
  • Would individual benefit from treatment with antidepressant drug therapy?

Regarding prognosis:

  • Did individual receive prompt, appropriate treatment for a causative condition such as encephalitis, meningitis, or brain abscess?
  • How extensive is impairment?
  • Can additional function be restored to this individual through physical therapy?
  • Is individual receiving appropriate rehabilitative (speech, behavioral, or psychological) therapy?
  • Would individual benefit from an extended period or additional forms of therapy?
  • Does individual have an underlying condition that may affect recovery, such as cerebral palsy, multiple sclerosis, or other diseases that can cause muscle atrophy/weakness?

Source: Medical Disability Advisor



References

Cited

Bruno, Auri A. "Motor Recovery In Stroke." eMedicine. Eds. Milton J. Klein, et al. 9 Dec. 2004. Medscape. 21 Dec. 2004 <http://emedicine.com/pmr/topic234.htm>.

Source: Medical Disability Advisor






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