1
|
Champigny CM, Feldman SJ, Beribisky N, Desrocher M, Isaacs T, Krishnan P, Monette G, Dlamini N, Dirks P, Westmacott R. Predictors of neurocognitive outcome in pediatric ischemic and hemorrhagic stroke. Child Neuropsychol 2024; 30:444-461. [PMID: 37204222 DOI: 10.1080/09297049.2023.2213461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 05/05/2023] [Indexed: 05/20/2023]
Abstract
This clinical study examined the impact of eight predictors (age at stroke, stroke type, lesion size, lesion location, time since stroke, neurologic severity, seizures post-stroke, and socioeconomic status) on neurocognitive functioning following pediatric stroke. Youth with a history of pediatric ischemic or hemorrhagic stroke (n = 92, ages six to 25) underwent neuropsychological testing and caregivers completed parent-report questionnaires. Hospital records were accessed for medical history. Spline regressions, likelihood ratios, one-way analysis of variance, Welch's t-tests, and simple linear regressions examined associations between predictors and neuropsychological outcome measures. Large lesions and lower socioeconomic status were associated with worse neurocognitive outcomes across most neurocognitive domains. Ischemic stroke was associated with worse outcome in attention and executive functioning compared to hemorrhagic stroke. Participants with seizures had more severe executive functioning impairments than participants without seizures. Youth with cortical-subcortical lesions scored lower on a few measures than youth with cortical or subcortical lesions. Neurologic severity predicted scores on few measures. No differences were found based on time since stroke, lesion laterality, or supra- versus infratentorial lesion. In conclusion, lesion size and socioeconomic status predict neurocognitive outcome following pediatric stroke. An improved understanding of predictors is valuable to clinicians who have responsibilities related to neuropsychological assessment and treatments for this population. Findings should inform clinical practice through enhanced appraisals of prognosis and the use of a biopsychosocial approach when conceptualizing neurocognitive outcome and setting up support services aimed at fostering optimal development for youth with stroke.
Collapse
Affiliation(s)
- Claire M Champigny
- Department of Psychology, The Hospital for Sick Children, Toronto, Canada
- Department of Psychology, York University, Toronto, Canada
| | - Samantha J Feldman
- Department of Psychology, The Hospital for Sick Children, Toronto, Canada
- Department of Psychology, York University, Toronto, Canada
| | | | - Mary Desrocher
- Department of Psychology, The Hospital for Sick Children, Toronto, Canada
- Department of Psychology, York University, Toronto, Canada
| | - Tamiko Isaacs
- Department of Psychology, York University, Toronto, Canada
| | - Pradeep Krishnan
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Canada
| | | | - Nomazulu Dlamini
- Division of Neurology, The Hospital for Sick Children, Toronto, Canada
| | - Peter Dirks
- Division of Neurosurgery, The Hospital for Sick Children, Toronto, Canada
| | - Robyn Westmacott
- Department of Psychology, The Hospital for Sick Children, Toronto, Canada
- Division of Neurology, The Hospital for Sick Children, Toronto, Canada
| |
Collapse
|
2
|
Wilson A, Beribisky N, Desrocher M, Dlamini N, Williams T, Westmacott R. Predictors of externalizing behavior outcomes following pediatric stroke. Child Neuropsychol 2024; 30:241-263. [PMID: 36891616 DOI: 10.1080/09297049.2023.2185216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 02/16/2023] [Indexed: 03/10/2023]
Abstract
Children who experience pediatric stroke are at higher risk for future behavioral problems in childhood. We examined the prevalence of parent reported externalizing behaviors and executive function problems in children following stroke and neurological predictors. This study included 210 children with pediatric ischemic stroke (mean age 9.18 years (SD = 3.95)). The parent form of the Behavioral Assessment System for Children-Second Edition (BASC-2) and Behavior Rating Inventory of Executive Function (BRIEF) were used to evaluate externalizing behavior and executive function. No externalizing behavior or executive function differences were found between perinatal (n = 94) or childhood (n = 116) stoke, except for the shift subscale which had higher T-scores among the perinatal group (M = 55.83) than childhood group (M = 50.40). When examined together, 10% of children had clinically elevated hyperactivity T-scores as opposed to the expected 2%. Parents endorsed higher ratings of concern on the behavior regulation and metacognition indices of the BRIEF. Externalizing behaviors were correlated moderately to strongly with executive functions (r = 0.42 to 0.74). When examining neurological and clinical predictors of externalizing behaviors, only female gender was predictive of increased hyperactivity (p = .004). However, there were no significant gender differences in diagnosis of attention deficit hyperactivity disorder (ADHD). In summary, in this cohort, children with perinatal and childhood stroke did not differ on parent reported externalizing behavior or executive function outcomes. However, compared to normative data, children with perinatal or childhood stroke are significantly more likely to experience clinically elevated levels of hyperactivity.
