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Functional outcome following stroke in children
Anne L Gordon1, Vijeya Ganesan, Anthony Towell
1Great Ormond Street Hospital for Children NHS Trust, London, England. gordonanne@yahoo.co.uk
Insights
Childhood stroke significantly impacts daily activities and health-related quality of life in children. This study highlights the extensive health needs of both affected children and their parents, emphasizing the need for comprehensive support.
Area of Science:
- Pediatric Neurology
- Neurorehabilitation
- Child Health Outcomes
Background:
- Childhood stroke, or cerebral infarction, can lead to long-term functional limitations.
- Understanding the sequelae of pediatric stroke is crucial for effective intervention and support.
- Parental health is often overlooked but may be affected by caring for a child with a chronic condition.
Purpose of the Study:
- To describe functional consequences of childhood stroke, focusing on activity limitations.
- To explore the relationship between brain damage extent, neurological impairment, and functional outcomes.
- To assess the health status of parents of children with stroke.
Main Methods:
- A cohort of 17 children and adolescents with middle cerebral artery territory stroke was studied.
- A novel Paediatric Stroke Activity Limitation Measure (PSALM) was developed and validated.
- Standardized assessments included the Child Health Questionnaire, Pediatric Stroke Outcome Measure, and Short-Form 36 General Health Survey.
Main Results:
- Activity limitations were observed in education, self-care, and motor skills.
- A strong correlation was found between the extent of brain damage, neurological impairment, and functional outcomes.
- Children with stroke scored below average in physical and psychological health compared to population norms.
- Parental health was also generally lower than expected.
Conclusions:
- Childhood stroke results in significant activity limitations and impaired health-related quality of life.
- The extent of brain damage directly correlates with functional sequelae in pediatric stroke survivors.
- Both children with stroke and their parents exhibit considerable and diverse health needs requiring integrated care approaches.
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.