Building Strength and Stability: Rehabilitation in HPHA

While medications can help manage the chemical balance in your brain, rehabilitation is essential for optimizing your body’s movement and daily function. In Hemiparkinsonism-Hemiatrophy Syndrome (HPHA), rehabilitation is individualized because you are managing both the slowness and stiffness of parkinsonism, and the physical asymmetry or weakness of hemiatrophy ^[1][2].

Because HPHA is rare, there is no single “standard” exercise program. However, evidence from related movement disorders and case studies suggests that targeted training may help preserve function, improve mobility, and manage the mismatch between your two sides ^[2].

The Role of Professional Therapy

A multidisciplinary approach is the most effective way to address the unique challenges of HPHA. Your program should be assessed individually, particularly if you have dystonia, spasticity, contractures, pain, or high fall risk.

• Physical Therapy (PT): A physical therapist helps address bradykinesia (slowness) by teaching you how to take larger, more deliberate steps and improve your arm swing ^[3][4]. They also work on balance training to reduce the risk of falls, which is a common concern when one side of the body is weaker ^[5].
• Occupational Therapy (OT): An occupational therapist focuses on “fine motor” skills and daily tasks. If you struggle with hand dexterity, an OT can help you find compensatory strategies—techniques or adaptive tools that allow you to complete a task safely ^[2].
• Speech-Language Therapy: If you experience speech or swallowing problems, a speech-language pathologist should be included in your care.

Targeted Strategies for Daily Life

Living with one-sided symptoms requires intentional adjustments to your daily routine:

Managing Slowness and Gait

• Use Rhythmic Cues: Some people find that walking to a steady beat or using visual guides (like bright tape on the floor) helps overcome slowness and “freezing” ^[3][6]. Note: Ensure any visual markers do not themselves become trip hazards.
• Large-Amplitude Movement: Practicing large movements can help re-calibrate your brain’s sense of effort required to move a stiff limb.
• Orthotics and Aids: Consider orthotics or mobility aids when appropriate to improve stability.

Managing Weakness and Clumsiness

• Task Modification: Use non-slip mats or specialized kitchen tools that stabilize objects so you can use your stronger hand safely while keeping the affected side active.
• Strength and Conditioning: Progressive resistance training may help preserve strength and improve function ^[7]. However, exercise cannot prevent or reverse fixed limb/bone asymmetry or neurologic atrophy.
• Fall Prevention: Ensure your home is well-lit and free of trip hazards like loose rugs or cluttered walkways ^[8]. Installing grab bars in the bathroom provides an extra layer of safety.

The Importance of Safety and Consistency

Rehabilitation in HPHA requires a proactive approach. It is crucial to obtain an individualized home program from a PT or OT before doing balance or strengthening exercises unsupervised.

Stop any exercise for pain, dizziness, or worsening symptoms, and have your therapist review your home program regularly. By working closely with a multidisciplinary team, you can develop a personalized toolkit of strategies to help you stay as mobile and independent as possible ^[2][5].