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Lo D, Waite M, Rose TA. Looking beyond body structure and function: a scoping review of non-impairment impacts of stroke on adolescents. Brain Inj 2024:1-14. [PMID: 39277841 DOI: 10.1080/02699052.2024.2390858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 06/18/2024] [Accepted: 08/06/2024] [Indexed: 09/17/2024]
Abstract
BACKGROUND Much of the childhood stroke literature has not distinguished impacts for adolescents from those of younger children. Research has also focused on body impairments. With adolescence being a unique period, this scoping review aimed to identify the impacts of childhood stroke on activity, participation, and quality of life for adolescents 13-18 years, and identify how these impacts were determined. METHOD This review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Data pertaining to non-impairment impacts of childhood stroke for adolescents, participant and study characteristics, and measurement instruments were extracted. RESULTS Following screening, 79 articles were included, and 33 measurement instruments identified. Only 6 studies reported separate data for adolescents, identifying difficulties with daily activities, social and academic impacts, and reduced quality of life. Impacts of post-stroke communication difficulties on daily activities and schooling were also noted. Measurement instruments developed specifically for adolescents with stroke are lacking. INTERPRETATION The review identified limited research reporting non-impairment impacts of childhood stroke for adolescents. Further research specific to this population and the development of measurement instruments for adolescents who have experienced childhood stroke is required to support future research and clinicians working with this population.
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Affiliation(s)
- Davina Lo
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Monique Waite
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Tanya A Rose
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
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2
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Harrar DB, Sun LR, Segal JB, Lee S, Sansevere AJ. Neuromonitoring in Children with Cerebrovascular Disorders. Neurocrit Care 2023; 38:486-503. [PMID: 36828980 DOI: 10.1007/s12028-023-01689-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 01/31/2023] [Indexed: 02/26/2023]
Abstract
BACKGROUND Cerebrovascular disorders are an important cause of morbidity and mortality in children. The acute care of a child with an ischemic or hemorrhagic stroke or cerebral sinus venous thrombosis focuses on stabilizing the patient, determining the cause of the insult, and preventing secondary injury. Here, we review the use of both invasive and noninvasive neuromonitoring modalities in the care of pediatric patients with arterial ischemic stroke, nontraumatic intracranial hemorrhage, and cerebral sinus venous thrombosis. METHODS Narrative review of the literature on neuromonitoring in children with cerebrovascular disorders. RESULTS Neuroimaging, near-infrared spectroscopy, transcranial Doppler ultrasonography, continuous and quantitative electroencephalography, invasive intracranial pressure monitoring, and multimodal neuromonitoring may augment the acute care of children with cerebrovascular disorders. Neuromonitoring can play an essential role in the early identification of evolving injury in the aftermath of arterial ischemic stroke, intracranial hemorrhage, or sinus venous thrombosis, including recurrent infarction or infarct expansion, new or recurrent hemorrhage, vasospasm and delayed cerebral ischemia, status epilepticus, and intracranial hypertension, among others, and this, is turn, can facilitate real-time adjustments to treatment plans. CONCLUSIONS Our understanding of pediatric cerebrovascular disorders has increased dramatically over the past several years, in part due to advances in the neuromonitoring modalities that allow us to better understand these conditions. We are now poised, as a field, to take advantage of advances in neuromonitoring capabilities to determine how best to manage and treat acute cerebrovascular disorders in children.
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Affiliation(s)
- Dana B Harrar
- Division of Neurology, Children's National Hospital, George Washington University School of Medicine, Washington, DC, USA.
| | - Lisa R Sun
- Divisions of Pediatric Neurology and Vascular Neurology, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - J Bradley Segal
- Division of Child Neurology, Department of Neurology & Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Sarah Lee
- Division of Child Neurology, Department of Neurology & Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Arnold J Sansevere
- Division of Neurology, Children's National Hospital, George Washington University School of Medicine, Washington, DC, USA
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3
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Malone LA, Levy TJ, Peterson RK, Felling RJ, Beslow LA. Neurological and Functional Outcomes after Pediatric Stroke. Semin Pediatr Neurol 2022; 44:100991. [PMID: 36456032 DOI: 10.1016/j.spen.2022.100991] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 08/15/2022] [Accepted: 08/22/2022] [Indexed: 12/01/2022]
Abstract
Pediatric stroke results in life-long morbidity for many patients, but the outcomes can vary depending on factors such as age of injury, or mechanism, size, and location of stroke. In this review, we summarize the current understanding of outcomes in different neurological domains (eg, motor, cognitive, language) for children with stroke of different mechanisms (ie, arterial ischemic stroke, cerebral sinus venous thrombosis, and hemorrhagic stroke), but with a focus on World Health Organization International Classification for Functioning, Disability, and Health (ICF-CY) framework for measuring health and disability for children and youth. We describe outcomes for the population as a whole and certain factors that may further refine prognostication.
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Affiliation(s)
- Laura A Malone
- Kennedy Krieger Institute, Baltimore, MD; Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD; Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD.
| | - Todd J Levy
- The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Rachel K Peterson
- Kennedy Krieger Institute, Baltimore, MD; Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD
| | - Ryan J Felling
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD
| | - Lauren A Beslow
- The Children's Hospital of Philadelphia, Philadelphia, PA; Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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4
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Mota LAT, Silva DRB, Pfeifer LI. Functional outcomes in children related to self-care, mobility, and social function after stroke in early childhood: a cohort study. ARQUIVOS DE NEURO-PSIQUIATRIA 2022; 80:13-22. [PMID: 35043927 PMCID: PMC9651499 DOI: 10.1590/0004-282x-anp-2021-0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 04/30/2021] [Indexed: 11/21/2022]
Abstract
ABSTRACT Background: Stroke has been increasingly recognized as an important morbidity and mortality factor in neonates and children. Children have different and more diverse risk factors than adults, commonly related to an underlying disease. Stroke may compromise functional capacity in children. Few studies have focused on functional outcomes related to activities and participation. Objectives: To investigate post-stroke functionality of children related to self-care, mobility, and social function. Methods: We assessed the functional outcome of 14 children younger than 7.5 years who suffered a stroke in early childhood through the use of the Pediatric Evaluation of Disability Inventory (PEDI). Results: The average age of the sample at assessment was 3.6 ± 1.4 years (2 - 6 years). The average scores in the PEDI functional domains of self-care, mobility, and social function were, respectively, 37.6 ± 15.4, 36.2 ± 15.4, and 48.7 ± 11.1. Children showed age-appropriate functional outcomes in the PEDI functional domains: 71.4% of them in self-care and mobility and 92.9% in social function. Children with bilateral injuries (p = 0.05) and longer hospital stays (r = -0.79, p = 0.001) showed the worst scores in PEDI's social function domains. Conclusions: Overall, our sample of preschool children showed age-appropriate functional outcomes on self-care, mobility, and social function domains after stroke. However, children with bilateral injuries and longer hospital stays showed the worst scores in social function domains. We recommend focusing on functional rehabilitation to promote activities and participation and to monitor the development of children's social skills after stroke.
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von Stülpnagel C, Kutschker S, Sperl W, Berweck S, Staudt M, Berndt M, Kluger G. Childhood Stroke: Long-Term Outcomes and Health-Related Quality of Life with a Special Focus on the Development of Epilepsy. Neuropediatrics 2021; 52:469-474. [PMID: 34255332 DOI: 10.1055/s-0041-1731805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Childhood stroke is rare and can predispose to post-stroke epilepsy. The purpose of this study was to evaluate long-term quality of life (QoL) in patients with childhood stroke, focusing on epileptic aspects. METHOD This involves a retrospective study of 98 patients with childhood stroke (pre- and neonatal strokes excluded), who had been inpatients between 1986 and 2003 for early rehabilitation. Data were obtained via interviews using a standardized questionnaire: QoL evaluation with KINDL, functional outcome with Barthel Index, and motor handicaps-assessment with modified Rankin Score. RESULTS Forty-nine of 98 patients (31 males, mean follow-up 16 years, range 8-25 years) were included. Six patients passed away (three of sudden unexpected death in epilepsy). At least one epileptic seizure occurred in 27/49 patients (occurrence: 2 days-13 years.; mean 3.3 years.). Epilepsy manifested in 19/49 patients. No correlation was found between the development of epilepsy and the location or etiology of the stroke. The presence of functional independence was significantly higher in seizure-free patients and in patients without epilepsy. For the external assessment (filled in for the patient by the parent/caregiver), there was no significant difference in QoL in patients with and without epilepsy; however, in the in-person KINDL questionnaire a significantly lower QoL was noted in epilepsy patients compared with patients without epilepsy. CONCLUSION One important finding in our study is that in the long-term course 39% of patients developed epilepsy after a childhood stroke. It occurred as late as 13 years after the acute episode and affected the QoL especially in cognitively less handicapped patients.
