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Aprasidze T, Shatirishvili T, Oesch G, Lomidze G, Tatishvili N. Outcome in Childhood Stroke: Comparing Functional Outcome by Modified Rankin Scale with Neurological Outcome by Pediatric Stroke Outcome Measure. JOURNAL OF PEDIATRIC NEUROLOGY 2023. [DOI: 10.1055/s-0043-1761620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
AbstractDifferent scales are used as outcome predictors following arterial ischemic stroke (AIS) in children. Pediatric stroke outcome measure (PSOM) gives information about neurological deficits and function and modified Rankin scale (mRS) about functional outcome. Research examining the relationship between the two measures is scarce. The aim of this study is to correlate the two different scales and to get some information on the long course of outcomes according to these outcome measures. Sixty-one children with the diagnosis of AIS and normal neurodevelopment prior to stroke were investigated. Results of outcome measures (PSOM and mRS) from ≥ 2 years of follow-up were analyzed. Changes of neurological deficits (subcategories of PSOM) over time (discharge, 6 months, and ≥2 years) and prognostic impact on the outcome of the Pediatric National Institutes of Health Stroke Scale and etiology/risk factors are presented.Cramer's V with a coefficient of 0.836 (df-1) indicates a strong association between dichotomized total PSOM and mRS scores. The correlation between the total scales was strong (rho = 0.983, p < 0.001). The correlation coefficient was highest for sensorimotor (rho = 0.949, p < 0.001), then for language (rho = 0.464, p < 0.001) and cognitive (rho = 0.363, p = 0.004) subscales. PSOM scores improved at 6 months compared to the discharge state in sensorimotor (p<0.001) and language (p<0.026) domains, however, there was no statistically significant difference between PSOM scores at 6 months and >2 years follow-up. There was no improvement in cognitive PSOM scores during the follow-up period.There was a high concordance level between the two scales, illustrating that long-term neurological deficits after stroke are related to poor functional outcome. Significant improvement of sensorimotor and language function happened within the period from onset to 6 months of follow-up. Thus, early mobilization of appropriate rehabilitative therapy might improve the outcome. We conclude that both outcome classifications are applicable for assessing outcome after childhood AIS.
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Affiliation(s)
- Tatia Aprasidze
- Department of Neurology, David Tvildiani Medical University, Tbilisi, Georgia
- Department of Neuroscience, M. Iashvili Children's Central Hospital, Tbilisi, Georgia
| | - Teona Shatirishvili
- Department of Neurology, David Tvildiani Medical University, Tbilisi, Georgia
- Department of Neuroscience, M. Iashvili Children's Central Hospital, Tbilisi, Georgia
| | - Gabriela Oesch
- Division of Child Neurology, Department of Pediatrics, University Children's Hospital Bern, University of Bern, Bern, Switzerland
| | - Giorgi Lomidze
- Department of Neurology, European University, Tbilisi, Georgia
| | - Nana Tatishvili
- Department of Neurology, David Tvildiani Medical University, Tbilisi, Georgia
- Department of Neuroscience, M. Iashvili Children's Central Hospital, Tbilisi, Georgia
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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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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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Wales L, Dunford C, Davis K. Following severe childhood stroke, specialised residential rehabilitation improves self-care independence but there are ongoing needs at discharge. Br J Occup Ther 2020. [DOI: 10.1177/0308022619894870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Stroke is a major cause of mortality and disability in childhood. There is a false belief that children will recover better than adults and recent research confirms that younger age at injury can have a negative impact on rehabilitation outcomes, resulting in lifelong disability. Self-care is a key rehabilitation outcome for children and young people. Methods This service evaluation reviews routinely collected clinical self-care data from one specialised residential rehabilitation centre in the United Kingdom. Admission and discharge scores from the United Kingdom Functional Independence Measure +Functional Assessment Measure, Rehabilitation Complexity Scale – E and Northwick Park Nursing Dependency Scale were analysed. Results Twenty-six children and young people age 8 years and over with severe stroke were included. Mean scores of independence increased and mean scores of complexity and dependency decreased. A proportion of the sample had ongoing self-care needs in relation to support needed in washing, dressing and bathing. A small number remained highly dependent, requiring assistance from two carers. Conclusion Children and young people make significant gains in self-care independence during specialised rehabilitation. However, a proportion return to the community with high self-care needs. Occupational therapists and the wider care team should address ongoing self-care needs in this population.