Collapse
Affiliation(s)
- Alyssia Wilson
- Department of Psychology, York University, Toronto, ON, Canada
| | | | - Mary Desrocher
- Department of Psychology, York University, Toronto, ON, Canada
| | - Nomazulu Dlamini
- Department of Psychology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Tricia Williams
- Department of Psychology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Robyn Westmacott
- Department of Psychology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
3
|
Rivella C, Zanetti A, Bertamino M, Primavera L, Moretti P, Viterbori P. Emotional and social functioning after stroke in childhood: a systematic review. Disabil Rehabil 2023; 45:4175-4189. [PMID: 36384380 DOI: 10.1080/09638288.2022.2144490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 11/02/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE To provide an overview of the effects of pediatric stroke on emotional and social functioning in childhood. METHODS A literature review was completed in accordance with the Preferred Reporting Items for Systematic Reviews. A systematic search of studies on internalizing problems and social functioning after pediatric stroke in PsycInfo, PsycArticles, and PubMed databases was conducted from inception to November 2021. A total of 583 studies were identified, and 32 met the inclusion criteria. RESULTS The review suggests that children after stroke are at risk of developing internalizing problems and a wide range of social difficulties. Internalizing problems are often associated with environmental factors such as family functioning and parents' mental health. In addition, a higher risk of developing psychosocial problems is associated with lower cognitive functioning and severe neurological impairment. CONCLUSIONS The assessment of psychological well-being and social functioning after pediatric stroke is helpful to provide adequate support to children and their families. Future studies are needed to better investigate these domains and to develop adequate methodologies for specific interventions.Implication for rehabilitationThis paper reviews research concerning emotional and social functioning following pediatric stroke in order to provide helpful information to clinicians and families and to improve rehabilitation pathways.Emotional and social functioning should be addressed during post-stroke evaluation and follow-up, even when physical and cognitive recovery is progressing well.Care in pediatric stroke should include volitional treatment and address emotional and social issues.
Collapse
Affiliation(s)
- Carlotta Rivella
- Department of Educational Science, University of Genoa, Genoa, Italy
| | - Alice Zanetti
- Physical Medicine and Rehabilitation Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Marta Bertamino
- Physical Medicine and Rehabilitation Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | | | - Paolo Moretti
- Physical Medicine and Rehabilitation Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Paola Viterbori
- Department of Educational Science, University of Genoa, Genoa, Italy
| |
Collapse
|
4
|
Champigny CM, Feldman SJ, Westmacott R, Wojtowicz M, Aurin C, Dlamini N, Dirks P, Desrocher M. Adjusting to life after pediatric stroke: A qualitative study. Dev Med Child Neurol 2023; 65:1357-1365. [PMID: 36866398 DOI: 10.1111/dmcn.15556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 12/28/2022] [Accepted: 01/23/2023] [Indexed: 03/04/2023]
Abstract
AIM To examine adjustment after stroke in adolescence from the perspective of affected young people. METHOD Fourteen participants (10 female) aged 13 to 25 years with a history of ischemic or hemorrhagic stroke in adolescence participated in one-on-one semi-structured interviews at the Hospital for Sick Children, Toronto, Canada. Interviews were audio-recorded and transcribed verbatim. Two independent coders conducted a reflexive thematic analysis. RESULTS Five themes were identified as representative of adjustment after stroke: (1) 'Processing the story'; (2) 'Loss and challenges'; (3) 'I've changed'; (4) 'Keys to recovery'; and (5) 'Adjustment and acceptance'. INTERPRETATION This qualitative study provides medical professionals with a personal, patient-driven lens through which to better understand the challenges of adjusting to life after pediatric stroke. Findings highlight the need to provide mental health support to patients to assist them in processing their stroke and adapting to long-lasting sequelae. WHAT THIS PAPER ADDS Processing the onset event is a key component of adjustment to stroke. Feelings of anxiety, sadness, frustration, and self-consciousness impede adjustment to stroke. Young people may feel overwhelmed academically owing to neurocognitive deficits. Sequelae may rid young people of hobbies and passions, and alter plans for the future. To adjust to stroke, survivors draw on resilience, patience, determination, and social support.
Collapse
Affiliation(s)
- Claire M Champigny
- Department of Psychology, the Hospital for Sick Children, Toronto, Canada
- Department of Psychology, York University, Toronto, Canada
| | - Samantha J Feldman
- Department of Psychology, the Hospital for Sick Children, Toronto, Canada
- Department of Psychology, York University, Toronto, Canada
| | - Robyn Westmacott
- Department of Psychology, the Hospital for Sick Children, Toronto, Canada
- Division of Neurology, the Hospital for Sick Children, Toronto, Canada
| | | | - Casey Aurin
- Department of Psychology, York University, Toronto, Canada
| | - Nomazulu Dlamini
- Division of Neurology, the Hospital for Sick Children, Toronto, Canada
| | - Peter Dirks
- Division of Neurosurgery, the Hospital for Sick Children, Toronto, Canada
| | - Mary Desrocher
- Department of Psychology, the Hospital for Sick Children, Toronto, Canada
- Department of Psychology, York University, Toronto, Canada
| |
Collapse
|
5
|
Back to School: Academic Functioning and Educational Needs among Youth with Acquired Brain Injury. CHILDREN 2022; 9:children9091321. [PMID: 36138630 PMCID: PMC9497748 DOI: 10.3390/children9091321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/19/2022] [Accepted: 08/24/2022] [Indexed: 11/17/2022]
Abstract
Youth with a history of traumatic or non-traumatic acquired brain injury are at increased risk for long-lasting cognitive, emotional, behavioral, social, and physical sequelae post-injury. Such sequelae have great potential to negatively impact this population’s academic functioning. Consistently, poorer academic achievement and elevated need for educational supports have been well-documented among youth with a history of acquired brain injury. The current paper reviews the literature on neuropsychological, psychiatric, and academic outcomes of pediatric acquired brain injury. A discussion of special education law as it applies to this patient population, ongoing limitations within the field, and a proposal of solutions are also included.
