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Swallowing, Oral Motor, Motor Speech, and Language Impairments Following Acute Pediatric Ischemic Stroke
Victoria Sherman1,2,3, Rosemary Martino1,2,4,5, Ishvinder Bhathal3
1Speech-Language Pathology, University of Toronto, ON, Canada (V.S., R.M., D.S.B.).
Insights
Pediatric stroke frequently causes swallowing (dysphagia), oral motor, and speech impairments, affecting up to 40% of children. Caregiver burden is also common, highlighting the need for early assessment and intervention strategies.
Area of Science:
- Neurology
- Pediatrics
- Speech-Language Pathology
Background:
- Adult stroke survivors commonly experience dysphagia, dysarthria, and aphasia.
- Impairments following pediatric stroke are less understood.
- This study systematically investigates common impairments in pediatric stroke patients.
Purpose of the Study:
- To assess the frequencies and co-occurrence of dysphagia, oral motor, motor speech, and language impairments in pediatric stroke.
- To examine associations between these impairments and caregiver burden.
- To establish baseline data for pediatric stroke-related communication and swallowing disorders.
Main Methods:
- Retrospective chart review of 173 pediatric patients (birth to 18 years) hospitalized for arterial ischemic stroke (AIS) or cerebral sinovenous thrombosis (CSVT) between 2013-2018.
- Two raters documented in-hospital dysphagia, oral motor dysfunction, motor speech, language impairment, and caregiver burden using predefined operational definitions.
- Univariate, bivariate, and logistic regression analyses were used to determine frequencies and associations.
Main Results:
- Impairment frequencies in children included dysphagia (41%), oral motor (41%), motor speech (37%), and language (31%).
- Common co-occurring impairments in children were oral motor and motor speech (24%), and dysphagia and motor speech (23%).
- Caregiver burden was reported in 58% of patients; associations were found between stroke type/severity and impairments in children.
Conclusions:
- This study provides the first systematic report on the frequencies and associations of key impairments in acute pediatric stroke.
- Each impairment (dysphagia, oral motor, motor speech, language) affects 30-40% of pediatric stroke patients.
- Further research is crucial for long-term outcome determination and developing age-specific assessment protocols.
Background And Purpose:
Following adult stroke, dysphagia, dysarthria, and aphasia are common sequelae. Little is known about these impairments in pediatric stroke. We assessed frequencies, co-occurrence and associations of dysphagia, oral motor, motor speech, language impairment, and caregiver burden in pediatric stroke.
Methods:
Consecutive acute patients from term birth-18 years, hospitalized for arterial ischemic stroke (AIS), and cerebral sinovenous thrombosis, from January 2013 to November 2018 were included. Two raters reviewed patient charts to detect documentation of in-hospital dysphagia, oral motor dysfunction, motor speech and language impairment, and caregiver burden, using a priori operational definitions for notation and assessment findings. Other variables abstracted included demographics, preexisting conditions, stroke characteristics, and discharge disposition. Impairment frequencies were obtained by univariate and bivariate analysis and associations by simple logistic regression.
Results:
A total of 173 patients were stratified into neonates (N=67, mean age 2.9 days, 54 AIS, 15 cerebral sinovenous thrombosis) and children (N=106, mean age 6.5 years, 73 AIS, 35 cerebral sinovenous thrombosis). Derived frequencies of impairments included dysphagia (39% neonates, 41% children); oral motor (6% neonates, 41% children); motor speech (37% children); and language (31% children). Common overlapping impairments included oral motor and motor speech (24%) and dysphagia and motor speech (23%) in children. Associations were found only in children between stroke type (AIS over cerebral sinovenous thrombosis) and AIS severity (more severe deficit at presentation) for all impairments except feeding impairment alone. Caregiver burden was present in 58% patients.
Conclusions:
For the first time, we systematically report the frequencies and associations of dysphagia, oral motor, motor speech, and language impairment during acute presentation of pediatric stroke, ranging from 30% to 40% for each impairment. Further research is needed to determine long-term effects of these impairments and to design standardized age-specific assessment protocols for early recognition following stroke.
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