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Khan MH, Smithson L, Li E, Kirton A, Pei J, Andersen J, Yager JY, Brooks BL, Rasmussen C. Executive behavior and functional abilities in children with perinatal stroke and the associated caregiver impact. Child Neuropsychol 2020; 27:83-95. [PMID: 32718269 DOI: 10.1080/09297049.2020.1796953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Perinatal stroke is the most common form of stroke in childhood and is followed by a variety of outcomes, with many children experiencing specific functional and neuropsychological deficits. The association of these outcomes with the psychosocial impact caregivers face is not well documented. The goal of our pilot study was to examine caregivers' perception of executive behavior and functional abilities among children with perinatal stroke, and how these outcomes impact the caregivers. We administered three questionnaires to primary caregivers of children with perinatal stroke to obtain caregiver-reported measures of (1) executive behavior of their child (Behavior Rating Inventory of Executive Function, Second Edition), (2) the functional abilities of their child (Pediatric Evaluation of Disability Inventory Computer Adaptive Test), and (3) the psychosocial impact experienced by the caregiver themselves (Parental Outcome Measure). Participants included 20 children (mean age = 9.3 years, range = 6-16 years) with perinatal stroke and their primary caregivers. Functional abilities in the children were rated as clinically impaired in the domains of daily activities and mobility. Half of the children exhibited clinically impaired ratings on at least one executive behavior domain, but the mean scores for these domains did not reach clinically impaired levels. Greater ratings of problems in daily activities for the child was associated with greater caregiver guilt (r = -0.55, p = 0.02). Caregivers of children with perinatal stroke who experience limitations in performing daily activities should be more closely monitored for adverse impact and be provided the necessary support and education to alleviate the associated guilt.
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Affiliation(s)
- Muhammad H Khan
- Department of Pediatrics, University of Alberta , Edmonton, Canada
| | - Lisa Smithson
- Department of Pediatrics, University of Calgary , Calgary, Canada
| | - Eliza Li
- Department of Educational Psychology, University of Alberta , Edmonton, Canada
| | - Adam Kirton
- Department of Pediatrics, University of Calgary , Calgary, Canada
| | - Jacqueline Pei
- Department of Educational Psychology, University of Alberta , Edmonton, Canada
| | - John Andersen
- Department of Pediatrics, University of Alberta , Edmonton, Canada.,Section of Pediatric Neurosciences, Stollery Children's Hospital , Edmonton, Canada.,Child Health, Glenrose Rehabilitation Hospital , Edmonton, Canada
| | - Jerome Y Yager
- Department of Pediatrics, University of Alberta , Edmonton, Canada.,Section of Pediatric Neurosciences, Stollery Children's Hospital , Edmonton, Canada
| | - Brian L Brooks
- Department of Pediatrics, University of Calgary , Calgary, Canada.,Neuropsychology Service, Alberta Children's Hospital , Calgary, Canada.,Alberta Children's Hospital Research Institute, University of Calgary , Calgary, Canada.,Department of Clinical Neurosciences, Cumming School of Medicine , Calgary, Canada.,Department of Psychology, University of Calgary , Calgary, Canada
| | - Carmen Rasmussen
- Department of Pediatrics, University of Alberta , Edmonton, Canada
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Arterial ischemic stroke in non-neonate children: Diagnostic and therapeutic specificities. Rev Neurol (Paris) 2020; 176:20-29. [DOI: 10.1016/j.neurol.2019.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 03/13/2019] [Accepted: 03/14/2019] [Indexed: 12/12/2022]
