Functional Outcome Following Stroke in Children

Abstract

The aim of this study was to describe the functional consequences of childhood stroke in terms of activity limitation and to explore the relationship between extent of brain damage, impairment, and functional sequelae. A further aim was to describe the health of the parents of these children. Seventeen children and adolescents with cerebral infarction in the territory of the middle cerebral artery were enrolled in the study. A new activity limitation measure with a 4-point Likert scale (the Paediatric Stroke Activity Limitation Measure) was designed to examine the degree of difficulty experienced by the children in daily activities. The relationship between activity limitation scores, standardized health-related quality of life assessment (Child Health Questionnaire), extent of brain damage, and results of a comprehensive neurologic examination (Pediatric Stroke Outcome Measure) were investigated. Parent health was assessed using the Short-Form 36 General Health Survey. Activity limitation was evident in the domains of education, self-care, and motor skills. There was very good interobserver agreement using the new activity limitation scale between the occupational therapist and pediatric neurologist (Cohen's kappa = 0.88). In comparison with population norms, the subjects scored below average in both physical and psychologic health. There was a clear relationship between radiologically apparent extent of brain damage, degree of impairment, and functional outcome. Parental health also rated generally lower than expected. This exploratory study suggests that both children who have had a stroke and their parents have significant and wide-ranging health needs.

Factors affecting cognitive outcome in early pediatric stroke

“…[7][8][9][10] However, younger age at stroke is associated with poorer intellectual outcome and a broader spectrum of dysfunctions across multiple neuropsychological domains. 6,[11][12][13][14][15][16][17] Further, children with combined cortical and subcortical lesions have overall poorer cognitive outcome, 16,18 and larger lesion size negatively influences cognitive and functional outcome, 4,19,20 possibly due to disruption of more neural network connections, adversely affecting functional brain organization. 21 Regarding lesion laterality, controversial reports exist concerning the effect of lesion laterality on neuropsychological outcome.…”

Could infarct location predict the long-term functional outcome in childhood arterial ischemic stroke?

“…This finding is in contrast to previous studies, which showed that combined cortical and subcortical lesions are significantly more likely to result in cognitive impairment in the long term compared to isolated cortical or subcortical infarctions 18,19 . One study even associated the presence of isolated subcortical lesions with a favorable outcome 20 . Although the study criteria could explain these differences, the leading cause of these results may lie in the size of the stroke, since combined lesions are likely to be the largest, as well.…”

Modified constraint‐induced movement therapy after childhood stroke

“…Motor impairment is common and health-related quality of life significantly affected in these children. 4 Although effective rehabilitation has the potential to improve this, scarcity of resources means these children have minimal input beyond the acute phase of recovery.…”

“…Intensive CIT is effective in acute rehabilitation of adult stroke patients. 2,3 As hand function is the most disabling aspect of motor impairment after paediatric AIS 1,4 we were interested in the potential benefits of CIT in this group. The current pilot study aims to investigate the feasibility, tolerability, and effect of mCIT in school-aged children with hemiparesis after AIS.…”