Abstract 2373: Childhood Stroke Impairs Functional Behavior

Abstract

BACKGROUND: Stroke can affect children with long-term impairment of intellectual ability and increased risk of attention deficits and psychiatric disorders. Although limited studies in the literature suggest that stroke can chronically impair functional behavior and social adaptation, these functional outcomes have received little attention. We performed a pilot case-control study to examine the hypothesis that pediatric stroke impairs adaptive behavior, and we addressed the secondary hypotheses that stroke volume and location predict impaired functional behavior. METHODS: Children ages 6-15 years who had neonatal or childhood onset arterial ischemic stroke were identified by chart review at the Nationwide Children’s (Columbus, OH, USA) and Royal Children’s Hospital (Melbourne, Australia). Subjects were included if they could complete the test battery. Age- and gender-matched children who had asthma were selected as controls. Stroke cases were assessed with the Pediatric Stroke Outcome Measure and had an MRI brain scan after the acute phase of stroke. Cases and controls underwent functional assessments at least one year after the incident stroke. The battery of tests and ratings included the Wechsler Abbreviated Scales of Intelligence, WISC-IV Processing Speed Index, Child Behavior Checklist, Adaptive Behavior Assessment System, and Child & Adolescent Scale of Participation. Infarct volumes were measured by manual segmentation. RESULTS: The sample included 10 children with perinatal stroke, 26 with acquired childhood stroke, and 15 controls. Median age at assessment was 8.7 yrs (IQR 6.9-11.9) and median time after presentation was 5.1 yrs (IQR 2.8-7.4). The median PSOM for stroke cases was 1 (range 0-8.0) and for controls was 0 (range 0-1). Stroke was significantly associated with lower levels of multiple daily living skills (p range 0.001-0.025), functional academics (p=0.048), and self-care (p=0.020), as well as a trend toward impaired school participation (p=0.064), but was not associated with impaired intellectual functioning or behavioral adjustment. Larger Infarcts showed a trend association with higher PSOM total scores (p=0.091). Infarcts that involved both cortex and subcortical parenchyma were associated with poorer daily living skills (p range 0.005-0.052) and a trend toward impaired home community participation (p=0.079). Age of stroke onset was not associated with impairments. Conclusions: Stroke causes deficits that may not be appreciated by standard IQ screening or report of overt behavior disorders. These deficits can affect daily living skills and result in impaired adaptive behavior. Strokes involving both cortex and subcortex, as a proxy for more extensive strokes, may be particularly associated with impaired adaptive behavior. These results are “best case” estimates because our study excluded mentally retarded or grossly impaired children.