Functional trajectory following pediatric stroke: a cohort study of acute inpatient rehabilitation outcomes

Abstract

Background. Stroke in childhood is a significant cause of morbidity and mortality. Neurologic impairments due to childhood stroke are associated with long-term disability and decreased quality of life. However, there are limited studies examining functional outcomes of childhood stroke. The goal of this study was to characterize functional outcomes of children and adolescents admitted to acute inpatient rehabilitation following stroke. Methods. A retrospective cross-sectional study of 100 patients aged 0 to 21 years admitted to a pediatric acute inpatient rehabilitation program following new diagnosis of stroke in childhood. The primary outcome measures were Functional Independence Measure in Children (WeeFIM) score at admission and discharge. Secondary outcome measures included change in WeeFIM score and IRF Efficiency score. Results. The 56 male/43female/1 transgender patients were 10.4±6.1 years old with ischemic (n=53), hemorrhagic (n=41), and hemorrhagic converted ischemic (n=6) strokes. At admission, the group demonstrated moderate-to-severe functional impairments (WeeFIM total score=47.9±26.3 points). Inpatient rehabilitation length of stay was 34.1±28.6 days and at inpatient rehabilitation discharge, WeeFIM total score improved to 73.2±31.5 points, representing a group IRF Efficiency score of 1.42±1.5 points/day. Group effects were also found for medical management of agitation, stroke prophylaxis, and stimulant therapy. Conclusions. Acute inpatient rehabilitation demonstrates statistically and clinically significant functional improvements following pediatric stroke as measured on the WeeFIM scale. Additional studies are needed to examine group effects found from medical management in the inpatient rehabilitation setting.