Hemiplegia Treatment Guidelines

Communication: Pre-Treatment

  • Approach non-affected side and walk towards client’s mid-line
  • Ask client to tell you when they can’t see you any more
    • Let them know you’ll angle their head towards you when working on affected side
  • Place their arm into flexed position, shoulder adducted and internally rotated, elbow flexed, wrist flexed, fingers and thumb flexed
  • Slowly take them out of the position, and state that this is to decrease spasticity
  • Place bolster over hand to keep it weighted down

Specific Treatment

  • Start with posterior-lateral neck. Avoid the anterior lateral neck
  • Check in with client that they can feel your hand
  • Tell the client where you’re touching and what you’re doing
  • Perform simple neuromuscular techniques
  • Pectoralis Muscle will be spastic
    • Double check with client you can work in this area
    • Move their head towards you
    • Perform slow palmar kneading, and 3 neuromuscular techniques
    • Check in that they can feel you and let them know what you are doing
  • Release and stabilize arm to perform range of motion of their shoulder
    • Ask if they can feel their arm move away from their body
      • Use visual feedback if they cannot
  • Biceps Brachii will be spasctic
    • Perform muscle approximation for about 30 seconds, GTO, O+I, fingertip kneading.
    • Ask if client can feel what your fingers are doing
  • Forearm Flexors will be spastic
    • Ask ” Do you feel my fingers moving down your arm?” ” Do you feel any tension or pain?”
    • Slowly extend wrist
    • Perform neuromuscular techniques, slowly
    • Perform range of motion at elbow, wrist and fingers.
    • Ask “Do you feel your joints moving?”
    • Put into spastic position, then bring out
  • Deltoids will be flaccid
    • Stimulating techniques: jostling, tapotement, vibration
    • Ask them to bring arms towards you. ” Imagine your arm is moving toward you head”
    • You can use an ice cube and ask if they feel the cold
  • Triceps will be flaccid
    • Ask if they feel what you are doing
    • Ask client to extend arm into hand
    • Perform pincement, tapping, vibration, jostling
    • Quick stretch : have elbow extended then bring flexed 3 x. Assist for the 2nd and 3rd repetition
    • Perform joint approximation
  • Wrist extensors will be flaccid
    • Similar techniques to other flaccid muscles
    • Ask client to extend wrist
    • Perform a quick stretch with wrist in neutral than flexed position 3 times. Assist them on the 2nd and 3rd repetition
    • Perform joint approximation for about 5 seconds
    • Ask them to imagine opening a heavy door as a motor engram


  • Assist client up after treatment
  • Ask if they feel dizzy and need assistance off the table

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