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Affiliation(s)
- C von Stülpnagel
- Institute for Transition, Rehabilitation and Palliation, Paracelsus Private Medical University of Salzburg, Salzburg, Austria.,Comprehensive Epilepsy Program for Children, Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Department of Pediatrics, University Hospital Munich, LMU Munich, Munich, Germany
| | | | - Wolfgang Sperl
- University Hospital for Children and Adolescents, Landeskrankenhaus, Salzburg, Austria
| | - Steffen Berweck
- Institute for Transition, Rehabilitation and Palliation, Paracelsus Private Medical University of Salzburg, Salzburg, Austria.,Center for Pediatric Neurology, Neurorehabilitation and Epileptology; Schön Clinic, Vogtareuth, Germany
| | - Martin Staudt
- Center for Pediatric Neurology, Neurorehabilitation and Epileptology; Schön Clinic, Vogtareuth, Germany
| | - Markus Berndt
- Institute for Medical Education, University Hospital, LMU Munich, Munich, Germany.,Richard W. Riley College of Education and Leadership, Walden University, Minneapolis, Minnesota, United States
| | - G Kluger
- Institute for Transition, Rehabilitation and Palliation, Paracelsus Private Medical University of Salzburg, Salzburg, Austria.,Center for Pediatric Neurology, Neurorehabilitation and Epileptology; Schön Clinic, Vogtareuth, Germany
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Slavova N, Fullerton HJ, Hills NK, Breiding PS, Mackay MT, Steinlin M. Validation of the focal cerebral arteriopathy severity score (FCASS) in a Swiss cohort: Correlation with infarct volume and outcome. Eur J Paediatr Neurol 2020; 28:58-63. [PMID: 32826156 DOI: 10.1016/j.ejpn.2020.07.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 06/09/2020] [Accepted: 07/27/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Focal cerebral arteriopathy (FCA), a major cause of childhood arterial ischemic stroke (AIS), can progress and lead to increased infarct size and/or recurrent stroke. Evaluating treatment options depends on the ability to quantify reliably the degree of stenosis in FCA. AIMS We validated the recently introduced FCA severity score (FCASS) in an independent cohort from the Swiss Neuro-Paediatric Stroke Registry (SNPSR). MATERIALS AND METHODS We included children with FCA who had MR or CT angiography and a Pediatric Stroke Outcome Measure (PSOM) at 6-months and 2-years post-stroke. A paediatric neuroradiologist applied the FCASS and the modified pediatric Alberta Stroke Program Early Computed Tomography Score (ASPECTS), a measure of infarct volume, to all available imaging. Two senior paediatric stroke neurologists and a neuroradiology fellow independently assigned FCASS scores to test interrater reliability. Pairwise correlations between FCASS, pedASPECTS, and PSOM were examined. RESULTS Thirty-two children [median (IQR) age = 5.9 (1.8, 9.6), 19 males] were included. The median maximum FCASS score at any time was 9 (IQR 6, 12; range 3, 16). Larger infarct volume scores correlated with both higher maximum FCASS scores and worse post-stroke outcomes, although we found no direct correlation between FCASS and outcomes. Stroke neurologists tended to assign lower FCASS scores than the neuroradiologist, but interrater reliability was predominantly good. CONCLUSIONS In this independent validation cohort, higher maximum FCASS correlated with greater infarct volume scores that also correlated with worse neurological outcomes. Scoring by non-imaging specialists seems to be valuable, although differences are present.
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Affiliation(s)
- Nedelina Slavova
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Inselspital, and University of Bern, Switzerland; Department of Interventional, Pediatric and Diagnostic Radiology, Inselspital, University Hospital, and University of Bern, Switzerland.
| | | | - Nancy K Hills
- Department of Neurology, University of California, San Francisco, USA; Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - Philipe S Breiding
- Department of Diagnostic and Interventional Radiology, Kantonsspital Frauenfeld, Switzerland
| | - Mark T Mackay
- Royal Children's Hospital and Murdoch Children's Research Institute, University of Melbourne, Australia
| | - Maja Steinlin
- Division of Neuropaediatrics, University Hospital Inselspital, and University of Bern, Switzerland
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Slim M, Fox CK, Friefeld S, Dlamini N, Westmacott R, Moharir M, MacGregor D, deVeber G. Validation of the pediatric stroke outcome measure for classifying overall neurological deficit. Pediatr Res 2020; 88:234-242. [PMID: 32179868 DOI: 10.1038/s41390-020-0842-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 02/06/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND The pediatric stroke outcome measure (PSOM) is a standardized, disease-specific outcome measure. We aimed to validate the overall classification of neurological deficit severity using PSOM. METHODS We identified 367 neonates/children with arterial ischemic stroke (AIS) (Derivation Cohort). We analyzed the PSOM subscales (scored as 0 [no deficit], 0.5 [minimal/mild deficit; normal function], 1 [moderate deficit; slowing function], or 2 [severe deficit; missing function]) to derive severity levels using latent class analysis (LCA). We validated a severity classification scheme (PSOM-SCS) in: (a) children who had Pediatric Evaluation of Disability Inventory (PEDI; n = 63) and/or the Pediatric Quality-of-Life Inventory (PedsQL; n = 97) scored; and (b) an external cohort (AIS; n = 102) with concurrently scored modified Rankin Scale (mRS), King's Outcome Scale for Childhood Head-Injury (KOSCHI) and PSOM. RESULTS Within the Derivation Cohort, LCA identified three severity levels: "normal/mild," "moderate," and "severe" (83.7%, 13.3%, and 3%, respectively). We developed severity classification based on PSOM subscale scores: "normal/mild"-normal function in all domains or slowing in one domain, "moderate"-slowing in ≥2 domains or missing function in one domain, and "severe"-missing function in ≥2 domains or slowing in ≥1 plus missing in one domain. PEDI and PedsQL both differed significantly across the severity groups. PSOM-SCS displayed high concordance with mRS (agreement coefficient [AC2] = 0.88) and KOSCHI (AC2 = 0.79). CONCLUSION The PSOM-SCS constitutes a valid tool for classifying overall neurological severity emphasizing function and encompassing the full range of severity in pediatric stroke. IMPACT Arithmetic summing of the PSOM subscales scores to assess severity classification is inadequate.The prior severity classification using PSOM overestimates poor outcomes.Three distinct severity profiles using PSOM subscales are identified.The PSOM-SCS is in moderate to excellent agreement with other disability measures.PSOM-SCS offers a valid tool for classifying the overall neurological deficit severity.
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Affiliation(s)
- Mahmoud Slim
- Department of Pediatrics, Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Christine K Fox
- Departments of Neurology and Pediatrics, University of California, San Francisco, San Francisco, CA, USA
| | - Sharon Friefeld
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Nomazulu Dlamini
- Department of Pediatrics, Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Robyn Westmacott
- Department of Psychology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Mahendranath Moharir
- Department of Pediatrics, Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Daune MacGregor
- Department of Pediatrics, Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Gabrielle deVeber
- Department of Pediatrics, Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada.
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8
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Imaging Developmental and Interventional Plasticity Following Perinatal Stroke. Can J Neurol Sci 2020; 48:157-171. [DOI: 10.1017/cjn.2020.166] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
ABSTRACT:Perinatal stroke occurs around the time of birth and leads to lifelong neurological disabilities including hemiparetic cerebral palsy. Magnetic resonance imaging (MRI) has revolutionized our understanding of developmental neuroplasticity following early injury, quantifying volumetric, structural, functional, and metabolic compensatory changes after perinatal stroke. Such techniques can also be used to investigate how the brain responds to treatment (interventional neuroplasticity). Here, we review the current state of knowledge of how established and emerging neuroimaging modalities are informing neuroplasticity models in children with perinatal stroke. Specifically, we review structural imaging characterizing lesion characteristics and volumetrics, diffusion tensor imaging investigating white matter tracts and networks, task-based functional MRI for localizing function, resting state functional imaging for characterizing functional connectomes, and spectroscopy examining neurometabolic changes. Key challenges and exciting avenues for future investigations are also considered.
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9
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Hendry K, Ownsworth T, Waters AM, Jackson M, Lloyd O. [Formula: see text] Investigation of children and adolescents' mood and self-concept after acquired brain injury. Child Neuropsychol 2020; 26:1005-1025. [PMID: 32253978 DOI: 10.1080/09297049.2020.1750577] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Few studies have examined the self-reported mental health of children with an acquired brain injury (ABI). The current study aimed to: 1) identify levels of child-reported depressive and anxiety symptoms and poor self-concept, 2) investigate demographic and injury-related factors associated with children's mood and self-concept, and 3) examine associations between children's self-reported mental health and parents' reports of children's emotional and behavioral functioning in children specifically with traumatic brain injury (TBI). 122 children (66% male) aged 8-16 years with ABI of mixed etiology were consecutively recruited through an outpatient rehabilitation clinic. Children were administered the Beck Youth Inventories - Second Edition, and parents completed the Adaptive Behavior Assessment System and the Child Behavior Checklist (CBCL). Relative to the norms, 16.4% of children scored in the clinical range for the depression and anxiety scales, and 24.6% reported clinically low self-concept. Children with lower functional status had greater anxiety symptoms. Older children (13-16 years) reported significantly higher depressive and anxiety symptoms and lower self-concept than younger children (8-12 years). A significant interaction between age and sex indicated that older girls reported greater depressive and anxiety symptoms than younger girls whereas no age-based differences were found for boys. Parent-reported total emotional and behavioral problems were positively associated with children's self-reported depressive and anxiety symptoms and were negatively correlated with self-concept. These findings indicate that adolescents, particularly girls, may be at heightened risk of poor mental health following ABI. Further research investigating the reasons for these demographic differences may inform developmentally sensitive interventions.
