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Published on: December 29, 2023
Outcome and rehabilitation after childhood stroke
1Institute of Child Health, University College, London, UK.
Insights
Childhood vascular strokes cause significant mortality and long-term impairments, particularly cognitive deficits. Rehabilitation must be individualized to the child's specific impairments, not just the diagnosis, to improve outcomes.
Area of Science:
- Pediatric Neurology
- Neurorehabilitation
Background:
- Childhood vascular stroke syndromes, including arterial ischemic stroke, cerebral sinovenous thrombosis, and intracranial hemorrhage, lead to significant mortality and morbidity.
- Impairments resulting from childhood stroke vary based on lesion etiology, distribution, and child's age, with cognitive deficits often emerging over time.
Purpose of the Study:
- To highlight the significant impact of childhood vascular strokes.
- To emphasize the need for tailored, evidence-based rehabilitation strategies.
- To discuss the potential of novel therapeutic approaches.
Main Methods:
- Review of existing literature on childhood stroke outcomes and rehabilitation.
- Analysis of common impairment patterns in pediatric stroke survivors.
- Evaluation of current rehabilitation practices and their limitations.
Main Results:
- Childhood strokes result in diverse and persistent functional impairments, affecting multiple domains, especially cognition.
- Current rehabilitation often uses non-evidence-based approaches, typically targeting spasticity rather than prevalent issues like dystonia.
- Age is a critical factor influencing natural recovery and response to interventions.
Conclusions:
- Long-term vigilance is crucial for identifying delayed-onset impairments in childhood stroke survivors.
- Rehabilitation must be personalized to the specific pattern of impairment (e.g., dystonia) rather than a generalized diagnosis.
- Emerging therapies like constraint-induced movement therapy and transcranial magnetic stimulation show promise for improving functional recovery.
Abstract:
In contrast to popular belief, the vascular stroke syndromes of childhood (arterial ischemic stroke, cerebral sinovenous thrombosis, and nontraumatic intracranial hemorrhage) result in appreciable mortality and significant morbidity in survivors. The specific nature and range of impairments is affected by the etiology and distribution of the lesion as well as the age of the child. However, no domain of function is universally spared. Impairments, in particular affecting cognitive function, may only emerge over time and therefore long-term vigilance is important. Current rehabilitation approaches in these children are rarely evidence based and are usually based on approaches used in management of congenital disorders such as cerebral palsy. The rehabilitation approach should be targeted to the observed pattern of impairment rather than the diagnosis - for example dystonia, rather than spasticity, is a far more common consequence of arterial ischemic stroke in children, whereas most conventional stroke rehabilitation approaches target spasticity. Age is likely to be an important factor in both determining the potential for natural recovery as well as the response to rehabilitation. New rehabilitation approaches such as constraint induced movement therapy and transcranial magnetic stimulation hold promise.
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