Collapse
|
6
|
Sporns PB, Fullerton HJ, Lee S, Kim H, Lo WD, Mackay MT, Wildgruber M. Childhood stroke. Nat Rev Dis Primers 2022; 8:12. [PMID: 35210461 DOI: 10.1038/s41572-022-00337-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/07/2022] [Indexed: 01/09/2023]
Abstract
Stroke is an important cause of neurological morbidity in children; most survivors have permanent neurological deficits that affect the remainder of their life. Stroke in childhood, the focus of this Primer, is distinguished from perinatal stroke, defined as stroke before 29 days of age, because of its unique pathogenesis reflecting the maternal-fetal unit. Although approximately 15% of strokes in adults are haemorrhagic, half of incident strokes in children are haemorrhagic and half are ischaemic. The causes of childhood stroke are distinct from those in adults. Urgent brain imaging is essential to confirm the stroke diagnosis and guide decisions about hyperacute therapies. Secondary stroke prevention strongly depends on the underlying aetiology. While the past decade has seen substantial advances in paediatric stroke research, the quality of evidence for interventions, such as the rapid reperfusion therapies that have revolutionized arterial ischaemic stroke care in adults, remains low. Substantial time delays in diagnosis and treatment continue to challenge best possible care. Effective primary stroke prevention strategies in children with sickle cell disease represent a major success, yet barriers to implementation persist. The multidisciplinary members of the International Pediatric Stroke Organization are coordinating global efforts to tackle these challenges and improve the outcomes in children with cerebrovascular disease.
Collapse
Affiliation(s)
- Peter B Sporns
- Department of Neuroradiology, Clinic of Radiology & Nuclear Medicine, University Hospital Basel, Basel, Switzerland.,Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Heather J Fullerton
- Departments of Neurology and Pediatrics, Benioff Children's Hospital, University of California at San Francisco, San Francisco, CA, USA
| | - Sarah Lee
- Division of Child Neurology, Department of Neurology & Neurological Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Helen Kim
- Departments of Anesthesia and Perioperative Care, and Epidemiology and Biostatistics, Center for Cerebrovascular Research, University of California at San Francisco, San Francisco, CA, USA
| | - Warren D Lo
- Departments of Pediatrics and Neurology, Nationwide Children's Hospital and The Ohio State University, Columbus, OH, USA
| | - Mark T Mackay
- Department of Neurology, Royal Children's Hospital, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Moritz Wildgruber
- Department of Radiology, University Hospital Munich, LMU Munich, Munich, Germany.
| |
Collapse
|
7
|
Bennett SD, Heyman I, Coughtrey AE, Varadkar S, Stephenson T, Shafran R. Telephone-guided self-help for mental health difficulties in neurological conditions: a randomised pilot trial. Arch Dis Child 2021; 106:862-867. [PMID: 33402326 DOI: 10.1136/archdischild-2019-318577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 12/04/2020] [Accepted: 12/09/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVE This study aimed to conduct a randomised pilot trial to assess the feasibility of a randomised controlled trial (RCT) to investigate the effect of telephone-guided self-help for the treatment of mental health difficulties in children with neurological conditions. DESIGN Preliminary RCT. The primary outcome measure was the Strengths and Difficulties Questionnaire. SETTING Neurology clinics in a national tertiary paediatric hospital. PATIENTS Young people attending neurology clinics who met criteria for mental health difficulties according to the Development and Wellbeing Assessment. INTERVENTIONS 12 weeks of telephone-guided self-help based on a modular approach to psychological therapy for children delivered to children and/or their parents (n=17; eight males; mean age 12.04 years, SD=3.34) or a waiting list for telephone-guided self-help with no additional intervention over 12 weeks (n=17; nine males; mean age 10.53 years, SD=3.14). RESULTS 124 participants completed the DAWBA, and 34 children and young people were entered into the trial. 65% of those randomised to the intervention arm completed the full intervention, and the intervention was acceptable to those completing it. However, there were significant problems related to lack of data completion (38% data loss for primary outcome measure), choice of control comparator and outcome measures. Due to significant loss of data at follow-up, the effect size findings are considered unreliable. CONCLUSIONS Further feasibility work should be conducted to improve data completeness before progression to a definitive trial of guided self-help for mental health problems in children with neurological conditions can be recommended. TRIAL REGISTRATION NUMBER ISRCTN21184717.