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Affiliation(s)
- Kathryn Hendry
- School of Applied Psychology & Menzies Health Institute of Queensland, GriffithUniversity , Brisbane, Australia
| | - Tamara Ownsworth
- School of Applied Psychology & Menzies Health Institute of Queensland, GriffithUniversity , Brisbane, Australia
| | - Allison M Waters
- School of Applied Psychology & Menzies Health Institute of Queensland, GriffithUniversity , Brisbane, Australia
| | - Megan Jackson
- School of Psychological Sciences, University of Melbourne , Melbourne, Australia.,Queensland Paediatric Rehabilitation Service, The Queensland Children's Hospital, Children's Health Queensland , Brisbane, Australia.,School of Psychology, University of Queensland , Brisbane, Australia
| | - Owen Lloyd
- School of Applied Psychology & Menzies Health Institute of Queensland, GriffithUniversity , Brisbane, Australia.,Queensland Paediatric Rehabilitation Service, The Queensland Children's Hospital, Children's Health Queensland , Brisbane, Australia.,School of Psychology, University of Queensland , Brisbane, Australia
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10
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Zhao QY, Zheng Y, Wang XM. [Clinical and imaging features of cerebral infarction in children]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2019; 21:354-358. [PMID: 31014428 PMCID: PMC7389228 DOI: 10.7499/j.issn.1008-8830.2019.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 03/02/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To summarize and analyze the etiology, clinical manifestations and imaging features of children with cerebral infarction. METHODS A retrospective analysis was performed for the clinical data of 54 children with cerebral infarction, including etiology, clinical manifestations, distribution of infarcts, type of infarcts and clinical outcome. RESULTS Of the 54 children, 93% had a clear cause, among whom 46% had the coexistence of multiple factors, and the top three causes were infection (54%), vascular disease (40%) and trauma (26%). Major clinical manifestations included limb paralysis (85%), pyrexia (20%), disturbance of consciousness (19%) and convulsion (17%). As for the location of infarcts, 80% of the infarcts were located in the cerebral cortex and 52% in the basal ganglia. Major types of infarcts were small-area infarcts (74%) and multifocal infarcts (56%). Viral encephalitis was the most common cause of cerebral infarction caused by infection, with the cerebral cortex as the most common location of infarcts (21/23, 91%) and multiple infarcts as the most common type of infarcts (13/23, 57%). Among the 12 children with cerebral infarction caused by nonspecific endarteritis, 10 (83%) had infarcts located in the basal ganglia and only one child had multiple infarcts. Among the five children with cerebral infarction caused by moyamoya disease, four children (80%) had infarcts located in the cerebral cortex, and large-area infarction (4/5, 80%) and multifocal infarction (4/5, 80%) were the major types of infarcts. Among the children with traumatic cerebral infarcts, 92% had infarcts located in the basal ganglia, and small-area infarcts (92%) and single infarcts (85%) were the major types of infarcts. Among the 46 children with limb paralysis, 34 (74%) had infarcts located in the basal ganglia; 50% of the children with disturbance of consciousness had infarcts located in the basal ganglia. Subcortical infarcts were observed in all six children with epilepsy. Seventy-five percent of the infarcts located in the cerebral cortex and 87% of the infarcts located in the basal ganglia had a good prognosis. Among the two children with cerebral infarcts located in the brainstem, one had the sequela of hemiplegia and the other had the sequela of cognitive impairment. Eighty-eight percent of the children with cerebral infarction caused by infection and 82% of the children with traumatic cerebral infarction tended to have a good prognosis, and 83% of the children with cerebral infarction caused by nonspecific endarteritis had good prognosis. Recurrence was observed in all three children with cerebral infarction caused by vascular malformations. Of the five children with cerebral infarction caused by moyamoya disease, one child died and four children survived with the sequela of localized brain atrophy, among whom one child also had the sequela of epilepsy. CONCLUSIONS Infection, vascular disease and trauma are the most common causes of cerebral infarction in children, and limb paralysis is the most common clinical manifestation. Cerebral cortex is the most common infarct site, and small-area infarcts and multifocal infarcts are the most common types of infarcts, which tend to have a better prognosis.
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Affiliation(s)
- Qi-Yu Zhao
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang 110004, China.
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11
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Management of Stroke in Neonates and Children: A Scientific Statement From the American Heart Association/American Stroke Association. Stroke 2019; 50:e51-e96. [DOI: 10.1161/str.0000000000000183] [Citation(s) in RCA: 240] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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12
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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.
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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
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13
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Gordon AL, Nguyen L, Panton A, Mallick AA, Ganesan V, Wraige E, McKevitt C. Self-reported needs after pediatric stroke. Eur J Paediatr Neurol 2018; 22:791-796. [PMID: 29960841 DOI: 10.1016/j.ejpn.2018.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 06/11/2018] [Accepted: 06/12/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Pediatric stroke has the potential for long term impact on the lives of children and their families. Child-centred intervention depends on understanding of needs from diagnosis onwards. However, little is known about the health and care support self-reported needs of this population. AIMS This study aimed to describe the nature and extent of needs (met and unmet) of pediatric stroke patients and their families and compare these with previously reported adult stroke needs. METHODS The questionnaire, adapted from a previously published adult stroke study, was conducted with parents of children who had an ischemic or haemorrhagic stroke between birth - 18 years, and young people with stroke now aged between 12 and 18 years. Participants were recruited from three tertiary pediatric stroke clinics in England. Levels and type of needs, and self-reported neurological impairment were captured. Comparisons of needs was reported descriptively and explored using Chi-square test. RESULTS Of 44 participants (39 parents, 5 young people), over two thirds reported at least one unmet need. Over half had difficulties in school-related activities, and over one-third in leisure activities and social relationships. Participants reported similar nature and extent of need when compared to previously reported adult stroke needs. Higher severity of neurological impairment was associated with higher number of needs. CONCLUSIONS Children and young people and their parents have high levels of unmet need across a range of health domains in the months and years after pediatric stroke. This information supports the importance of a needs-based approach to maximising health and well-being.
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Affiliation(s)
- Anne L Gordon
- Evelina London Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, UK; King's College London, UK.
| | | | - Anna Panton
- Evelina London Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, UK; The Stroke Association, UK
| | | | - Vijeya Ganesan
- University College London, Great Ormond Street Institute of Child Health, UK
| | - Elizabeth Wraige
- Evelina London Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, UK
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14
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Gerzson LR, Ranzan J, Almeida CSD, Riesgo RDS. O impacto do acidente vascular cerebral na qualidade de vida de crianças e adolescentes. FISIOTERAPIA E PESQUISA 2018. [DOI: 10.1590/1809-2950/17007025032018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO O objetivo deste estudo foi avaliar a qualidade de vida (QV) de crianças/adolescentes com diagnóstico de acidente vascular cerebral (AVC) segundo as percepções do responsável e das próprias crianças/adolescentes comparados com um grupo controle (GC). Participaram 78 sujeitos divididos em: Grupo de crianças/adolescentes que tiveram histórico de AVC (GAVC, n=39) e um Grupo de crianças/adolescentes saudáveis como Controle (GC, n=39), sendo pareados por sexo e idade. Utilizou-se de entrevista semiestruturada para descrever os aspectos sociodemográficos e do instrumento Pediatric Quality of Life Inventory (PedsQLTM 4.0) para avaliar a QV dos sujeitos no seu desenvolvimento. A mediana de idade do diagnóstico de AVC do GAVC foi sete meses, sendo que a maioria apresentou AVC isquêmico (71,8%) e hemiparesia. De acordo com os responsáveis do GAVC, a Capacidade Funcional dos seus filhos foi significativamente diferente, apresentando inferioridade em relação ao GC. Para os responsáveis também a variável escolaridade do pai manteve efeito positivo significativo nos aspectos emocionais da criança, e a variável idade da criança/adolescente e tempo do AVC >29 dias de vida apresentou efeito negativo nos aspectos escolares. Já para as crianças/adolescentes, a variável idade em que entrou na escola e gênero apresentou efeito significativo negativo no desfecho de aspectos escolares em relação ao GC. Concluímos que a percepção dos responsáveis difere da percepção da criança/adolescente em relação à capacidade funcional desta; a escolaridade do pai influenciou positivamente nos aspectos emocionais da criança, e as crianças sentem-se com um prejuízo no desempenho escolar, principalmente os meninos.
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Affiliation(s)
| | | | | | - Rudimar dos Santos Riesgo
- Universidade Federal do Rio Grande do Sul, Brazil; Universidade Federal do Rio Grande do Sul, Brazil
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15
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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.
