User:Tsenft7/sandbox

Monoplegia
In medicine, monoplegia is a paralysis of a single limb, usually an arm. It is frequently associated with cerebral palsy. This is the mildest form of cerebral palsy, and individuals with it generally have a good prognosis for later life. It can also be used if just one muscle group or muscle is affected. It is often thought as hemiplegia with much less involvement of the other limb.

Monoplegia of the upper limb is sometimes referred to as brachial monoplegia, while that of the lower limb is called crural monoplegia. Monoplegia in the lower extremities is not as common as occurrence in the arms. Monoparesis is a similar condition, but less severe because one limb is very weak in this case, but it is not paralyzed. For more information, see paresis.

Signs and Symptoms
There are a number of symptoms associated with monoplegia. Curling of the hands and stiffness of the feet, weakness, numbness, paralysis, pain in the affected limb, headaches, and shoulder pain are all considered to be symptoms of monoplegia. Patients of monoplegia usually feel symptoms of weakness and loss of sensation in an extremity, usually an arm. The extremity with paralysis continues to maintain a strong pulse. Different causes can elicit different combinations of symptoms.

Causes
Some potential causes of monoplegia are listed below, although cerebral palsy is considered to be the main cause.


 * 1) Central nervous mass lesion, including tumor, hematoma, or abscess
 * 2) Complicated migraine
 * 3) Epilepsy
 * 4) Head or spinal trauma
 * 5) Hereditary brachial neuritis
 * 6) Hereditary neuropathy with liability to pressure palsy
 * 7) Neonatal brachial plexus paralysis
 * 8) Neuropathy
 * 9) Plexopathy
 * 10) Traumatic peroneal neuropathy
 * 11) Vaccine-associated paralytic poliomyelitis

Specifically, monoplegia in the lower extremities is typically caused by Brown Sequard syndrome and hematomas in the fronto-parietal cortex near the middle that could produce a deficit such as this, but this is a very uncommon occurrence.

Mechanism
Monoplegia resulting from upper extremity impairments following a stroke occurs due to direct damage to the primary motor cortex, primary somatosensory complex, secondary sensorimotor complex, sensorimotor cortical areas, subcortical structures, and/or the corticospinal tract. It is often found that impairments following stroke are either caused by damage to the same or adjacent neurological structures. The results of damage to one or some of these structures include paresis, loss of fractional movement, abnormal muscle tone, and/or loss of somatosensation. A combination of these impairments is more likely than just one in isolation.

Diagnosis
Needle Electromyography is used to study all limbs, essentially showing the extent in each limb involvement. An approach called single-pulse transcranial magnetic stimulation (spTMS) has been used to help diagnose motors deficits such as monoplegia. This is done by evaluating the functional level of the corticospinal tract.

Treatment
There is no cure for monoplegia, but treatments typically include physical therapy and counseling to help recover muscle tone and function. Recovery will vary depending on diagnosis from temporary, partial or complete paralysis. Much of the therapies focus on the upper limb due to the fact that monoplegia in the upper limbs is much more common than in the lower limbs. It has been found that intense activity-based and goal-directed therapy, such as constraint-induced movement therapy and bimanual therapy, are more effective than standard care. Additionally, there is strong evidence to support that occupational therapy home programs that are goal-directed could be used to supplement hands-on direct therapy.

Constraint-induced movement therapy (CIMT) is specifically targeted at upper limb monoplegia as a result of a stroke. In CIMT the unaffected arm is restrained, forcing the use and frequent practice of the affected arm. This approach to therapy is carried out during ordinary and daily activities by the affected person. It has been found that CIMT is more effective at specifically improving arm movement than a physiotherapy approach or no treatment at all.

Brain computer interface (BCI) systems have been proposed as a tool for rehabilitation of monoplegia, specifically in the upper limb after a stroke. BCI systems provide sensory feedback in the brain via functional electrical stimulation, virtual reality environments, or robotic systems, which allows for the use of brain signals.This is extremely crucial because the networking in the brain is often compromised after a stroke, leading to impaired movement or paralysis. BCI systems allow for detection of intention to move through the primary motor cortex, then provide the matched sensory stimulation according to feedback that is provided. This leads to activity-dependent plasticit y within the user, requiring them to pay careful attention to tasks that require the activation or deactivation of specific brain areas. BCI systems utilize different sources of information for feedback, including electroencephalography (EEG), magnetoencephalography, functional magnetic resonance imaging, near-infrared spectroscopy, or electrocorticography. Among all of these, the EEG signals are the most useful for this type of rehabilitation because they are highly accurate and stable.

Another form of treatment for monoplegia is functional electrical stimulation (FES). It is targeted at patients who acquired monoplegia through incidents such as a spinal cord injury, stroke, multiple sclerosis, or cerebral palsy and utilizes electrical stimulation in order to cause the remaining motor units in the paralyzed muscles to contract. As in traditional muscular training, FES improves the force with which the unaffected muscles contract. For less severely affected patients, FES allows for greater improvement in range of motion than traditional physical therapy.