Collapse
Affiliation(s)
- Sophie D Bennett
- UCL Great Ormond Street Institute of Child Health, UCL, London, UK
| | - Isobel Heyman
- UCL Great Ormond Street Institute of Child Health, UCL, London, UK.,Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | - Anna E Coughtrey
- UCL Great Ormond Street Institute of Child Health, UCL, London, UK.,Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | - Sophia Varadkar
- UCL Great Ormond Street Institute of Child Health, UCL, London, UK.,Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | | | | | - Roz Shafran
- UCL Great Ormond Street Institute of Child Health, UCL, London, UK
| |
Collapse
|
8
|
Solomon DL, Dirlikov B, Shem KL, Elliott CS. The Time Burden of Specialty Clinic Visits in Persons With Neurologic Disease: A Case for Universal Telemedicine Coverage. Front Neurol 2021; 12:559024. [PMID: 34017297 PMCID: PMC8130896 DOI: 10.3389/fneur.2021.559024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 03/31/2021] [Indexed: 01/06/2023] Open
Abstract
Objective: Those with chronic neurologic disorders are often burdened not only by the condition itself but also an increased need for subspecialty medical care. This may require long distance travel, while even small distances can be a hardship secondary to impaired mobility and transportation. We sought to examine the burden of time associated with clinical visits for those with chronic neurologic disorders and their family/caregivers. These topics are discussed as an argument to support universal coverage for telemedicine in this population. Design: Cohort Study. Setting: Specialty clinic at community hospital. Participants: 208 unique patients with chronic neurologic disability at physical medicine and rehabilitation or neurourology clinic over a 3-month period. Main Outcome Measures: Patient survey on commute distance, time, difficulties, and need for caregiver assistance to attend visits. Results: Approximately 40% of patients were covered by Medicare. Many patients (42%) perceived it difficult to attend their clinic visit with transportation difficulties, commute time, and changes to their daily schedule being the most commonly cited reasons. Most patients (75%) lived within 25 miles of our clinics and experienced an average commute time of 79.4 min, though 10% required 3 h or more. Additional family/caregiver assistance was required for 76% of patients, which resulted in an inclusive average commute time of 138.2 min per patient. Conclusion: Chronically neurologically-disabled patients and their caregivers may be burdened by the commute to outpatient appointments. To minimize this burden, increased emphasis on telemedicine coverage for those with chronic neurologic disability should be considered by all payors.
Collapse
Affiliation(s)
- Daniel L Solomon
- Rehabilitation Research Center, Santa Clara Valley Medical Center, San Jose, CA, United States
| | - Benjamin Dirlikov
- Rehabilitation Research Center, Santa Clara Valley Medical Center, San Jose, CA, United States
| | - Kazuko L Shem
- Department of Physical Medicine and Rehabilitation, Santa Clara Valley Medical Center, San Jose, CA, United States
| | - Christopher S Elliott
- Division of Urology, Santa Clara Valley Medical Center, San Jose, CA, United States.,Department of Urology, Stanford University School of Medicine, Stanford, CA, United States
| |
Collapse
|
9
|
Ryan NP, Greenham M, Gordon AL, Ditchfield M, Coleman L, Cooper A, Crowe L, Hunt RW, Monagle P, Mackay MT, Anderson V. Social Cognitive Dysfunction Following Pediatric Arterial Ischemic Stroke: Evidence From a Prospective Cohort Study. Stroke 2021; 52:1609-1617. [PMID: 33827249 DOI: 10.1161/strokeaha.120.032955] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
Collapse
Affiliation(s)
- Nicholas P Ryan
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia (N.P.R., M.G., L.C., A.C, L.C., R.W.H., P.M., M.T.M., V.A.).,School of Psychology, Deakin University, Geelong, Australia (N.P.R.).,Department of Paediatrics, The University of Melbourne, Australia (N.P.R., A.C., R.W.H., P.M., M.T.M., V.A.)
| | - Mardee Greenham
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia (N.P.R., M.G., L.C., A.C, L.C., R.W.H., P.M., M.T.M., V.A.)
| | - Anne L Gordon
- Paediatric Neuroscience Department, Evelina London Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom (A.L.G.).,Department of Population Health Sciences, Kings College London, United Kingdom (A.L.G.)
| | - Michael Ditchfield
- Paediatric Imaging, Monash Children's Hospital, Melbourne, Australia (M.D.).,Department of Radiology and Paediatrics, Monash University, Melbourne, Australia (M.D.)
| | - Lee Coleman
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia (N.P.R., M.G., L.C., A.C, L.C., R.W.H., P.M., M.T.M., V.A.).,Department of Medical Imaging (L.C.), The Royal Children's Hospital, Melbourne, Australia
| | - Anna Cooper
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia (N.P.R., M.G., L.C., A.C, L.C., R.W.H., P.M., M.T.M., V.A.).,Department of Paediatrics, The University of Melbourne, Australia (N.P.R., A.C., R.W.H., P.M., M.T.M., V.A.)