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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
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16
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Vázquez López M, Castro de Castro P, Gil Villanueva N, Alcaraz Romero AJ, Pascual Pascual SI. Quality of life heart-disease children who have suffered from an arterial ischaemic stroke. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.anpede.2017.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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17
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Vázquez López M, Castro de Castro P, Gil Villanueva N, Alcaraz Romero AJ, Pascual Pascual SI. Calidad de vida de niños cardiópatas que han sufrido un ictus arterial isquémico. An Pediatr (Barc) 2018; 88:167-169. [DOI: 10.1016/j.anpedi.2017.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 03/13/2017] [Accepted: 04/02/2017] [Indexed: 10/19/2022] Open
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18
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Skoch J, Tahir R, Abruzzo T, Taylor JM, Zuccarello M, Vadivelu S. Predicting symptomatic cerebral vasospasm after aneurysmal subarachnoid hemorrhage with an artificial neural network in a pediatric population. Childs Nerv Syst 2017; 33:2153-2157. [PMID: 28852853 DOI: 10.1007/s00381-017-3573-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Accepted: 08/09/2017] [Indexed: 01/23/2023]
Abstract
PURPOSE Artificial neural networks (ANN) are increasingly applied to complex medical problem solving algorithms because their outcome prediction performance is superior to existing multiple regression models. ANN can successfully identify symptomatic cerebral vasospasm (SCV) in adults presenting after aneurysmal subarachnoid hemorrhage (aSAH). Although SCV is unusual in children with aSAH, the clinical consequences are severe. Consequently, reliable tools to predict patients at greatest risk for SCV may have significant value. We applied ANN modeling to a consecutive cohort of pediatric aSAH cases to assess its ability to predict SCV. METHODS A retrospective chart review was conducted to identify patients < 21 years of age who presented with spontaneously ruptured, non-traumatic, non-mycotic, non-flow-related intracranial arterial aneurysms to our institution between January 2002 and January 2015. Demographics, clinical, radiographic, and outcome data were analyzed using an adapted ANN model using learned value nodes from the adult aneurysmal SAH dataset previously reported. The strength of the ANN prediction was measured between - 1 and 1 with - 1 representing no likelihood of SCV and 1 representing high likelihood of SCV. RESULTS Sixteen patients met study inclusion criteria. The median age for aSAH patients was 15 years. Ten underwent surgical clipping and 6 underwent endovascular coiling for definitive treatment. One patient experienced SCV and 15 did not. The ANN applied here was able to accurately predict all 16 outcomes. The mean strength of prediction for those who did not exhibit SCV was - 0.86. The strength for the one patient who did exhibit SCV was 0.93. CONCLUSIONS Adult-derived aneurysmal SAH value nodes can be applied to a simple AAN model to accurately predict SCV in children presenting with aSAH. Further work is needed to determine if ANN models can prospectively predict SCV in the pediatric aSAH population in toto; adapted to include mycotic, traumatic, and flow-related origins as well.
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Affiliation(s)
- Jesse Skoch
- Division of Neurosurgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA.,Department of Neurosurgery, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, OH, 45267, USA
| | - Rizwan Tahir
- Department of Neurosurgery, Henry Ford Hospital, 2799 West Grand Blvd, Detroit, MI, 48202, USA
| | - Todd Abruzzo
- Department of Neurosurgery, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, OH, 45267, USA.,Division of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
| | - John M Taylor
- Division of Neurology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
| | - Mario Zuccarello
- Department of Neurosurgery, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, OH, 45267, USA
| | - Sudhakar Vadivelu
- Division of Neurosurgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA. .,Department of Neurosurgery, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, OH, 45267, USA. .,Division of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA. .,Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave. MLC-2016, Cincinnati, OH, 45229 - 3039, USA.
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19
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O'Keeffe F, Stark D, Murphy O, Ganesan V, King J, Murphy T. Psychosocial outcome and quality of life following childhood stroke - A systematic review. Dev Neurorehabil 2017. [PMID: 28632465 DOI: 10.1080/17518423.2017.1282052] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The aim of this paper was to critically review the recent literature on psychosocial and behavioral outcome following childhood stroke, to assess whether quality of life is affected and to investigate the factors related to psychosocial outcome. METHODS Literature searches were conducted and identified 36 relevant papers from the period 1908-2016. RESULTS The systematic review found that many children experience difficulties in a wide range of psychosocial domains. Quality of life can also be significantly reduced. Inconsistent findings regarding the correlates of outcome are likely due to methodological limitations. These issues include small and heterogeneous samples, lack of control groups, and measurement difficulties. CONCLUSIONS This systematic review strongly indicates that childhood stroke can affect a myriad of psychosocial domains and a child's quality of life. Methodological issues, particularly around heterogeneous samples and measures, limit the conclusions that can be drawn regarding the predictors of outcome.
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Affiliation(s)
- Fiadhnait O'Keeffe
- a Research Department of Clinical, Health and Educational Psychology , University College London , London , UK.,b Department of Clinical Psychology , National Rehabilitation Hospital, Dun Laoghaire, Co . Dublin , Ireland
| | - Daniel Stark
- c Institute of Child Health, Great Ormond Street Hospital for Children NHS Trust , London , UK
| | - Orlagh Murphy
- b Department of Clinical Psychology , National Rehabilitation Hospital, Dun Laoghaire, Co . Dublin , Ireland
| | - Vijeya Ganesan
- c Institute of Child Health, Great Ormond Street Hospital for Children NHS Trust , London , UK
| | - John King
- a Research Department of Clinical, Health and Educational Psychology , University College London , London , UK
| | - Tara Murphy
- c Institute of Child Health, Great Ormond Street Hospital for Children NHS Trust , London , UK
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20
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Klaassen ILM, Lauw MN, van de Wetering MD, Biemond BJ, Middeldorp S, Abbink FCH, Bierings M, Te Loo DMMW, Pieters R, van der Sluis IM, Tissing WJE, Michel Zwaan C, Heleen van Ommen C. TropicALL study: Thromboprophylaxis in Children treated for Acute Lymphoblastic Leukemia with Low-molecular-weight heparin: a multicenter randomized controlled trial. BMC Pediatr 2017; 17:122. [PMID: 28486976 PMCID: PMC5424373 DOI: 10.1186/s12887-017-0877-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 04/27/2017] [Indexed: 12/13/2022] Open
Abstract
Background Venous thromboembolism (VTE) is a common and severe complication during treatment of acute lymphoblastic leukemia (ALL). An important cause is the intensive use of asparaginase. Prospective cohort studies in which prophylactic low-molecular-weight heparin (LMWH) was used to prevent VTE showed lower VTE risk than in historic control cohorts, with a negligible bleeding risk. However, the efficacy of thromboprophylaxis with LMWH during ALL treatment has never been investigated in a randomized design. Here, we present the protocol of a randomized controlled trial in which the efficacy and safety of thromboprophylaxis with high prophylactic dose LMWH versus no thromboprophylaxis will be assessed in children treated for primary ALL with asparaginase. Methods/Design Thromboprophylaxis in Children treated for Acute Lymphoblastic Leukemia with Low-molecular-weight heparin (TropicALL) is a multicenter, randomized controlled open-label trial conducted in the Netherlands. Patients between 1 and 19 years of age with primary ALL, who are treated within the Dutch Childhood Oncology Group (DCOG) ALL-11 or 12 study will be randomized to thromboprophylaxis with LMWH once daily, (dose of 85 IU/kg (intervention arm A)), or to no thromboprophylaxis (arm B, standard of care) during asparaginase courses of ALL treatment. Primary efficacy endpoint is symptomatic objectified VTE during ALL treatment; secondary efficacy endpoints are overall survival and the composite of symptomatic and asymptomatic objectified VTE. Primary safety endpoints are major bleeding, clinically relevant non-major bleeding and minor bleeding. A total of 324 patients will be included to obtain a relative risk reduction of 75% with a power of 80%, using a two-sided test with significance level α = 0.05. Discussion This trial will be the first to assess efficacy and safety of thromboprophylaxis with LMWH during asparaginase treatment for ALL in children in a randomized design. Trail registration Nederlands Trial Register NTR4707. Registered 30 July 2014.
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Affiliation(s)
- Irene L M Klaassen
- Department of Pediatric Hematology, Academic Medical Center, Amsterdam, The Netherlands.,Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Mandy N Lauw
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands.,Department of Hematology, Academic Medical Center, Amsterdam, The Netherlands
| | | | - Bart J Biemond
- Department of Hematology, Academic Medical Center, Amsterdam, The Netherlands
| | - Saskia Middeldorp
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Floor C H Abbink
- Department of Hematology/Oncology, VU Medical Center, Amsterdam, The Netherlands
| | - Marc Bierings
- Department of Hematology/Oncology, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - D Maroeska M W Te Loo
- Department of Pediatric Hematology/Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rob Pieters
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Inge M van der Sluis
- Department of Pediatric Oncology/Hematology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Wim J E Tissing
- Department of Pediatric Oncology, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, the Netherlands
| | - C Michel Zwaan
- Department of Pediatric Oncology/Hematology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - C Heleen van Ommen
- Department of Pediatric Oncology/Hematology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.
