motor index and 30 from the walking index. each task in this inventory has a maximum score of seven except for the 2 minute walk test which is out of two. the impairment component of the test evaluates the upper and lower extremities, postural control and pain. the impairment inventory focuses on the seven stages of recovery from stroke from flaccid paralysis to normal motor functioning. a training workshop is recommended if the measure is being utilized for the purpose of data collection. the stroke rehabilitation assessment of movement (stream) 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. treatment treatment for hemiparesis is the same treatment given to those recovering from strokes or brain injuries. health care professionals such as physical therapists and occupational therapists 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 neuromuscular electrical stimulation to decrease spasticity and increase awareness of the limb. at the more advanced level, using constraint-induced movement therapy will encourage overall function and use of the affected limb. mirror therapy (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. 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. also speech pathologists work to increase function for people with hemiparesis. treatment should be based on assessment by the relevant health professionals, including physiotherapists, doctors and occupational therapists. 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. medication drugs can be used to treat issues related to the upper motor neuron syndrome. drugs like librium or valium 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 brain injury. intra-muscular injection of botulinum toxin 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. a randomized trial pointed out that individualized homeopathic medication in addition to the standard physiotherapy might have some effect in post-stroke hemiparesis. surgery surgery may be used if the individual develops a secondary issue of contracture, from a severe imbalance of muscle activity. in such cases the surgeon may cut the ligaments 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 prosthetic device. there are many types of braces and splints available to stabilize a joint, assist with walking and keep the upper body erect. rehabilitation 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 occupational therapy can significantly improve the quality of life. physical therapy physical therapy (pt) can help improve muscle strength & coordination, mobility (such as standing and walking), and other physical function using different sensorimotor techniques. physiotherapists can also help reduce shoulder pain by maintaining shoulder range of motion, as well as using functional electrical stimulation. supportive devices, such as braces or slings, can be used to help prevent or treat shoulder subluxation 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. a treatment method that can be implemented with the goal of helping to regain motor function in the affected limb is constraint-induced movement therapy. this consists of constraining the unaffected limb, forcing the affected limb to accomplish tasks of daily living. occupational therapy occupational therapists 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. orthotic intervention 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 (hmwpe,) carbon fiber; etc.) and design may be changed to address many different conditions. prognosis 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 blood clots. 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. popular culture in barbara kingsolver's novel, the poisonwood bible, the character adah is incorrectly diagnosed, in childhood, as having hemiplegia. rock band haerts released an ep called hemiplegia via columbia records in 2013. in the 1994 jodie foster film nell, the title character portrayed by foster has developed her own language (idioglossia), developed in part due to the distinct speech patterns of her mother, caused by her hemiplegia due to a stroke. in the anime series mobile suit gundam: iron-blooded orphans, 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.