| | - Louise Crowe
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia (N.P.R., M.G., L.C., A.C, L.C., R.W.H., P.M., M.T.M., V.A.)
| | - Rod W Hunt
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia (N.P.R., M.G., L.C., A.C, L.C., R.W.H., P.M., M.T.M., V.A.).,Department of Paediatrics, The University of Melbourne, Australia (N.P.R., A.C., R.W.H., P.M., M.T.M., V.A.).,Department of Neonatal Medicine (R.W.H.), The Royal Children's Hospital, Melbourne, Australia
| | - Paul Monagle
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia (N.P.R., M.G., L.C., A.C, L.C., R.W.H., P.M., M.T.M., V.A.).,Department of Paediatrics, The University of Melbourne, Australia (N.P.R., A.C., R.W.H., P.M., M.T.M., V.A.).,Department of Haematology (P.M.), The Royal Children's Hospital, Melbourne, Australia
| | - Mark T Mackay
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia (N.P.R., M.G., L.C., A.C, L.C., R.W.H., P.M., M.T.M., V.A.).,Department of Paediatrics, The University of Melbourne, Australia (N.P.R., A.C., R.W.H., P.M., M.T.M., V.A.).,Department of Neurology (M.T.M.), The Royal Children's Hospital, Melbourne, Australia
| | - Vicki Anderson
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia (N.P.R., M.G., L.C., A.C, L.C., R.W.H., P.M., M.T.M., V.A.).,Department of Paediatrics, The University of Melbourne, Australia (N.P.R., A.C., R.W.H., P.M., M.T.M., V.A.).,Department of Psychology (V.A.), The Royal Children's Hospital, Melbourne, Australia
| |
Collapse
|
10
|
Rivella C, Viterbori P. [Formula: see text] Executive function following pediatric stroke. A systematic review. Child Neuropsychol 2020; 27:209-231. [PMID: 32969322 DOI: 10.1080/09297049.2020.1820472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Pediatric strokes are rare events that can lead to neuropsychological impairment or disability. While motor deficits are relatively easy to identify and investigate, cognitive outcomes after stroke are more complex to define. Many studies have focused on global cognitive outcomes, while only a few recent studies have focused on specific cognitive processes. The aims of the present review were to provide an overview of the effects of pediatric strokes on executive function and to investigate the relations between executive functioning and clinical factors. METHOD Studies concerning executive functioning after pediatric stroke were identified using PsycInfo, PsycArticles and PubMed. A total of 142 studies were identified, and 22 met the inclusion criteria. RESULTS The review of the 22 studies included clearly indicates that childhood and perinatal strokes can affect executive function, and in particular inhibition. In contrast, the results concerning clinical factors related to EF outcomes are inconsistent. DISCUSSION Our results highlight the importance to assess EF following pediatric stroke. Early identification of difficulties in EF is crucial to provide adequate training to the children and to prevent the development of other correlated difficulties, such as behavioral problems or learning difficulties. Methodological issues regarding the heterogeneity of samples and measurement difficulties limit the conclusions that can be made about the clinical predictors of the outcomes. Studies are needed to better understand this aspect and to develop adequate EF interventions for children following stroke.
Collapse
Affiliation(s)
- Carlotta Rivella
- Department of Educational Science, University of Genoa , Genoa, Italy
| | - Paola Viterbori
- Department of Educational Science, University of Genoa , Genoa, Italy
| |
Collapse
|
11
|
Champigny CM, Deotto A, Westmacott R, Dlamini N, Desrocher M. Academic outcome in pediatric ischemic stroke. Child Neuropsychol 2020; 26:817-833. [DOI: 10.1080/09297049.2020.1712346] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
| | - Angela Deotto
- Department of Psychology, York University, Toronto, Canada
| | - Robyn Westmacott
- Department of Psychology, the Hospital for Sick Children, Toronto, Canada
| | - Nomazulu Dlamini
- Division of Neurology, the Hospital for Sick Children, Toronto, Canada
| | - Mary Desrocher
- Department of Psychology, York University, Toronto, Canada
- SickKids Research Institute, The Hospital for Sick Children, Toronto, Canada
| |
Collapse
|
12
|
de Montferrand C, Vassel-Hitier J, Yvon-Chaou E, Câmara-Costa H, Dellatolas G, Chevignard M. Language and cognitive outcomes after childhood stroke: Theoretical implications for hemispheric specialization. Cortex 2019; 120:509-523. [PMID: 31520846 DOI: 10.1016/j.cortex.2019.07.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 02/21/2019] [Accepted: 07/30/2019] [Indexed: 01/11/2023]
Abstract
The purpose of this study was to investigate language and cognitive outcomes following severe childhood stroke, and the role of age at stroke according to lesion lateralization. We retrospectively included children consecutively admitted to a physical medicine and rehabilitation department between 1992 and 2015 following childhood stroke (age at stroke 1 month to15 years). Data collection included demographic and clinical information, results of cognitive assessments on the Wechsler Intelligence scales, detailed language assessments by speech and language therapists, and long-term academic outcome. Overall, 184 children (52% boys; mean age at assessment = 8.5 years, range .7-15.4 years) were hospitalized following ischemic (n = 79) or hemorrhagic (n = 105) stroke. After a median time since stroke of 4 months (n = 135), mean Full-Scale, Verbal, and Performance Intellectual Quotient (FSIQ, VIQ and PIQ) were 85 (SD = 19), 93 (SD = 22), and 85 (SD = 20), respectively. In language tests (n = 130) assessing lexical and syntactic expression and comprehension, 26%-53% of the children exhibited impairments (scores <2SD). After a median follow-up of 40 months, only 27% of the children were following a normal curriculum without adaptations or delay, and 27% were attending special education programs. School situation was strongly associated with language and FSIQ scores. Language and verbal IQ scores were significantly lower (p < .01) among patients with lesions in the left hemisphere as opposed to the right. After a left hemisphere lesion, language skills were not associated with age at stroke, but for right hemisphere lesions, language was more impaired among children who were younger at stroke onset. PIQ tended to correlate positively with age at stroke in left hemisphere lesions (poorer PIQ in early lesions) and negatively for right hemisphere lesions (poorer PIQ in late lesions). These findings, discussed in the light of the brain vulnerability and plasticity hypotheses, are in favor of a developmental view of hemispheric specialization.