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21
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Pediatric arterial ischemic stroke: Epidemiology, risk factors, and management. Blood Cells Mol Dis 2017; 67:23-33. [PMID: 28336156 DOI: 10.1016/j.bcmd.2017.03.003] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 03/06/2017] [Accepted: 03/06/2017] [Indexed: 12/17/2022]
Abstract
Pediatric arterial ischemic stroke (AIS) is an uncommon but important cause of neurologic morbidity in neonates and children, with consequences including hemiparesis, intellectual disabilities, and epilepsy. The causes of pediatric AIS are unique to those typically associated with stroke in adults. Familiarity with the risk factors for AIS in children will help with efficient diagnosis, which is unfortunately frequently delayed. Here we review the epidemiology and risk factors for AIS in neonates and children. We also outline consensus-based practices in the evaluation and management of pediatric AIS. Finally we discuss the outcomes observed in this population. While much has been learned in recent decades, many uncertainties sill persist in regard to pediatric AIS. The ongoing development of specialized centers and investigators dedicated to pediatric stroke will continue to answer such questions and improve our ability to effectively care for these patients.
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22
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D Lo W. Quality of life and paediatric stroke: the shadows of things that may be. Dev Med Child Neurol 2017; 59:7-8. [PMID: 28340284 DOI: 10.1111/dmcn.13327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Warren D Lo
- The Ohio State University and Nationwide Children's Hospital, Columbus, OH, USA
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23
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Kornfeld S, Studer M, Winkelbeiner S, Regényi M, Boltshauser E, Steinlin M. Quality of life after paediatric ischaemic stroke. Dev Med Child Neurol 2017; 59:45-51. [PMID: 27767202 DOI: 10.1111/dmcn.13295] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/09/2016] [Indexed: 12/31/2022]
Abstract
AIM Paediatric arterial ischaemic stroke can lead to reduced quality of life (QoL). It is important to identify predictors of QoL to support recovery. We examined long-term QoL after arterial ischaemic stroke concerning different variables. METHOD Children registered in the Swiss Neuropediatric Stroke Registry and suffering from arterial ischaemic stroke between 2000 and 2008 were included. Two years post-stroke, assessments included intelligence quotient tests for cognitive impairment and modified Rankin Scale (mRS) for neurological impairment; 5 years post-stroke, the Kidscreen-27 was used for QoL, DSM-IV criteria screening was used for attention deficits, and the ABILHAND-Kids was used for manual motor skills. Age at stroke, sex, socioeconomic status, lesion characteristics, neuropsychological and motor outcome, and mRS were correlated with QoL measures. RESULTS Seventy children were examined (49 males, 21 females; mean age 7y 2wks). Age at stroke, sex, socioeconomic status, and lesion characteristics did not influence QoL; IQ below average and attention deficits partially influenced QoL. The highest predictive value for QoL was found for manual motor impairment (p=0.002) and mRS scores (p=0.013). Combined motor, cognitive, and attention impairment negatively affected QoL (p=0.001). INTERPRETATION Neurological and cognitive impairments after paediatric arterial ischaemic stroke negatively influence QoL. Children with motor and neurological problems, as well as those with combined motor, cognitive, and attention problems, are at higher risk for low QoL.
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Affiliation(s)
- Salome Kornfeld
- University Children's Hospital Bern, Bern, Switzerland.,Center for Cognition, Learning and Memory, University of Bern, Bern, Switzerland
| | - Martina Studer
- University Children's Hospital Bern, Bern, Switzerland.,Center for Cognition, Learning and Memory, University of Bern, Bern, Switzerland
| | | | - Mária Regényi
- University Children's Hospital Bern, Bern, Switzerland
| | | | - Maja Steinlin
- University Children's Hospital Bern, Bern, Switzerland.,Center for Cognition, Learning and Memory, University of Bern, Bern, Switzerland
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24
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Braun LT, Grady KL, Kutner JS, Adler E, Berlinger N, Boss R, Butler J, Enguidanos S, Friebert S, Gardner TJ, Higgins P, Holloway R, Konig M, Meier D, Morrissey MB, Quest TE, Wiegand DL, Coombs-Lee B, Fitchett G, Gupta C, Roach WH. Palliative Care and Cardiovascular Disease and Stroke: A Policy Statement From the American Heart Association/American Stroke Association. Circulation 2016; 134:e198-225. [DOI: 10.1161/cir.0000000000000438] [Citation(s) in RCA: 143] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The mission of the American Heart Association/American Stroke Association includes increasing access to high-quality, evidence-based care that improves patient outcomes such as health-related quality of life and is consistent with the patients’ values, preferences, and goals. Awareness of and access to palliative care interventions align with the American Heart Association/American Stroke Association mission. The purposes of this policy statement are to provide background on the importance of palliative care as it pertains to patients with advanced cardiovascular disease and stroke and their families and to make recommendations for policy decisions. Palliative care, defined as patient- and family-centered care that optimizes health-related quality of life by anticipating, preventing, and treating suffering, should be integrated into the care of all patients with advanced cardiovascular disease and stroke early in the disease trajectory. Palliative care focuses on communication, shared decision making about treatment options, advance care planning, and attention to physical, emotional, spiritual, and psychological distress with inclusion of the patient’s family and care system. Our policy recommendations address the following: reimbursement for comprehensive delivery of palliative care services for patients with advanced cardiovascular disease and stroke; strong payer-provider relationships that involve data sharing to identify patients in need of palliative care, identification of better care and payment models, and establishment of quality standards and outcome measurements; healthcare system policies for the provision of comprehensive palliative care services during hospitalization, including goals of care, treatment decisions, needs of family caregivers, and transition to other care settings; and health professional education in palliative care as part of licensure requirements.
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25
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Hawks C, Jordan LC, Gindville M, Ichord RN, Licht DJ, Beslow LA. Educational Placement After Pediatric Intracerebral Hemorrhage. Pediatr Neurol 2016; 61:46-50. [PMID: 27262667 PMCID: PMC4983212 DOI: 10.1016/j.pediatrneurol.2016.05.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Accepted: 05/03/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND This study describes educational placement of school-aged children after spontaneous intracerebral hemorrhage and examines whether educational placement is associated with severity of neurological deficits. METHODS Children with spontaneous intracerebral hemorrhage presenting from 2007 to 2013 were prospectively enrolled at three tertiary children's hospitals. The Pediatric Stroke Outcome Measure and parental interview gathered information about neurological outcome, school attendance, and educational placement. RESULTS The cohort of 92 enrolled children included 42 school-aged children (6 to 17 years) with intracerebral hemorrhage. Four children died; one was excluded because of preexisting cognitive deficits. Thirty-seven children completed three-month follow-up, and 30 completed 12-month follow-up. At 12 months, 14 children (46.7%) received regular age-appropriate programming, 12 (40%) attended school with in-class services, three (10%) were in special education programs, and one child (3.3%) received home-based services because of intracerebral hemorrhage-related deficits. Of 30 children with three- and 12-month follow-up, 14 (46.7%) improved their education status, 13 (43.3%) remained at the same education level, and three (10%) began to receive in-class services. An increasing Pediatric Stroke Outcome Measure score predicted the need for educational modifications at three months (odds ratio, 3.3; 95% confidence interval, 1.4 to 7.9; P = 0.007) and at 12 months (odds ratio, 2.1; 95% confidence interval, 1.1 to 3.9; P = 0.025). CONCLUSIONS Most children returned to school within a year after intracerebral hemorrhage, and many had a reduction in the intensity of educational support. However, a great need for educational services persisted at 12 months after intracerebral hemorrhage with fewer than half enrolled in regular age-appropriate classes. Worse deficits on the Pediatric Stroke Outcome Measure were associated with remedial educational placement.
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Affiliation(s)
- Charlotte Hawks
- Department of Pediatrics, Division of Pediatric Neurology, Vanderbilt University Medical Center, Nashville, TN
| | - Lori C. Jordan
- Department of Pediatrics, Division of Pediatric Neurology, Vanderbilt University Medical Center, Nashville, TN
| | - Melissa Gindville
- Department of Pediatrics, Division of Pediatric Neurology, Vanderbilt University Medical Center, Nashville, TN
| | - Rebecca N. Ichord
- Division of Child Neurology, Children’s Hospital of Philadelphia, Pereleman School of Medicine of the University of Pennsylvania, Philadelphia, PA
| | - Daniel J. Licht
- Division of Child Neurology, Children’s Hospital of Philadelphia, Pereleman School of Medicine of the University of Pennsylvania, Philadelphia, PA
| | - Lauren A. Beslow
- Departments of Neurology and Pediatric Neurology, Yale University School of Medicine, New Haven, CT
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26
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Fuentes A, Westmacott R, Deotto A, deVeber G, Desrocher M. [Formula: see text]Working memory outcomes following unilateral arterial ischemic stroke in childhood. Child Neuropsychol 2016; 23:803-821. [PMID: 27424626 DOI: 10.1080/09297049.2016.1205008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
There is a dearth of research examining working memory (WM) following pediatric arterial ischemic stroke (AIS). This study assesses the WM patterns of 32 children, aged 6 to 14 years, with a history of unilateral AIS and 32 controls using a paradigm based on Baddeley and Hitch's multi-component WM model. The results indicate compromised WM in children with AIS relative to controls and parent reports confirm higher rates of dysfunction. Supplementary analyses of impairment confirm higher rates in children with AIS, ranging from 31.25% to 38.70% on performance-based measures and 50.00% on parent reports, compared to 0.00% to 21.88% on performance-based measures in controls and 15.63% on parent reports. Continual follow-up is recommended given that a subset of children with stroke appear to be at risk for WM impairment. Moreover, the subtle nature of WM challenges experienced by many children who have experienced a stroke increases the likelihood that WM impairment could go undetected. The long-term trajectories of WM in the pediatric stroke population remains unknown and future studies are needed to track changes in WM functioning over time.