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Morard MD, Dinomais M, Bull K, Rippert P, Chevignard M, deVeber G, Chabrier S, Vuillerot C. Additional validation study and French cross-cultural adaptation of the Pediatric Stroke Outcome Measure-Summary of Impressions (PSOM-SOI). Ann Phys Rehabil Med 2019; 64:101341. [PMID: 31816450 DOI: 10.1016/j.rehab.2019.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 10/28/2019] [Accepted: 10/28/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND The Pediatric Stroke Outcome Measure-Summary of Impressions (PSOM-SOI) measures neurological function across right and left sensorimotor domains (Item A), language production (Item B), language comprehension (Item C), and cognition/behaviour (Item D). OBJECTIVE This study was a cross-cultural adaptation into French of the PSOM-SOI and an assessment of its reliability and limitations of use. MATERIAL AND METHODS The translation and adaptation of the PSOM-SOI was followed by the assessment of its reliability in a cohort of 69 children with diagnosed acute neonatal arterial ischemic stroke. Three independent raters retrospectively scored the PSOM-SOI based on data from in-person neurological examination and results of standardized tests performed at age 7 in the cohort database. Comparison 1 (C1) involved a less experienced rater and an experienced rater and comparison 2 (C2) involved 2 experienced raters. Inter-rater reliability (IRR) was measured with Kappa coefficients. RESULTS The cross-cultural adaptation was easily performed, and no rater had difficulties using the French PSOM-SOI. The IRR was better in C1 than C2. For Item A, the agreement in C1 (κ=0.47) and C2 (κ=0.44) was moderate. The C1 agreement was substantial for Items B (κ=0.71) and C (κ=0.70); the C2 agreement was fair for Item B (κ=0.23) and slight for Item C (κ=0.16). For Item D, the agreement was moderate in C1 (κ=0.52) and fair in C2 (κ=0.35). In all but one comparison, agreement or minor disagreement (≤0.5 points) was obtained for more than 90% of the item scores. Regarding the total score, agreement for normal function (≤0.5) versus abnormal function (>0.5) was achieved for 90% in C1 and 67% in C2. CONCLUSION The IRR of the French PSOM-SOI gave variable results depending on the item and rater's experience, but the extent of disagreements was minor for individual items and total score. Additional prospective validation studies using the French PSOM-Short Neurological Exam to score the PSOM-SOI are needed. A dichotomised total score (cut-off≤0.5) could be used to define normal function versus poor outcome.
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Affiliation(s)
- Marie-Doriane Morard
- Département de médecine physique et de réadaptation pédiatrique, hôpital femme-mère-enfant, hospices civils de Lyon, 69500 Bron, France; UMR 1059 SAINBIOSE, Inserm et université de Lyon, 42023 Saint-Étienne, France.
| | - Mickael Dinomais
- Département de médecine physique et de réadaptation, université d'Angers, CHU d'Angers 49933 Angers, France; Laboratoire Angevin de recherche en ingénierie des systèmes (LARIS)-EA7315, université Angers, 49933 Angers, France
| | - Kim Bull
- Clinical and experimental sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Pascal Rippert
- Pôle de santé publique, hospices civils de Lyon, 69003 Lyon, France
| | - Mathilde Chevignard
- Département de rééducation des pathologies neurologiques acquises de l'enfant, hôpitaux de Saint-Maurice, 94410, Saint-Maurice, France; UMR 7371, UMR_S 1146, LIB, Sorbonne Université, UPMC Université Paris 06, 75005 Paris, France
| | - Gabrielle deVeber
- Division of Neurology, Hospital for sick children, Child Health Evaluative Sciences Program, 555, University Ave, M5G1X8 Toronto, ON, Canada
| | - Stéphane Chabrier
- UMR 1059 SAINBIOSE, Inserm et université de Lyon, 42023 Saint-Étienne, France; Inserm CIC1408, département de médecine physique et de réadaptation pédiatrique, centre national de référence de l'AVC de l'enfant, CHU de Saint-Étienne, 42055 Saint-Étienne, France
| | - Carole Vuillerot
- Département de médecine physique et de réadaptation pédiatrique, hôpital femme-mère-enfant, hospices civils de Lyon, 69500 Bron, France; CNRS UMR 5558, laboratoire de biométrie et biologie évolutive, équipe bio statistique santé, 69310 Pierre-Bénite, France; Université Lyon I, 69100 Villeurbanne, France; Université de Lyon, 69000 Lyon, France