Collapse
Affiliation(s)
- Camille de Montferrand
- Rehabilitation Department for Children with Acquired Neurological Injury, and Outreach Team for Children and Adolescents with Acquired Brain Injury, Saint Maurice Hospitals, Saint Maurice, France; L'Escale, Service de Médecine Physique et de Réadaptation Pédiatrique, Hôpital Femme-Mère-Enfant, Hospices Civils de Lyon, Bron, France
| | - Jeanne Vassel-Hitier
- Rehabilitation Department for Children with Acquired Neurological Injury, and Outreach Team for Children and Adolescents with Acquired Brain Injury, Saint Maurice Hospitals, Saint Maurice, France
| | - Estelle Yvon-Chaou
- Rehabilitation Department for Children with Acquired Neurological Injury, and Outreach Team for Children and Adolescents with Acquired Brain Injury, Saint Maurice Hospitals, Saint Maurice, France
| | - Hugo Câmara-Costa
- Université Paris-Saclay, Université Paris-SUD, UVSQ, CESP, INSERM, Paris, France
| | - Georges Dellatolas
- Université Paris-Saclay, Université Paris-SUD, UVSQ, CESP, INSERM, Paris, France
| | - Mathilde Chevignard
- Rehabilitation Department for Children with Acquired Neurological Injury, and Outreach Team for Children and Adolescents with Acquired Brain Injury, Saint Maurice Hospitals, Saint Maurice, France; Sorbonne Université, Laboratoire d'Imagerie Biomédicale, LIB, Paris, France; French Centre for Paediatric Stroke, Bellevue Hospital, Saint Etienne, France; GRC n°24, Handicap Moteur et Cognitif et Réadaptation (HaMCRe), Sorbonne Université, Paris, France.
| |
Collapse
|
13
|
Chen Q, Cao C, Gong L, Zhang Y. Health related quality of life in stroke patients and risk factors associated with patients for return to work. Medicine (Baltimore) 2019; 98:e15130. [PMID: 31008934 PMCID: PMC6494282 DOI: 10.1097/md.0000000000015130] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
To clarify dynamic change of quality of life (QOL) in patients with stroke after treatment, and to explore the predictors associated with return to work (RTW) within 48 weeks.Patients diagnosed with stroke were enrolled. All patients enrolled were asked to fill in the Short Form 36 Health Survey. For patients with stroke, SF-36 questionnaires were measured repeatedly 4 weeks after treatment. We used phone call to find out if the patient was RTW. The investigation time was 48 weeks.Patients with stroke had lower scores in terms of physiological dimensions, such as physical functional, role limitations due to physical problems, and general health (P < .001). While patients with strokes scored significantly lower in all mental dimensions including vitality, social functioning, role limitations due to emotional problems, and mental health (P < .001). After 4-weeks treatment, we found that, except for bodily pain, scores in dimensions like physical functioning, role limitations due to physical problems, and general health had increased significantly (P < .001). Multivariate logistic regression analysis was conducted, and the result showed that older age (P = .04) and singleness (P = .03) were risk factors associated with QOL improvement in stroke patients after treatment. Outcomes of stroke patients within 48 weeks were explored. The results showed that 108 out of 136 patients RTW within 48 weeks. Average days it took for patients with cerebral infarction to return to work were 77 ± 79, significantly less than patients with cerebral hemorrhage (206 ± 159 days) and patients with subarachnoid hemorrhage (117 ± 113 days, P < .001). Multivariate analysis indicated that only QOL improvement (P = .04) and subtype of stroke (P = .01) were independent factors associated with RTW within 48 weeks.QOL of stroke patients was significantly reduced. After treatments, the physiological quality of stroke patients increased, but the psychological quality remained low. In addition, patients with cerebral hemorrhage and patients with no significant improvement in QOL are independent risk factors for RTW. Therefore, for this subgroup of the population, early diagnosis, close follow-up and monitor of the psychological state should be provided to avoid the occurrence of adverse events.
