Course 449: Pediatrics: Pediatric Stroke Recovery

Abstract

Objective: Pediatric stroke recovery is not as well understood as adult stroke. We reviewed the pediatric poststroke recovery patterns of motor, swallowing, speech, and sphincter functions. Design: Retrospective study by medical chart review. Prognostic factors were investigated based on the final achieved functional levels. Setting: Acute pediatric rehabilitation inpatient and outpatient units affiliated with a university hospital. Participants: 44 patients admitted to an acute pediatric inpatient rehabilitation unit with diagnosis of first-ever stroke. Interventions: The recovery pattern was analyzed in regard to muscle tone by modified Brunnstrom stage, skills for ambulation by gross motor functional classification system, and activities of daily living (ADLs) by degree of indepency, swallowing by feeding methods, speech by communication level, and sphincter control by degree of continence. Prognostic factors were investigated based on the final achieved functional levels. Main Outcome Measures: Same as intervention. Results: Recovery of swallowing function occurred earlier than other functions in the first 2 to 3 months poststroke. Less than half of the patients were able to use the affected arms and legs without assistive devices. 11 of 32 patients who initially had poor body control became ambulatory without assistive devices. A total of 18 of 44 patients could walk without assistive devices. Most patients re-entered their premorbid schools, but half of them needed learning support. Bilateral hemisphere lesions and flaccid muscle tone of the affected extremity following stroke had a less favorable prognosis than unilateral hemispheric lesions and nonflaccid hemiplegia at stroke onset in terms of ambulation and ADLs. Hemorrhagic strokes without surgical complications had a better prognosis than nonhemorrhagic strokes. Conclusions: Most of the functional recovery for pediatric stroke occurs in the first 2 to 3 months after stroke, but the quality of functional recovery was better in the pediatric population. The lesion size of the stroke was related to prognosis.