|
|
|
« Back
Most Functional Recovery From Pediatric Stroke Is Within 2-3 Months
|
Posted on: 11/30/1999
|
More children have strokes than people realize; it's not an uncommon thing. In fact, childhood (or pediatric) strokes are among the top 10 reasons for death in children in the United States. Unfortunately though, little research has been done when compared to the research for strokes in adults.
Luckily, children who have had a stroke have a better chance of improving and regaining their pre-stroke level of function (37 percent) than their adult counterparts (25 percent). This difference is significant because it tells researchers that there are issues in childhood strokes that don't affect adults and without proper research among children, they can't be discovered.
When adults have a stroke, if they're going to have a good outcome and return of function, it usually happens within the first three months after the stroke occurs. The next three months may see some minor improvements too though. Without knowing if this is true among children, it's harder to predict how things will turn out among them. The authors of this article wanted to review cases of children who had strokes to see if they could establish a pattern of development and improvement over time.
Researchers reviewed the charts of 44 children who had an arterial stroke (blockage in the artery, causing stroke). The children were followed from the time they were hospitalized (inpatient care) through to outpatient care. The researchers used the Modified Brunnstrom Scale to evaluate the muscle tone in patients who had hemiplegic (half the body, right or left) arm muscle tone and to check for changes. Stage 1 meant the arm was completely flaccid (limp), Stage 2 had no active movement but had reflexes and sometimes resisted movement by someone else. Stage 3 included movement on the child's behalf, up to 50 percent of normal in at least one joint. Stage 4 was 50 percent or more of movement involving one part of the arm or one joint, and Stage 5 was full range of motion but not completely full, while Stage 6 was fairly close to total movement.
The Gross Motor Function Classification System (GMFCS) evaluated Level 1: walking or running without help but slower with difficulty in balance, speed and coordination; Level 2: walking with an assistive device for more than 250 feet but needs help for more activity; Level 3: walking with or without assistive device but requires close supervision or a contact guard; Level 4: requiring mostly to be transported but is able to walk with or without an assistive device for a few steps while requiring close supervision or contact guard; and Level 5: must be moved, can manage electric or power wheelchair independently.
The patients were also checked for bathroom habits: incontinent, continent, or combined. Speech and ability to swallow were evaluated, as were activities of daily living (grooming, bathing, dressing, etc.). School was assessed as Level 1: maximum assistance required or totally dependent; Level 2: Moderate assistance required; Level 3: some special support needed; and Level 4: return to school independently.
The results of the review showed that the children ranged in age from 8 months to 17 years and their average length of stay in the hospital was 20.7 days, ranging from five to 131 days. Most children had non-hemmorhagic strokes (bleeding in the brain) while only 17 had hemmorhagic strokes - these children tended to be older. Lesions on the left side of the brain were more common than the right or both.
Among the effects of the strokes,. 27 had flaccid arms (Brunnstrom), eight were Stage 2, two were Stage 6 when the stroke happened. The eight of the 27 children who had flaccid arms progressed to stage 6 within an average of 58.5 days. The other 19 didn't make it to Stage 6.
Twenty two of the children weren't able to control their bowel or bladder when they had their stroke. At the end of the evaluation, all but seven had become continent again, usually regained at around 23.3 days after the stroke. All but five patients had difficulty swallowing after the stroke, which improved for 39 by an average of 17.7 days.
Speech was severely affected in 19 of the children and 17 were somewhat affected. When the researchers looked at mobility, they found that 19 of the patients were able to walk with a brace or minor assistance on an average of 50.3 days after the stroke and 18 were able to be completely independent in walking. Five of these patients were able to sit up and stay sitting when they had their stroke and they were also the ones who were able to walk independently the earliest of all the patients who were not able to keep their balance while sitting.
Activities of daily living is another way of evaluating how a patient is progressing. At the end of the study, 20 patients were able to do most of the ADLs alone. Looking at education progress, 10 children were not yet in school. Of the remaining students, 33 were enrolled in a regular school program at the time of their stroke and one was receiving special education because of a diagnosis of autism. At the end of the studies, 32 of the patients were able to return to their schools; 14 were independent and 18 needed assistance.
The authors concluded that although there isn't a lot of data on children recovering from strokes, there seems to be a general idea that children are more able to bounce back after a stroke, more so than adults. But, with the findings the researchers studied, the length of recovery and speed (mostly within three months) is the same as adults. In addition, they wrote that because of their immature brain, children may actually have more brain damage from the stroke and have further to go to recuperate. Results of studies in children are often contradictory, including when recovery of functions may be expected. An interesting finding is that children who had a stroke before they were a year old had a harder time gaining speech-language function.
More research is needed to truly understand the effects of stroke on children, their recovery, and prognosis.
|
References:
Chong-Tae Kim, MD, PhD, James Han, DO,MS, and Heakyung Kim, MD. Pediatric Stroke Recovery: A Descriptive Analysis. In
Archives of Physical Medicine & Rehabilitation. April 2009. Vol. 90. No. 4. Pp. 657 to 662.
|
|
|
« Back
|
|
|
|
*Disclaimer:*The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic. |
 | All content provided by eORTHOPOD® is a registered trademark of Mosaic Medical Group, L.L.C.. Content is the sole property of Mosaic Medical Group, LLC and used herein by permission. |
|