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Affiliation(s)
- Amanda Fuentes
- a Department of Psychology , York University , Toronto , Canada.,b Department of Psychology , Hospital for Sick Children , Toronto , Canada
| | - Robyn Westmacott
- b Department of Psychology , Hospital for Sick Children , Toronto , Canada
| | - Angela Deotto
- a Department of Psychology , York University , Toronto , Canada
| | - Gabrielle deVeber
- c Department of Pediatrics, Division of Neurology , Hospital for Sick Children , Toronto , Canada
| | - Mary Desrocher
- a Department of Psychology , York University , Toronto , Canada
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27
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Mallick AA, Ganesan V, Kirkham FJ, Fallon P, Hedderly T, McShane T, Parker AP, Wassmer E, Wraige E, Amin S, Edwards HB, Cortina-Borja M, O'Callaghan FJ. Outcome and recurrence 1 year after pediatric arterial ischemic stroke in a population-based cohort. Ann Neurol 2016; 79:784-793. [PMID: 26928665 DOI: 10.1002/ana.24626] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 02/24/2016] [Accepted: 02/25/2016] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Arterial ischemic stroke (AIS) is an important cause of acquired brain injury in children. Few prospective population-based studies of childhood AIS have been completed. We aimed to investigate the outcome of childhood AIS 12 months after the event in a population-based cohort. METHODS Children aged 29 days to < 16 years with radiologically confirmed AIS occurring over a 1-year period residing in southern England (population = 5.99 million children) were eligible for inclusion. Outcome was assessed during a home visit using the Pediatric Stroke Outcome Measure (PSOM). Parental impressions of recovery were assessed using the Pediatric Stroke Recurrence and Recovery Questionnaire. PSOM score was estimated via telephone interview or clinician interview whenever home visit was not possible. RESULTS Ninety-six children with AIS were identified. Two children were lost to follow-up. Nine of 94 (10%) children died before the 12-month follow-up. One child had an AIS recurrence. PSOM scores were available for 78 of 85 living children at follow-up. Thirty-nine of 78 (50%) had a good outcome (total PSOM score < 1), and 39 of 78 (50%) had a poor outcome. Seizures at onset of AIS were associated with a poor outcome (odds ratio = 3.5, 95% confidence interval = 1.16-10.6). Twenty-eight of 73 (38%) children were judged by their carers to have fully recovered. Ten of 84 (12%) children had recurrent seizures, and 17 of 84 (20%) reported recurrent headaches. INTERPRETATION AIS carries a significant risk of mortality and long-term neurological deficit. However, the rates of mortality, recurrence, and neurological impairment were markedly lower in this study than previously published figures in the United Kingdom. Ann Neurol 2016;79:784-793.
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Affiliation(s)
- Andrew A Mallick
- Department of Paediatric Neurology, Bristol Royal Hospital for Children, Bristol
| | - Vijeya Ganesan
- Neurosciences Unit, University College London Institute of Child Health, London
| | - Fenella J Kirkham
- Neurosciences Unit, University College London Institute of Child Health, London
- Department of Child Health, Southampton University Hospitals National Health Service Trust, Southampton
| | - Penny Fallon
- Department of Paediatric Neurology, St George's Hospital, London
| | - Tammy Hedderly
- Department of Paediatric Neurology, King's College Hospital National Health Service Foundation Trust, London
- Department of Paediatric Neurosciences, Evelina Children's Hospital, London
| | - Tony McShane
- Department of Paediatric Neurology, John Radcliffe Hospital, Oxford
| | - Alasdair P Parker
- Department of Paediatric Neurology, Addenbrooke's Hospital, Cambridge
| | - Evangeline Wassmer
- Department of Paediatric Neurology, Birmingham Children's Hospital, Birmingham
| | - Elizabeth Wraige
- Department of Paediatric Neurosciences, Evelina Children's Hospital, London
| | - Sam Amin
- Neurosciences Unit, University College London Institute of Child Health, London
| | - Hannah B Edwards
- School of Social and Community Medicine, University of Bristol, Bristol
| | - Mario Cortina-Borja
- Population, Policy, and Practice Programme, University College London Institute of Child Health, London
| | - Finbar J O'Callaghan
- Neurosciences Unit, University College London Institute of Child Health, London
- School of Clinical Sciences, University of Bristol, Bristol, United Kingdom
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Lehman LL, Watson CG, Kapur K, Danehy AR, Rivkin MJ. Predictors of Stroke After Transient Ischemic Attack in Children. Stroke 2015; 47:88-93. [PMID: 26556823 DOI: 10.1161/strokeaha.115.009904] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 10/14/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Transient ischemic attack (TIA) in children has received far less attention compared with TIA in adults. The risk factors of stroke after TIA in children are relatively unknown. We aimed to determine the percentage of children who have stroke after TIA and the risk factors associated with stroke after TIA. METHODS We searched the medical records at Boston Children's Hospital for the year 2010 to find children who were evaluated for TIA to determine associated risk factors of stroke after TIA. We included children who were evaluated in 2009 through 2010 for TIA and had magnetic resonance imaging. We examined follow-up imaging through August 2014 for subsequent stroke. Logistic regression was used to calculate odds ratios for factors in our cohort who are associated with stroke after presentation with TIA. RESULTS We identified 63 children who experienced a TIA. The mean time of imaging follow-up was 4.5 years after TIA presentation. Of the 63 children, 10 (16%) developed radiological evidence of ischemic cerebral injury within the follow-up period. Four of the 10 (6%) demonstrated diffusion abnormalities on magnetic resonance imaging at TIA presentation, whereas 8 (13%) had a stroke after their TIA. Arteriopathy, female sex, and autoimmune disorders were significantly associated with stroke after TIA. CONCLUSIONS In our cohort of children, stroke occurred after TIA at a rate similar to that seen in adults, but the risk factors for stroke after TIA in children are different.
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Affiliation(s)
- Laura L Lehman
- From the Departments of Neurology (L.L.L., C.G.W., K.K., M.J.R.), Psychiatry (M.J.R.), and Radiology (A.R.D., M.J. R.), Boston Children's Hospital, MA; and Departments of Radiology (A.R.D.) and Neurology (L.L.L., M.J.R.), Harvard Medical School, Boston, MA.
| | - Christopher G Watson
- From the Departments of Neurology (L.L.L., C.G.W., K.K., M.J.R.), Psychiatry (M.J.R.), and Radiology (A.R.D., M.J. R.), Boston Children's Hospital, MA; and Departments of Radiology (A.R.D.) and Neurology (L.L.L., M.J.R.), Harvard Medical School, Boston, MA
| | - Kush Kapur
- From the Departments of Neurology (L.L.L., C.G.W., K.K., M.J.R.), Psychiatry (M.J.R.), and Radiology (A.R.D., M.J. R.), Boston Children's Hospital, MA; and Departments of Radiology (A.R.D.) and Neurology (L.L.L., M.J.R.), Harvard Medical School, Boston, MA
| | - Amy R Danehy
- From the Departments of Neurology (L.L.L., C.G.W., K.K., M.J.R.), Psychiatry (M.J.R.), and Radiology (A.R.D., M.J. R.), Boston Children's Hospital, MA; and Departments of Radiology (A.R.D.) and Neurology (L.L.L., M.J.R.), Harvard Medical School, Boston, MA
| | - Michael J Rivkin
- From the Departments of Neurology (L.L.L., C.G.W., K.K., M.J.R.), Psychiatry (M.J.R.), and Radiology (A.R.D., M.J. R.), Boston Children's Hospital, MA; and Departments of Radiology (A.R.D.) and Neurology (L.L.L., M.J.R.), Harvard Medical School, Boston, MA
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Smith SE, Vargas G, Cucchiara AJ, Zelonis SJ, Beslow LA. Hemiparesis and epilepsy are associated with worse reported health status following unilateral stroke in children. Pediatr Neurol 2015; 52:428-34. [PMID: 25559938 PMCID: PMC4556437 DOI: 10.1016/j.pediatrneurol.2014.11.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 11/26/2014] [Accepted: 11/28/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Perinatal and childhood stroke result in neurological impairment in the majority of survivors, but less is known about patient and parent perception of function following stroke in children. Our aim was to characterize parent-proxy and child-reported health status in children following unilateral arterial ischemic stroke or intraparenchymal hemorrhage. METHODS Fifty-nine children 2-18 years (30 girls, 29 boys) with unilateral arterial ischemic stroke or spontaneous intraparenchymal hemorrhage at least 6 months before evaluation were enrolled from a single center. The PedsQL version 4.0 Generic Short Form and PedsQL version 3.0 Cerebral Palsy Module were administered to childhood stroke subjects and parents. Generic PedsQL Inventory scores were compared between children with stroke and published data from healthy children. Reported health status scores for children with varying degrees of hemiparesis were compared. RESULTS Children with stroke had lower reported health status scores on the Generic PedsQL Inventory than healthy children. Children with moderate-severe hemiparesis had worse scores than children without hemiparesis on several measures of the Cerebral Palsy Module as reported by both parents and children. The parents of children with epilepsy reported worse scores on several measures compared with children without epilepsy, and the parent scores were lower on several measures for children with lower intelligence quotients. Agreement between parent and child scores was better on the Cerebral Palsy Module than on the Generic Inventory. CONCLUSIONS Children with stroke have worse reported health status than healthy controls. Degree of hemiparesis, epilepsy, and lower intelligence quotient affect reported health status on some measures. Agreement between parent-proxy and child scores ranges from slight to good which suggests that both provide useful information.