Collapse
Affiliation(s)
| | - Chunni Cao
- Department of Hyperbaric Oxygen, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong Province, China
| | | | | |
Collapse
|
14
|
Godfrey M, Gillis MM, Khurana D, Poletto E, Tarazi RA. Neuropsychological outcome following thalamic stroke in adolescence: an identical twin comparison. Clin Neuropsychol 2018; 33:905-927. [DOI: 10.1080/13854046.2018.1533997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Mary Godfrey
- Department of Psychology, Drexel University, Philadelphia, PA, USA
| | | | - Divya Khurana
- St. Christopher’s Hospital for Children, Philadelphia, PA, USA
- Department of Pediatrics, Drexel University, Philadelphia, PA, USA
| | - Erica Poletto
- St. Christopher’s Hospital for Children, Philadelphia, PA, USA
- Department of Pediatrics, Drexel University, Philadelphia, PA, USA
- Department of Radiologic Sciences, Drexel University, Philadelphia, PA, USA
| | - Reem A. Tarazi
- St. Christopher’s Hospital for Children, Philadelphia, PA, USA
- Department of Psychiatry, Drexel University, Philadelphia, PA, USA
| |
Collapse
|
15
|
Ghotra SK, Johnson JA, Qiu W, Newton AS, Rasmussen C, Yager JY. Health-related quality of life and its determinants in paediatric arterial ischaemic stroke survivors. Arch Dis Child 2018. [PMID: 29519944 DOI: 10.1136/archdischild-2017-313334] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Health-related quality of life (HRQL) instruments are patient or proxy-reported outcome measures that provide a comprehensive and subjective assessment of patient's well-being and hence vital for health outcomes evaluation. A clear and thorough understanding of HRQL and its determinants is especially important to appropriately guide health-improving interventions. In this study, HRQL of paediatric arterial ischaemic stroke survivors was assessed using guidelines recommended for interpretation and reporting of the patient-reported outcome data. Determinants of HRQL were also explored. METHODS Children diagnosed with arterial ischaemic stroke between 2003 and 2012 were assessed at least 1 year poststroke using the parent-proxy report versions of the Pediatric Quality of Life Inventory 4.0 and Pediatric Stroke Recurrence and Recovery Questionnaire. HRQL data were compared with population norms and used as outcome in multiple linear regression analysis. RESULTS 59 children were evaluated. Mean age at diagnosis of stroke was 2.2 years. Mean age at assessment and time elapsed since stroke was 7 years and 5 years, respectively. A total of 41% children had normal global outcome, whereas 51% had moderate to severe deficits. A lower overall HRQL was observed in both self and proxy reports. Parents reported the maximum impairment in emotional domain, whereas children indicated physical functioning to be the most affected. Neurological outcome, site of stroke and socioeconomic status were independently associated with overall HRQL. CONCLUSIONS Lower HRQL was demonstrated in children who survived arterial ischaemic stroke. Socioeconomic status of families was an important determinant of HRQL, over and above clinical parameters.
Collapse
Affiliation(s)
- Satvinder K Ghotra
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Jeffrey A Johnson
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Weiyu Qiu
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Amanda S Newton
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Carmen Rasmussen
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Jerome Y Yager
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|
16
|
Mackay MT, Steinlin M. Recent developments and new frontiers in childhood arterial ischemic stroke. Int J Stroke 2018; 14:32-43. [PMID: 30079825 DOI: 10.1177/1747493018790064] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
This review will discuss important developments in childhood arterial ischemic stroke over the past decade, focusing on improved understanding of the causes, consequences, and targets for intervention. Risk factors for childhood arterial ischemic stroke are different to adults. Infections, particularly herpes group viruses, are important precipitants for stroke. Non-atherosclerotic arteriopathies are the most common cause of childhood arterial ischemic stroke and an important predictor of recurrent events. Recent advances include the identification of serum biomarkers for inflammation and endothelial injury, and imaging biomarkers to monitor for vascular progression. Multicenter trials of immunotherapies in focal cerebral arteriopathies are currently in development. Recognition of clinical and radiological phenotypic patterns has facilitated the discovery of multisystem disorders associated with arterial ischemic stroke including ACTA2 arteriopathy and adenosine deaminase 2 deficiency. Identification of these Mendelian disorders provide insights into genetic mechanisms of disease and have implications for medical and surgical management. In contrast to adults, there are long diagnostic delays in childhood arterial ischemic stroke. Refinement of pediatric Code Stroke protocols and clinical decision support tools are essential to improve diagnostic certainty and improve access to reperfusion therapies. Children do not recover better than adults following arterial ischemic stroke, with more than half of survivors having long-term impairments. The physical, cognitive, and behavioral consequences of childhood arterial ischemic stroke are increasingly reported but further research is required to understand their impact on participation, quality of life, psychosocial, and family functioning. Longitudinal studies and the use of advanced imaging techniques, to understand neurobiological correlates of functional reorganization, are essential to developing targeted intervention strategies to facilitate recovery.