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Oshima O, Kawakami M, Okuyama K, Suda M, Oka A, Liu M. Effects of hybrid assistive neuromuscular dynamic stimulation therapy for hemiparesis after pediatric stroke: a feasibility trial. Disabil Rehabil 2019; 43:823-827. [PMID: 31335219 DOI: 10.1080/09638288.2019.1643415] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Hybrid assistive neuromuscular dynamic stimulation (HANDS) therapy, consisting of a wrist-hand splint and an integrated volitional control electrical stimulator to stimulate the extensor digitorum communis, is effective for chronic hemiparesis after stroke in adults. We investigated the feasibility and effects of HANDS therapy for patients with pediatric stroke by performing a longitudinal study. METHODS Twelve patients with chronic hemiparetic pediatric stroke (aged 14-38 years) wore the herapeutic device for 3 weeks. The device was active for 8 h during the daytime, and patients were instructed to use their paretic hand as much as possible. Upper extremity items of the Fugl-Meyer Motor Assessment Scale and the Stroke Impairment Assessment Set motor test were used to measure motor function and were compared before and after the intervention with the Wilcoxon signed rank test. RESULTS All patients were fully compliant with the therapy with no adverse events. After the intervention, both treatment endpoints improved significantly (p < .05). The effect size for upper extremity items of the Fugl-Meyer Motor Assessment Scale was medium (d = 0.59). CONCLUSION This preliminary study demonstrated the feasibility and effectiveness of HANDS therapy in patients with pediatric stroke.Implications for rehabilitationPediatric stroke is a very rare disease and patients are forced to live with sequelae in most of the rest of their lives.Hybrid assistive neuromuscular dynamic stimulation therapy is effective for upper limb paralysis of adult stroke.Hybrid assistive neuromuscular dynamic stimulation therapy was adaptable even for children, and improvement of upper limb paralysis was observed even in a relatively short period of intervention.
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Affiliation(s)
- Osamu Oshima
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Michiyuki Kawakami
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Kohei Okuyama
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Mabu Suda
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Asako Oka
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Meigen Liu
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
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Abstract
Neonatal Arterial Ischemic Stroke (NAIS) affects 6-17 newborns on 100 000-birth term neonates, most of these children keeping long-term motor and cognitive impairments. Based on a literature review, the objectives of this paper are to describe motor and cognitive outcomes after a NAIS and to propose a consensual monitoring of these children to improve their management. About 30 % of children after a NAIS will develop a unilateral cerebral palsy requiring a management by a team with expertise in physical medicine and rehabilitation. Unlike adults, especially after a left NAIS, children will not present aphasia but between 50 and 90 % will present disorders of speech and language in expression and/or reception. After NAIS, the global intellectual efficiency is usually preserved except when the size of the lesion is very important or when severe epilepsy occurs. Several studies are also in favor of vulnerability in visuospatial functions. To quantify impairments, activity limitations and participation restrictions resulting from this NAIS, early and at least yearly evaluations with reliable tools must be carried out systematically until puberty. A multidisciplinary team with a longitudinal follow-up, in all the different developmental dimensions, must conduct these evaluations in term of motor skills, cognitive impairment, behavior, autonomy, quality of life, and participation. Consequences on family functioning need to be evaluate in order to help children and family coping with this event.