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Affiliation(s)
- Sabrina E. Smith
- Department of Neurology, The Children’s Hospital of Philadelphia, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania,Department of Pediatrics, The Children’s Hospital of Philadelphia, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania,Division of Pediatric Neurology, Kaiser Permanente Oakland Medical Center, Oakland, California,Communications should be addressed to: Dr. Sabrina E. Smith; Division of Pediatric Neurology; Kaiser Permanente Oakland Medical Center; 275 W. MacArthur Blvd.; Oakland; CA 94611.
| | - Gray Vargas
- Department of Neurology, The Children’s Hospital of Philadelphia, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania,Department of Pediatrics, The Children’s Hospital of Philadelphia, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania,Department of Psychology, Penn State University, University Park, Pennsylvania
| | - Andrew J. Cucchiara
- Clinical and Translational Research Center, The University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sarah J. Zelonis
- Department of Neurology, The Children’s Hospital of Philadelphia, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania,Department of Pediatrics, The Children’s Hospital of Philadelphia, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lauren A. Beslow
- Department of Neurology, The Children’s Hospital of Philadelphia, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania,Department of Pediatrics, The Children’s Hospital of Philadelphia, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania,Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut,Department of Neurology, Yale University School of Medicine, New Haven, Connecticut
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Anderson V, Gomes A, Greenham M, Hearps S, Gordon A, Rinehart N, Gonzalez L, Yeates KO, Hajek CA, Lo W, Mackay M. Social competence following pediatric stroke: contributions of brain insult and family environment. Soc Neurosci 2015; 9:471-83. [PMID: 25040432 DOI: 10.1080/17470919.2014.932308] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Limited information is available regarding predictors of psychosocial difficulties in children following stroke. This study aimed to (i) compare social competence of children with arterial ischemic stroke (AIS) to those with chronic illness and healthy controls and (ii) investigate the contribution of stroke pathology, neurological outcome and environment. Thirty-six children with AIS > 12 months prior to recruitment were compared with children with chronic illness (asthma) (n = 15) and healthy controls (n = 43). Children underwent intellectual assessment, and children and parents completed questionnaires to assess social competence. Children with AIS underwent MRI scan and neurological evaluation. Child AIS was associated with poorer social adjustment and participation, and children with AIS were rated as having more social problems than controls. Lesion volume was not associated with social outcome, but subcortical stroke was linked to reduced social participation and younger stroke onset predicted better social interaction and higher self-esteem. Family function was the sole predictor of social adjustment. Findings highlight the risk of social impairment following pediatric stroke, with both stroke and environmental factors influencing children's social competence in the chronic stages of recovery. They indicate the potential for intervention targeting support at the family level.
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Affiliation(s)
- Vicki Anderson
- a Child Neuropsychology , Murdoch Childrens Research Institute , Melbourne , Australia
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Fuentes A, Deotto A, Desrocher M, deVeber G, Westmacott R. Determinants of cognitive outcomes of perinatal and childhood stroke: A review. Child Neuropsychol 2014; 22:1-38. [PMID: 25355013 DOI: 10.1080/09297049.2014.969694] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Our understanding of cognitive and behavioral outcomes of perinatal and childhood stroke is rapidly evolving. A current understanding of cognitive outcomes following pediatric stroke can inform prognosis and direct interventions and our understanding of plasticity in the developing brain. However, our understanding of these outcomes has been hampered by the notable heterogeneity that exists amongst the pediatric stroke population, as the influences of various demographic, cognitive, neurological, etiological, and psychosocial variables preclude broad generalizations about outcomes in any one cognitive domain. We therefore aimed to conduct a detailed overview of the published literature regarding the effects of age at stroke, time since stroke, sex, etiology, lesion characteristics (i.e., location, laterality, volume), neurologic impairment, and seizures on cognitive outcomes following pediatric stroke. A key theme arising from this review is the importance of interactive effects among variables on cognitive outcomes following pediatric stroke. Interactions particularly of note include the following: (a) age at Stroke x Lesion Location; (b) Lesion Characteristics (i.e., volume, location) x Neurologic Impairment; (c) Lesion Volume x Time Since Stroke; (d) Sex x Lesion Laterality; and (e) Seizures x Time Since Stroke. Further, it appears that these relationships do not always apply uniformly across cognitive domains but, rather, are contingent upon the cognitive ability in question. Implications for future research directions are discussed.
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Affiliation(s)
- Amanda Fuentes
- a Department of Psychology , York University , Toronto , ON , Canada
| | - Angela Deotto
- a Department of Psychology , York University , Toronto , ON , Canada
| | - Mary Desrocher
- a Department of Psychology , York University , Toronto , ON , Canada
| | - Gabrielle deVeber
- b Department of Pediatrics, Division of Neurology , The Hospital for Sick Children , Toronto , ON , Canada
| | - Robyn Westmacott
- c Department of Psychology , The Hospital for Sick Children , Toronto , ON , Canada
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Gordon AL. Functioning and disability after stroke in children: using the ICF-CY to classify health outcome and inform future clinical research priorities. Dev Med Child Neurol 2014; 56:434-44. [PMID: 24341384 DOI: 10.1111/dmcn.12336] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/11/2013] [Indexed: 11/29/2022]
Abstract
AIM The International Classification of Functioning Disability and Health, Child-Youth version (ICF-CY) provides a framework for describing and evaluating health, intervention outcomes, and needs assessment. It can, however, also serve as a system for classifying the focus of outcome studies and identification of gaps in current knowledge. METHOD The paediatric arterial ischaemic stroke (AIS) population was targeted. Multiple databases were systematically searched for AIS outcome studies focussing on functioning or disability. Findings were rated using the ICF-CY framework. RESULTS Twenty-eight studies were identified. Most were cross-sectional and age range at assessment varied widely. Sixty-seven different standardized measures were used, predominantly evaluating body functions. The most common domains of activity and participation reported were learning and applying knowledge, general tasks and demands, and self-care skills. Health-related quality of life was measured in nine papers. Environmental factors were rarely evaluated. INTERPRETATION AIS outcome studies addressing the relationship between body structures and functions (e.g. brain lesion characteristics, neurological examination findings) and activities, participation, and quality of life have emerged in recent years. Comparison of findings across studies is complicated by design and tool selection. The relationship between components of activity limitation and participation restriction is rarely explored.
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Affiliation(s)
- Anne L Gordon
- Paediatric Neurosciences Department, Evelina London Children's Hospital, Guy's & St Thomas' Hospital NHS Foundation Trust, Kings Health Partners, London, UK; Clinical Sciences Theme, Murdoch Childrens Research Institute, Melbourne, Vic., Australia
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Murias K, Brooks B, Kirton A, Iaria G. A Review of Cognitive Outcomes in Children Following Perinatal Stroke. Dev Neuropsychol 2014; 39:131-57. [DOI: 10.1080/87565641.2013.870178] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Gomes A, Rinehart N, Greenham M, Anderson V. A Critical Review of Psychosocial Outcomes Following Childhood Stroke (1995–2012). Dev Neuropsychol 2014; 39:9-24. [DOI: 10.1080/87565641.2013.827197] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Lo W, Gordon A, Hajek C, Gomes A, Greenham M, Perkins E, Zumberge N, Anderson V, Yeates KO, Mackay MT. Social competence following neonatal and childhood stroke. Int J Stroke 2013; 9:1037-44. [PMID: 25388858 DOI: 10.1111/ijs.12222] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 09/15/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Social functioning encompasses a range of important skills that an individual uses to interact with the social world. Previous studies suggest that social functioning (outcomes) may be impaired after childhood stroke, but research is limited. AIMS We examined the following: (1) the effect of ischemic stroke upon social outcomes in children; (2) the correlation of cognitive abilities and problem behaviors with social outcomes; and (3) the role of infarct characteristics as predictors of social outcomes. METHODS We conducted an observational case-controlled study to compare children with neonatal or childhood onset stroke and controls with chronic asthma. Neurological deficits were measured with the Pediatric Stroke Outcome Measure. Cognitive abilities, problem behavior, adaptive behavior, and social outcomes were assessed with standardized measures. RESULTS Overall stroke cases were impaired in several areas of adaptive behaviors but not in cognitive ability, problem behaviors, or social outcomes. Children with more severe neurological deficits had impairments in a range of adaptive behaviors, social adjustment, and social participation. Impaired cognitive ability and more problem behaviors correlated with impaired social adjustment, particularly in stroke cases. Larger infarcts correlated with greater neurological impairment, lower IQ, and poorer social participation. CONCLUSIONS Stroke can result in impaired adaptive and social functioning without apparent deficits in IQ or behavior. Infarct size, residual neurological deficits, impaired cognitive ability, and problem behaviors increase the risk for poor social adjustment and participation. These findings can help the clinician anticipate impaired social functioning after pediatric stroke, which is important because age-specific treatments are available.
