Clinically reviewed by What is paralysis
Paralysis means a muscle has lost its power because the nerve pathway controlling it is damaged. The damage may be in the brain, in the spinal cord, or in the nerve itself. The muscle is often perfectly healthy. The message is simply not reaching it.
In Urdu it is falij. Weakness down one side of the body, usually after a stroke, is hemiplegia. Weakness of both legs, usually from a spinal cord problem, is paraplegia. When all four limbs are affected the injury is higher, in the neck.
Partial weakness is far more common than complete paralysis, and partial weakness responds well to training.
Symptoms you might have
- Loss of power in an arm, a leg, both legs, or one whole side
- Limbs that feel heavy, or will not move at all on command
- Stiffness building over weeks, so the elbow, wrist, fingers or ankle become hard to straighten
- Loss of feeling in the affected area, in some cases but not all
- Difficulty sitting upright, standing, or moving from bed to chair
- Loss of bladder or bowel control, particularly with spinal cord damage
- Skin breaking down over the tailbone, hip or heel in anyone spending long hours in one position
Why it happens
- Stroke, the commonest cause of one-sided paralysis in adults
- Spinal cord injury from a fall, a road accident or a dive into shallow water
- Tuberculosis of the spine, still a real cause of leg paralysis in Pakistan, and treatable when caught early
- A disc, tumour or infection pressing on the spinal cord
- Nerve injury from trauma, or from an injection given into the wrong part of the buttock
- Brain or spinal infection, including meningitis
- Polio in children, and cerebral palsy from injury around birth
- Illnesses that make weakness spread over hours or days, which need urgent hospital assessment
When you should see a physiotherapist
Start physiotherapy as early as the doctor allows, often in the first week, even while the person is still in bed. The first few weeks decide how much stiffness and how many pressure sores you will be dealing with months later.
Dr. Zahra sees patients at home when travelling is not realistic, which is usually the case in the early months after a stroke or a spinal injury.
Go to a hospital immediately if weakness is new, if it is spreading, if it comes with a severe headache, vomiting or drowsiness, or if bladder or bowel control is newly lost. Paralysis that is getting worse is an emergency.
See a doctor the same day for a pressure sore that is deep, black or smelly, for fever, or if the person is choking on food or water.
Al-Shama Physiotherapy Clinic
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اپائنٹمنٹ کے بارے میں پوچھیںAppointment ke liye poochein
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یہ فارم پُر کریں؛ واٹس ایپ پر آپ کی تفصیلات کے ساتھ پیغام تیار ہو جائے گا۔Yeh form bharein, WhatsApp aap ki tafseel ke saath khul jaye ga.
How it is treated
Physiotherapy does not repair a damaged nerve or spinal cord. Nothing does. What it changes is what the body can do with the function that remains, and it prevents the complications that cause most of the suffering.
- Daily passive and assisted movement of every joint, which is what prevents contractures. A joint left unmoved for weeks becomes permanently fixed
- Positioning and turning: a change of position roughly every two hours, with pillows supporting the limbs, to prevent pressure sores
- Splinting and orthotics, a hand splint to keep the wrist and fingers open, an ankle splint to stop the foot dropping
- Exercise therapy, graded from assisted movement to active strengthening as power returns
- Sitting balance, transfers and standing practice, in that order. Independence in transfers changes daily life more than anything else
- Breathing exercises, because chest infection is a common and avoidable danger in anyone lying down for long periods
- Family training, the most important part of all. The family handles the patient the other twenty three hours of the day
Surgery is not a treatment for paralysis itself, although the cause sometimes needs it, for example a cord compression or an unstable fracture.
Exercises, and what to avoid
What helps
- Passive movement of every joint, slowly, to its comfortable end range, once or twice daily
- Position changes every two hours, day and night, with the heels lifted clear of the mattress
- Sitting up with support for longer periods, which helps breathing, swallowing and alertness
- Repeating whatever movement does exist, many times a day in short bursts
What to avoid
- Pulling on the weak arm when lifting or turning the person. This is the commonest cause of lasting shoulder pain
- Dragging the body across the bed sheet. That shearing is how a pressure sore starts
- Forcing a stiff joint hard or fast. Slow, sustained, comfortable stretch is what lengthens tissue
- Leaving the hand clenched. A clenched hand becomes a fixed hand within weeks
What you can do at home
Turn or shift the person every two hours, including at night. Check the tailbone, hips, heels and elbows.
Keep the skin clean and dry. Redness that does not fade within twenty minutes of taking the pressure off is the first stage of a pressure sore.
Support the weak arm on a pillow or lap tray when sitting. Never lift the person by that arm.
Move every joint through its full range once or twice a day, even when nothing seems to be changing.
Keep fluids up and watch for choking. If the person coughs on water, tell the doctor instead of carrying on.
How long it takes
Most neurological recovery happens in the first three to six months, and it continues more slowly for up to twelve to eighteen months.
After that the nerve damage itself is unlikely to change much. Function still can. Strength, balance, walking distance and independence keep improving with training long after nerve recovery stops, and they slip backwards if training stops.
With a complete spinal cord injury, movement below the level of the injury usually does not return. Treatment is honest about that and aims at independence, transfers and preventing complications.
What changes the outcome most is how early treatment starts, and how consistently the family does the daily work.
Urdu / Roman Urdu
Choose your reading script / اپنی پسند کا رسم الخط منتخب کریں
اردوUrdu script
فالج میں گوشت خراب نہیں ہوتا۔ دماغ یا ریڑھی کی ہڈی سے پیغام گوشت تک نہیں پہنچتا۔ اسی لیے ورزش اور تربیت سے فرق پڑتا ہے۔
فزیوتھراپی نس کی خرابی ٹھیک نہیں کرتی۔ لیکن یہ دو بڑی چیزیں روکتی ہے: جوڑوں کا اکڑ جانا، اور بیڈ سور کا بن جانا۔
ہر دو گھنٹے مریض کی کروٹ بدلیں۔ کمر، کولہے، ایڑی اور کہنی روز چیک کریں۔ کمزور بازو سے مریض کو کبھی نہ اٹھائیں، کندھا متاثر ہو سکتا ہے۔
ہر جوڑ کو روزانہ آرام سے ہلا کر پوری حرکت دیں۔ ہاتھ کو مشت بند ہونے نہ دیں۔
اگر کمزوری بڑھ رہی ہے، سخت سر درد ہو، یا پیشاب کا کنٹرول ختم ہو جائے، تو فوراً ہسپتال جائیں۔
Roman Urdu
Falij mein gosht kharab nahi hota. Dimagh ya reeri ki haddi se paigham gosht tak nahi pohnchta. Isi liye warzish aur training se farq parta hai.
Physiotherapy nas ki kharabi theek nahi karti. Lekin ye do bari cheezen rokti hai: joron ka akar jana, aur bed sore ka ban jana.
Har do ghante marize ki karwat badlen. Kamar, kolhe, airhi aur kohni roz check karen. Kamzor bazu se marize ko kabhi na uthayen, kandha mutasir ho sakta hai.
Har jor ko rozana aaram se hila kar poori harkat den. Haath ko musht band hone na den.
Agar kamzori barh rahi hai, sakht sar dard ho, ya peshab ka control khatam ho jaye, to foran hospital jayen.
Treatment at the clinic, and online
INFORMATION → INDIVIDUAL CARE
A plan built around you.
Talk with Dr. Zahra Fatima, DPT. Understand your next steps, with guidance for your own symptoms and daily routine.
Talk it through
Discuss your symptoms, what you find difficult and what you want to get back to.
Understand your next steps
Use the consultation to discuss which care and exercises fit your situation.
Take your plan with you
Your online consultation includes a written plan you can refer to afterwards.
Questions people ask
Can paralysis be cured?
Can physiotherapy help after falij?
How soon should treatment start after paralysis?
Do you do home visits for paralysis patients?
Is it too late to start a year after paralysis?
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