The Process of Recovery: After Hemiplegia

A group of 39 patients with hemiplegia due to cerebral infarction was followed from the time of onset for a period of at least 20 weeks. The subjects were selected on the basis of freedom from serious concomitant disease but having neurological disability persisting at least four weeks. The process of recovery was followed with standard neurological and functional tests. Some neurological recovery occurred in 34 patients. Recovery is usually best in the lower limb, but upper limb movement, sensation, body image, mental ability, and speech may also recover to some extent. Recovery may begin as early as the first week or as late as the seventh. Little neurological improvement took place after the fourteenth week and the average interval from onset to 80% final recovery was six weeks. Functional recovery closely follows neurological recovery. It is suggested that much of the early recovery and that of the upper limb could be due to return of circulation to ischemic areas. Transfer of function to undamaged neurons is suggested as a mechanism of late recovery, especially of the lower limbs and of speech. The role of cerebral edema is uncertain.