Physical therapy for a patient with right hemiplegia after cerebral infarction who had difficulty washing his face with both hands

A patient with right hemiplegia after cerebral infarction had difficulty washing his face with both hands. In the face-washing movement, the inability of the hands to touch the face and spillage of water from the hands were the problem. When the patient was observed in the standing posture, his weight was predominately on the left, non-paralyzed side. When the patient began washing his face, the pelvis moved to the left, non-paralyzed side with right, paralyzed side rotation. At this time, the patient's right, paralyzed side elbow flexion was poor. Furthermore, water fell from between both hands because of the inward rotation of the paralyzed right forearm. Measurements based on the observation of the face-washing movement revealed hypertonia and muscle shortening of the multifidus muscle on both sides. In addition, the abdominal oblique muscle, gluteus maximus and biceps brachii on the right, paralyzed side displayed hypotonia. Physical therapy performed for these problems led to the acquisition of the face-washing movement.