Language, cognitive and school outcomes following childhood stroke

Abstract

Studies on language outcome following childhood stroke are rare. The aims of this study were to study language, cognitive and school outcomes following childhood stroke. We retrospectively reviewed the files of children (1 month–15 years) consecutively admitted to a physical medicine and rehabilitation department following childhood stroke between 1992 and 2015. Age at onset, aetiology, lesion laterality, initial severity, motor and functional impairments upon admission and discharge, language tests, neuropsychological assessment (or developmental age/quotient) and academic outcome were collected. Over the study period, 184 children were hospitalised following ischemic ( n = 79) or hemorrhagic ( n = 105) stroke. Upon admission, after a median time since stroke of 22 days, 89% of the children had motor impairment and 42% were not able to walk. Upon discharge (median 6 months post-stroke), 25% could still not walk independently and 42% could not use their hand. Neuropsychological assessment performed after a median time since stroke of 4 months indicated severe impairment: n = 135 [m (SD)]: full scale IQ 85 (19), verbal IQ 93 (22), performance IQ 85 (20), working memory index 87 (18), processing speed index 79 (18). Language tests performed after a median time since stroke of 3 months also revealed severe impairment ( n = 130). The 4 language skills tested (receptive and expressive, semantic and syntax) were impaired, especially word finding (median SD = –2). Overall, significant impairment was found (scores < –2SD) in 26% of children for lexical extent, 53% for word finding, 38% for syntactic comprehension and 47% for syntactic expression. For 19 children who were under the age of three at assessment, mean developmental quotient was 57 (SD = 23) for the total score and 65 (SD = 24) for the language subscale. Language and verbal IQ were significantly lower ( p < 0.01) in patients with left-hemisphere lesion than in those with right-hemisphere lesions. After a median follow up of 40 months, only 34% of the children were following normal curriculum without adaptations or delay and 28% were attending special education programs. School outcome was highly correlated to language and IQ ( p < 0.0001). Childhood stroke leads to severe language and cognitive impairments, with negative and long lasting consequences on academic achievement.