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Affiliation(s)
- Warren Lo
- Division of Neurology, Department of Pediatrics, The Ohio State University and Nationwide Children's Hospital, Columbus, OH, USA
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Affiliation(s)
- Adam Kirton
- From the Calgary Pediatric Stroke Program, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada (A.K.); and Children's Stroke Program, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada (G.d.V.)
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Gall SL, Tran PL, Martin K, Blizzard L, Srikanth V. Sex Differences in Long-Term Outcomes After Stroke. Stroke 2012; 43:1982-7. [DOI: 10.1161/strokeaha.111.632547] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Seana L. Gall
- From the Menzies Research Institute Tasmania (S.L.G., P.L.T., K.M., L.B., V.S.), University of Tasmania, Hobart, Tasmania Australia; and the Stroke and Ageing Research Centre (V.S.), Department of Medicine, Southern Clinical School, Monash University, Monash, Australia
| | - Pham Lan Tran
- From the Menzies Research Institute Tasmania (S.L.G., P.L.T., K.M., L.B., V.S.), University of Tasmania, Hobart, Tasmania Australia; and the Stroke and Ageing Research Centre (V.S.), Department of Medicine, Southern Clinical School, Monash University, Monash, Australia
| | - Kara Martin
- From the Menzies Research Institute Tasmania (S.L.G., P.L.T., K.M., L.B., V.S.), University of Tasmania, Hobart, Tasmania Australia; and the Stroke and Ageing Research Centre (V.S.), Department of Medicine, Southern Clinical School, Monash University, Monash, Australia
| | - Leigh Blizzard
- From the Menzies Research Institute Tasmania (S.L.G., P.L.T., K.M., L.B., V.S.), University of Tasmania, Hobart, Tasmania Australia; and the Stroke and Ageing Research Centre (V.S.), Department of Medicine, Southern Clinical School, Monash University, Monash, Australia
| | - Velandai Srikanth
- From the Menzies Research Institute Tasmania (S.L.G., P.L.T., K.M., L.B., V.S.), University of Tasmania, Hobart, Tasmania Australia; and the Stroke and Ageing Research Centre (V.S.), Department of Medicine, Southern Clinical School, Monash University, Monash, Australia
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Kitchen L, Westmacott R, Friefeld S, MacGregor D, Curtis R, Allen A, Yau I, Askalan R, Moharir M, Domi T, deVeber G. The Pediatric Stroke Outcome Measure. Stroke 2012; 43:1602-8. [DOI: 10.1161/strokeaha.111.639583] [Citation(s) in RCA: 172] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Lisa Kitchen
- From the Children's Stroke Program (L.K., R.W., D.M., R.C., A.A., I.Y., R.A., M.M., T.D., G.d.V.), the Department of Psychology (R.W.), and the Division of Neurology (D.M., A.A., I.Y., R.A., M.M., G.d.V.), The Hospital for Sick Children, Toronto, Canada; and the Department of Occupational Science and Occupational Therapy (S.F.) and the Faculty of Medicine (S.F., D.M., I.Y., R.A., M.M., G.d.V.), University of Toronto, Toronto, Canada
| | - Robyn Westmacott
- From the Children's Stroke Program (L.K., R.W., D.M., R.C., A.A., I.Y., R.A., M.M., T.D., G.d.V.), the Department of Psychology (R.W.), and the Division of Neurology (D.M., A.A., I.Y., R.A., M.M., G.d.V.), The Hospital for Sick Children, Toronto, Canada; and the Department of Occupational Science and Occupational Therapy (S.F.) and the Faculty of Medicine (S.F., D.M., I.Y., R.A., M.M., G.d.V.), University of Toronto, Toronto, Canada
| | - Sharon Friefeld
- From the Children's Stroke Program (L.K., R.W., D.M., R.C., A.A., I.Y., R.A., M.M., T.D., G.d.V.), the Department of Psychology (R.W.), and the Division of Neurology (D.M., A.A., I.Y., R.A., M.M., G.d.V.), The Hospital for Sick Children, Toronto, Canada; and the Department of Occupational Science and Occupational Therapy (S.F.) and the Faculty of Medicine (S.F., D.M., I.Y., R.A., M.M., G.d.V.), University of Toronto, Toronto, Canada
| | - Daune MacGregor
- From the Children's Stroke Program (L.K., R.W., D.M., R.C., A.A., I.Y., R.A., M.M., T.D., G.d.V.), the Department of Psychology (R.W.), and the Division of Neurology (D.M., A.A., I.Y., R.A., M.M., G.d.V.), The Hospital for Sick Children, Toronto, Canada; and the Department of Occupational Science and Occupational Therapy (S.F.) and the Faculty of Medicine (S.F., D.M., I.Y., R.A., M.M., G.d.V.), University of Toronto, Toronto, Canada
| | - Rosalind Curtis
- From the Children's Stroke Program (L.K., R.W., D.M., R.C., A.A., I.Y., R.A., M.M., T.D., G.d.V.), the Department of Psychology (R.W.), and the Division of Neurology (D.M., A.A., I.Y., R.A., M.M., G.d.V.), The Hospital for Sick Children, Toronto, Canada; and the Department of Occupational Science and Occupational Therapy (S.F.) and the Faculty of Medicine (S.F., D.M., I.Y., R.A., M.M., G.d.V.), University of Toronto, Toronto, Canada
| | - Anita Allen
- From the Children's Stroke Program (L.K., R.W., D.M., R.C., A.A., I.Y., R.A., M.M., T.D., G.d.V.), the Department of Psychology (R.W.), and the Division of Neurology (D.M., A.A., I.Y., R.A., M.M., G.d.V.), The Hospital for Sick Children, Toronto, Canada; and the Department of Occupational Science and Occupational Therapy (S.F.) and the Faculty of Medicine (S.F., D.M., I.Y., R.A., M.M., G.d.V.), University of Toronto, Toronto, Canada
| | - Ivanna Yau
- From the Children's Stroke Program (L.K., R.W., D.M., R.C., A.A., I.Y., R.A., M.M., T.D., G.d.V.), the Department of Psychology (R.W.), and the Division of Neurology (D.M., A.A., I.Y., R.A., M.M., G.d.V.), The Hospital for Sick Children, Toronto, Canada; and the Department of Occupational Science and Occupational Therapy (S.F.) and the Faculty of Medicine (S.F., D.M., I.Y., R.A., M.M., G.d.V.), University of Toronto, Toronto, Canada
| | - Rand Askalan
- From the Children's Stroke Program (L.K., R.W., D.M., R.C., A.A., I.Y., R.A., M.M., T.D., G.d.V.), the Department of Psychology (R.W.), and the Division of Neurology (D.M., A.A., I.Y., R.A., M.M., G.d.V.), The Hospital for Sick Children, Toronto, Canada; and the Department of Occupational Science and Occupational Therapy (S.F.) and the Faculty of Medicine (S.F., D.M., I.Y., R.A., M.M., G.d.V.), University of Toronto, Toronto, Canada
| | - Mahendranath Moharir
- From the Children's Stroke Program (L.K., R.W., D.M., R.C., A.A., I.Y., R.A., M.M., T.D., G.d.V.), the Department of Psychology (R.W.), and the Division of Neurology (D.M., A.A., I.Y., R.A., M.M., G.d.V.), The Hospital for Sick Children, Toronto, Canada; and the Department of Occupational Science and Occupational Therapy (S.F.) and the Faculty of Medicine (S.F., D.M., I.Y., R.A., M.M., G.d.V.), University of Toronto, Toronto, Canada
| | - Trish Domi
- From the Children's Stroke Program (L.K., R.W., D.M., R.C., A.A., I.Y., R.A., M.M., T.D., G.d.V.), the Department of Psychology (R.W.), and the Division of Neurology (D.M., A.A., I.Y., R.A., M.M., G.d.V.), The Hospital for Sick Children, Toronto, Canada; and the Department of Occupational Science and Occupational Therapy (S.F.) and the Faculty of Medicine (S.F., D.M., I.Y., R.A., M.M., G.d.V.), University of Toronto, Toronto, Canada
| | - Gabrielle deVeber
- From the Children's Stroke Program (L.K., R.W., D.M., R.C., A.A., I.Y., R.A., M.M., T.D., G.d.V.), the Department of Psychology (R.W.), and the Division of Neurology (D.M., A.A., I.Y., R.A., M.M., G.d.V.), The Hospital for Sick Children, Toronto, Canada; and the Department of Occupational Science and Occupational Therapy (S.F.) and the Faculty of Medicine (S.F., D.M., I.Y., R.A., M.M., G.d.V.), University of Toronto, Toronto, Canada
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Brumback RA. Neurobiology of disease in children: a decade of successful symposia and a robust partnership with the Journal of Child Neurology. J Child Neurol 2011; 26:1475-9. [PMID: 22114242 DOI: 10.1177/0883073811426934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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