Monoplegia -Procedures, Side effects, Recovery time, Costs and alternatives

When paralysis affects only one limb of the patient then this condition is referred to as monoplegia. There are several medical conditions that can cause monoplegia but in the majority of the cases it occurs due to cerebral palsy. In a good number of cases, only an arm of the person gest affected. Although there have been cases where a patient of monoplegia is suffering from the impairment of a leg. There have been rare cases reported where paralysis is restricted to just a single muscle. Suffering from monoplegia restricts the function of the affected limb but the majority of the patients are able to take care of themselves.

A patient suffering from monoplegia can perform his/her daily tasks as they gradually learn several ways to work around the symptoms of the condition. People affected with monoplegia experience restriction in the functioning of the limb. It starts when a patient feels weakness in that limb. As time passes the effects of this condition intensify and lead to either complete or partial paralysis of the affected limb. Pain is experienced by a patient suffering from this condition around the limb which is affected. Monoplegia occurs when the part of the brain that which controls the affected area gets damaged. In very rare cases an injury to the spinal cord causes monoplegia. A spinal cord injury is mostly related to quadriplegia or paraplegia. The leading cause of monoplegia in the majority of the patients is cerebral palsy. Other limited conditions that can cause monoplegia are

• Aneurysms
• Head injury
• Injury in the spinal cord
• Lesions of brain
• Infection of the brain

Monoplegia does not have any permanent cure. However, the functionality of the affected limb can be regained through several therapies. The treatment for monoplegia includes the use of physiotherapy, constraint-induced movement therapy, and functional electrical stimulation. The type of treatment chosen is based on the complexity of the condition.

The treatment of monoplegia is aimed at regaining the functionality of the affected limb. A doctor may prescribe muscle relaxant medications to not only provide relief from the pain but also to relax the muscles which get stiff.

Physiotherapy: A treatment through physiotherapy is conducted by trained professional known by the name of physiotherapist. A physiotherapist makes use of exercise therapy to improve the condition of the affected limb. A treatment plan for monoplegia from physiotherapy first includes passive mobilization of the limb. In the second stage range of motion, exercises are required to be done by the patient. These two stages of the exercise continue until improvement is observed in the condition of the patient. After improvement is observed in the patient then patient undergoes active exercise and active resistive exercises to regain complete movement of the affected limb. The treatment is a slow process but the results of the treatment are very good.

Constraint-induced movement therapy: It is a treatment technique wherein a therapist tries to improve the motor and functional ability of the arm. In this treatment, the therapist restricts the use of an unaffected limb and forces the patient to make use of the affected limb. The restraint on the affected arm is attained through a splint, a plaster cast, or a sling. During the treatment with this therapy, the patient can make use of the unaffected arm only for bathing, toileting, and hygiene. For the rest of the activities, the patient is required to try to make use of the affected limb.

Functional electrical stimulation: In this treatment technique for monoplegia small electrical charges are given to muscles of the affected limb. The electrical charges assist in restoring the functionality of the muscles. Apart from giving electrical impulses, a patient undergoes rigorous exercise routine for a specific period of time. Over the years researches have indicated that in patients having nil movement in their limb regain considerable functionality after the treatment.

A patient is considered eligible for treatment of monoplegia if he/she is exhibiting the following symptoms

• Weakness in the limb of the person.
• Reduced sensation in the limb. Sometimes a patient might feel an unexplained sensation of pins and needle in the limb.
• Pain near the muscles of the limb. This pain usually arises due to loss of muscle control and stiffness.
• The fingers and the toes of the affected limb would get curled.
• The problem in moving the limb.

A doctor may also check the eligibility of the patient by conducting a physical examination of the limb.

Any person who is not exhibiting any symptoms of monoplegia is not eligible for the treatment. If the movement of the limb gets affected due to external injury like broken bone then that person is not eligible for treatment. Sometimes a doctor may misdiagnose a patient suffering from myasthenia gravis as a potential candidate for monoplegia. A person suffering from the condition of monoplegia is not eligible for the treatment.

Treatment and side effects almost always work in a combination. Whenever a patient needs treatment for some disorder there are chances that the patient might also experience the side effects of that treatment. The possibility of occurrence of the side effect varies from person to person. There is no need to panic if a patient experiences any minor side effect as they tend to vanish after a period of time. However, if a patient experiences any serious side effect then emergency medical attention is required.

The side effects experienced by a patient undergoing physiotherapy treatment include pain in the area where the exercise is being conducted, a patient might complain of muscle soreness, and a patient may experience fatigue. Bruising is also one of the side effects of undergoing treatment with physiotherapy.

For a patient undergoing treatment with functional electrical stimulation, the side effects experienced are burning sensation on the skin, a patient might also feel a tingling sensation on their skin.

The constraint induced movement therapy usually does not exhibit any side effect but being unable to make use of the affected limb for their activities may lead to a bout of depression in the patient.

The post-treatment guidelines play a very vital role in the recovery of a patient. A patient who religiously follows the post-treatment guidelines in the majority of the cases prevents the recurrence of that disease in the future. Post-treatment guidelines are a set of activities that are described by the doctor to help the staying healthy after the treatment is completed. Some post- treatment guidelines to be followed by the patient after getting treated for monoplegia are :

• Some modifications must be made in the diet of the patient like foods rich in fatty acid must be added to the diet for reducing the inflammation of the muscles.<.li>
• Vitamin B12 must be taken by a patient either through some medication or through foods rich in Vitamin B12 as it helps in the improvement of the functioning of the nervous system.
• The exercise regime must not be stopped abruptly but rather it is preferred that a patient continues to exercise even after the treatment is complete

Recovery of the patient suffering from monoplegia is generally slow and it may take a few months to recover. However, the recovery period depends on the passion of the patient to recover quickly. When some patients undergoing treatment for monoplegia do not see an early improvement in their condition they tend to get discouraged. They start to lose interest in their treatment. It is important for a patient to understand that recovery in monoplegia is a slow process but with continued passion towards their treatment an early recovery may be made.

The average cost of treatment for monoplegia in India ranges from 5000 rupees to 1,00,000 rupees this cost is inclusive of the duration of time for which the sessions of physiotherapy would be required for the treatment. Hiring a good physiotherapist in small cities would cost around 500 rupees per session. In metro cities, a session of physiotherapy costs around 1500 to 2000 rupees.

The results of the treatment in a patient suffering from monoplegia are not permanent. If a patient has suffered from monoplegia then there is a possibility that a patient might again experience the same problem. There is no permanent cure for this disorder. The treatment given is symptomatic. If a patient suffering from monoplegia experiences only partial paralysis then complete recovery is possible but, in case of complete paralysis of the limb, a complete recovery is never attained.

Besides the above treatment for monoplegia, a patient can also opt for acupressure and acupuncture for recovery of the muscle functionality. Some patients opt for natural remedies like 5 to 6 pieces of garlic are grind and mixed with honey to help in improving the flow of blood in the affected area. Another natural remedy is massaging the affected area with lukewarm kalonji oil.