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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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López-Espejo M, Hernández-Chávez M. Prevalence and Predictors of Long-Term Functional Impairment, Epilepsy, Mortality, and Stroke Recurrence after Childhood Stroke: A Prospective Study of a Chilean Cohort. J Stroke Cerebrovasc Dis 2017; 26:1646-1652. [PMID: 28476510 DOI: 10.1016/j.jstrokecerebrovasdis.2017.03.043] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Revised: 03/31/2017] [Accepted: 03/31/2017] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND To evaluate the prevalence and predictors of long-term impairment, epilepsy, mortality, and recurrences after the first stroke in a cohort of Chilean children. METHODS A prospective study involving 98 children who suffered a first stroke and underwent follow-up for at least 3 years in a single center. Functional outcome was measured using the modified Rankin Scale for children. We utilized multivariate logistic regression models to estimate the odds ratios (ORs) for outcomes while adjusting for age, sex, and underlying conditions (significance <.05). RESULTS Stroke recurrences were present in 18 children and were strongly associated with arteriopathies (OR 8.11; CI 1.5-43). Of 26 children who died during the follow-up period, a significant proportion had a cardiopathy (OR 6.57; CI 1.3-32) or a chronic head and neck disease (OR 41.3; CI 3.5-490). Among 72 survivors (median age 1.49 years; 38 girls; mean follow-up time 4.85 years), 28 presented marked impairment; these children were younger (P = .019) and had more commonly arteriopathies (OR 9.33; CI 1.7-51) and epilepsy (OR 10.5; CI 3.1-36) as compared to survivors without disabilities. Cumulative epilepsy prevalence was 55.6%; children with epilepsy were younger (P = .037) and had more commonly acute symptomatic seizures (OR 12.16; CI 2.93-50.4) as compared to survivors without epilepsy. CONCLUSIONS The prevalence of long-term adverse outcomes after childhood stroke is high and does not differ from other geographical and racial groups. Younger age, acute seizures, and arteriopathies but not sex and other underlying conditions predict adverse outcome following childhood stroke.
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Affiliation(s)
- Mauricio López-Espejo
- Unit of Pediatric Neurology, Division of Pediatrics, School of Medicine, Pontifical University Catholic of Chile, Santiago, Chile.
| | - Marta Hernández-Chávez
- Unit of Pediatric Neurology, Division of Pediatrics, School of Medicine, Pontifical University Catholic of Chile, Santiago, Chile.
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Abstract
Neuroscientific evidence indicates that human social functioning is supported by a distributed network of frontal and temporal brain regions that undergoes significant development during childhood and adolescence. Clinical studies of individuals with early brain insults (EBI) to frontotemporal regions suggest that such lesions may interfere with the maturation of sociocognitive skills and lead to increased sociobehavioural problems. However, little attention has focussed on the direct assessment of sociocognitive skills, such as moral reasoning, following focal EBI. In the present study, the performance of 15 patients with focal EBI (8–16 years) was compared to that of 15 demographically matched controls on basic neuropsychological measures (IQ and executive functions), sociocognitive tasks (moral reasoning, moral decision-making and empathy) and parent reports of sociobehavioural problems and social adaptive skills. Patients with focal EBI had significantly lower levels of moral reasoning maturity, moral decision-making, and empathy than their matched controls, but did not differ on more general measures of cognition. Their parents also reported increased sociobehavioural problems. These findings suggest that focal EBI to frontotemporal regions can result in reduced sociocognitive capacities, more specifically moral reasoning, and increased vulnerability to sociobehavioural problems.
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Jacomb I, Porter M, Brunsdon R, Mandalis A, Parry L. Cognitive outcomes of pediatric stroke. Child Neuropsychol 2016; 24:287-303. [DOI: 10.1080/09297049.2016.1265102] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Isabella Jacomb
- Department of Psychology, Macquarie University, North Ryde, Australia
| | - Melanie Porter
- Department of Psychology, Macquarie University, North Ryde, Australia
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Fragala-Pinkham MA, Dumas HM, Lombard KA, O'Brien JE. Responsiveness of the Pediatric Evaluation of Disability Inventory-Computer Adaptive Test in measuring functional outcomes for inpatient pediatric rehabilitation. J Pediatr Rehabil Med 2016; 9:215-22. [PMID: 27612081 DOI: 10.3233/prm-160382] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Responsiveness of the PEDI-CAT Mobility, Daily Activities, and Social/Cognitive domains and Wheelchair subdomain was evaluated for youth admitted to a pediatric post-acute care hospital. METHODS Inpatients ages 2-21 years, with a length of stay of ≥ 5 days and with both admission and discharge scores were included. The difference between mean admission and discharge PEDI-CAT scaled scores were analyzed using paired t-tests. Effect sizes, standard response means (SRMs), and minimal detectable change values were calculated. Score comparison between diagnostic subgroups (Traumatic Brain Injury, Neurological, Orthopedic, Medical) and age groups ( ≤ 5, > 5 but < 13, ≥ 13 years) were evaluated for the Mobility domain. RESULTS Sample size differed by domain with 66 Mobility, 30 Daily Activities, 19 Social/Cognitive and 9 Wheelchair subdomain pairs. Significant differences were found for all domains when mean admission and discharge scaled scores were compared. Moderate to large effect sizes and SRMs were found for the Mobility and Daily Activities domains and Wheelchair subdomain. Small effect size but large SRM was found for the Social/Cognitive domain. The Mobility domain was also responsive to changes in all diagnostic and age groups. CONCLUSION The PEDI-CAT was responsive to functional changes for youth discharged from an inpatient pediatric rehabilitation hospital.
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Affiliation(s)
| | - Helene M Dumas
- Research Center, Franciscan Hospital for Children, Brighton, MA, USA
| | - Kelly A Lombard
- Research Center, Franciscan Hospital for Children, Brighton, MA, USA.,Physical Therapy Department, Boston Children's Hospital, Boston, MA, USA
| | - Jane E O'Brien
- Research Center, Franciscan Hospital for Children, Brighton, MA, USA
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Abstract
PURPOSE To describe physical therapy (PT) examination and intervention during rehabilitation for a child poststroke with an implanted left ventricular assist device (LVAD). KEY POINTS A 10-year-old boy with a history of congenital heart disease awaiting heart transplant was admitted to a pediatric rehabilitation hospital with right hemiplegia, and an external, portable LVAD. This child participated in standard PT examination procedures and interventions with accommodations for the LVAD. Observation was used to evaluate exercise response because of inability to measure vital signs. At admission, impaired muscle tone, balance, and endurance contributed to limitations in functional mobility. By discharge, improvements were seen in all impairments and also in ambulation distance, speed, and independence. CONCLUSION This child awaiting heart transplant with an LVAD was able to tolerate intensive individualized PT. With monitoring and adjustments to the plan of care, he demonstrated improvements in functional mobility.
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17
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Acute ‘limited’ magnetic resonance imaging in childhood stroke—an illustrative case. Emerg Radiol 2015; 22:453-5. [DOI: 10.1007/s10140-015-1310-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 03/06/2015] [Indexed: 10/23/2022]
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18
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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: 30] [Impact Index Per Article: 3.0] [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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19
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Kapadia NM, Nagai MK, Zivanovic V, Bernstein J, Woodhouse J, Rumney P, Popovic MR. Functional electrical stimulation therapy for recovery of reaching and grasping in severe chronic pediatric stroke patients. J Child Neurol 2014; 29:493-9. [PMID: 23584687 DOI: 10.1177/0883073813484088] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Stroke affects 2.7 children per 100,000 annually, leaving many of them with lifelong residual impairments despite intensive rehabilitation. In the present study the authors evaluated the effectiveness of 48 hours of transcutaneous functional electrical stimulation therapy for retraining voluntary reaching and grasping in 4 severe chronic pediatric stroke participants. Participants were assessed using the Rehabilitation Engineering Laboratory Hand Function Test, Quality of Upper Extremity Skills Test, Pediatric Evaluation of Disability Inventory, and Assisting Hand Assessment. All participants improved on all measures. The average change scores on selected Rehabilitation Engineering Laboratory Hand Function Test components were 14.5 for object manipulation (P = .042), 0.78 Nm for instrumented cylinder (P = .068), and 14 for wooden blocks (P = .068) and on the grasp component of Quality of Upper Extremity Skills Test was 25.93 (P = .068). These results provide preliminary evidence that functional electrical stimulation therapy has the potential to improve upper limb function in severe chronic pediatric stroke patients.
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Affiliation(s)
- Naaz M Kapadia
- 1Toronto Rehabilitation Institute, University Hospital Network, Toronto, Canada
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20
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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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21
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de Kloet AJ, Hilberink SR, Roebroeck ME, Catsman-Berrevoets CE, Peeters E, Lambregts SAM, van Markus-Doornbosch F, Vliet Vlieland TPM. Youth with acquired brain injury in The Netherlands: A multi-centre study. Brain Inj 2013; 27:843-9. [DOI: 10.3109/02699052.2013.775496] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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22
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Lo WD, Ichord RN, Dowling MM, Rafay M, Templeton J, Halperin A, Smith SE, Licht DJ, Moharir M, Askalan R, