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Psychological aspects of hemiplegia
  1. ROBERT GOODMAN
  1. Department of Child and Adolescent Psychiatry
  2. Institute of Psychiatry
  3. De Crespigny Park
  4. London SE5 8AF

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    Do paediatricians think of childhood hemiplegia simply as a mild physical disability? Rightly or wrongly, parents often get that impression. This is unfortunate as children and families are easier to help when they know that their difficulties are not being underestimated. The disability does not seem mild to hemiplegic children who are always last on sports day, or self conscious about their body, or unable to carry out all manner of mundane two handed activities. Furthermore, hemiplegia is often more than a physical problem, being accompanied by a variety of ‘invisible’ psychological disabilities. Particularly in the school years, many parents and children are more concerned about the educational, behavioural, emotional, and social accompaniments of hemiplegia than about the physical disability itself. Some of these psychological accompaniments are understandable responses to disability; others are direct consequences of the brain damage itself; and many reflect the complex interplay of these reactive and organic pathways.

    Cognitive difficulties

    Though approximately two thirds of children with hemiplegia are of normal intelligence, the mean IQ of the group is shifted downwards, most markedly for those with the greatest neurological involvement.1 2 Hemiplegias acquired between 1 and 60 months of age may be particularly liable to reduce overall intelligence, perhaps because this is a peak period for synaptic creation and remodelling.2

    Many IQ tests distinguish between verbal IQ, based on tests of verbal …

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