Electricity is much vaunted; its value is trifling compared with that of the mechanical measures just mentioned, and it should not be em ployed to supplement massage and passive movements till after the expiration of two months from the seizure. The best routine is to com mence with the continuous current, using 5 to ro Leclanche cells, and large, well-moistened electrodes.
Thus in the early rigidity of the forearm and hand the extensor muscles may be gently and very slowly stroked with one electrode, whilst the other is kept stationary; any current which causes strong contraction or pain must not be employed. Passive movements at the digital, meta carpo-phalangeal and wrist joints should be perseveringly employed, and a large globular object may be left in the palm of the hand to prevent contraction of the flexor muscles. Once the patient is able to move about with help from room to room all splints should be abandoned in order to enable him to constantly exercise the weakened muscles, care being taken that by the aid of the sound limb the faulty position of the affected one is kept corrected by the patient himself. Before retiring to rest the splints should be reapplied so as to keep up this correction during sleep. Though it is maintained that no possible advantage can be expected from electrical treatment of the site of the brain lesion the writer has seen benefit follow the application of a current from five Leclanche elements, with one large electrode upon the forehead and the other over the occiput. After a week the current strength may he doubled, and he has employed ten cells, causing the current to flow from an electrode placed over the site of the hemorrhage on one side, with the other pole situated over the opposite region of the skull.
Later on, should the patient be able to move about in the open air, he must be encouraged to exercise constantly the muscles of the leg, stopping short of fatigue, an attendant being placed on each side to avoid falls. Whilst resting in the seated posture with his foot flexed, the forearm, arm and shoulder muscles may be likewise exercised, after which a short walk will again bring into action the leg muscles. When the return of power begins to manifest itself in the impaired muscles, incoordination and disorderly movements akin to what may be seen in ataxia may be observed; these must be met by careful re-educational methods, as in Fraenkel's system, passive and active movements being assiduously practised till the patient learns the necessary new movement memories.
The permanent spasticity following the attack of loss of power in the muscles has been successfully remedied in some instances by resection of the posterior roots of several of the spinal nerves and by the injection of Alcohol into the trunks of the nerves supplying the rigid muscles (see under Paralysis, Spastic).
The treatment of the aphasia which often accompanies the hemiplegic condition when this affects the right side of the body will be found detailed under Aphasia. The hemiplegia caused by cerebral tumour can only be dealt with by measures applicable to the relief of the primary disease.