Collapse
Affiliation(s)
- Mark T Mackay
- 1 Department of Neurology, Royal Children's Hospital, Parkville, Australia.,2 Murdoch Children's Research Institute, Parkville, Australia.,3 Department of Paediatrics, University of Melbourne, Parkville, Australia.,4 Florey Institute of Neurosciences and Mental Health, Parkville, Australia
| | - Maja Steinlin
- 5 Division of Paediatric Neurology, Development and Rehabilitation, University Children's Hospital, Bern, Switzerland.,6 Department of Paediatrics, University of Bern, Bern, Switzerland
| |
Collapse
|
17
|
Fiume A, Deveber G, Jang SH, Fuller C, Viner S, Friefeld S. Development and validation of the Pediatric Stroke Quality of Life Measure. Dev Med Child Neurol 2018; 60:587-595. [PMID: 29451699 DOI: 10.1111/dmcn.13684] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/12/2017] [Indexed: 11/26/2022]
Abstract
AIM To develop and validate a disease-specific parent proxy and child quality of life (QoL) measure for patients aged 2 to 18 years surviving cerebral sinovenous thrombosis (CSVT) and arterial ischaemic stroke (AIS). METHOD Utilizing qualitative and quantitative methods, we developed a 75-item Pediatric Stroke Quality of Life Measure (PSQLM) questionnaire. We mailed the PSQLM and a standardized generic QoL measure, Pediatric Quality of Life Inventory (PedsQL), to 353 families. Stroke type, age at stroke, and neurological outcome on the Pediatric Stroke Outcome Measure were documented. We calculated the internal consistency, validity, and reliability of the PSQLM. RESULTS The response rate was 29%, yielding a sample of 101 patients (mean age 9y 9mo [SD 4.30]; 69 AIS [68.3%], 32 CSVT [31.7%]). The internal consistency of the PSQLM was high (Cronbach's α=0.94-0.97). Construct validity for the PSQLM was moderately strong (r=0.3-0.4; p<0.003) and, as expected, correlation with the PedsQL was moderate, suggesting the PSQLM operationalizes QoL distinct from the PedsQL. Test-retest reliability at 2 weeks was very good (intraclass correlation coefficient [ICC] 0.85-0.95; 95% confidence interval 0.83-0.97) and good agreement was established between parent and child report (ICC 0.63-0.76). INTERPRETATION The PSQLM demonstrates sound psychometric properties. Further research will seek to increase its clinical utility by reducing length and establishing responsiveness for descriptive and longitudinal evaluative assessment. WHAT THIS PAPER ADDS A pediatric stroke-specific quality of life (QoL) measurement tool for assessments based on perceptions of importance and satisfaction. Moderate-to-high reliability and validity established for a new clinical scale evaluating QoL among children with stroke. Perceived QoL measured using the Pediatric Stroke Quality of Life Measure appears lower in children with neurological impairment.
Collapse
Affiliation(s)
- Andrea Fiume
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada.,Clinician Investigator Program, McMaster University, Hamilton, ON, Canada
| | - Gabrielle Deveber
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Neurology, Hospital for Sick Children, Toronto, ON, Canada
| | - Shu-Hyun Jang
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Colleen Fuller
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Shani Viner
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Sharon Friefeld
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
18
|
Greenham M, Gordon AL, Cooper A, Ditchfield M, Coleman L, Hunt RW, Mackay MT, Monagle P, Anderson V. Social functioning following pediatric stroke: contribution of neurobehavioral impairment. Dev Neuropsychol 2018; 43:312-328. [DOI: 10.1080/87565641.2018.1440557] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Mardee Greenham
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Australia
- School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Anne L. Gordon
- Paediatric Neuroscience Department, Evelina London Children’s Hospital, Guy’s & St Thomas’ NHS Foundation Trust, London, UK
- Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, UK
| | - Anna Cooper
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne Australia
| | - Michael Ditchfield
- Paediatric Imaging, Monash Children’s Hospital, Melbourne, Australia
- Department of Radiology and Paediatrics, Monash University, Melbourne, Australia
| | - Lee Coleman
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Australia
- Department of Medical Imaging, The Royal Children’s Hospital, Melbourne, Australia
| | - Rod W. Hunt
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne Australia
- Department of Neonatal Medicine, The Royal Children’s Hospital Melbourne, Melbourne, Australia
| | - Mark T. Mackay
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne Australia
- Department of Neurology, The Royal Children’s Hospital Melbourne, Melbourne, Australia
| | - Paul Monagle
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne Australia
- Department of Haematology, The Royal Children’s Hospital Melbourne, Melbourne, Australia
| | - Vicki Anderson
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Australia
- School of Psychological Sciences, University of Melbourne, Melbourne, Australia
- Department of Psychology, Royal Children’s Hospital, Melbourne, Australia
| |
Collapse
|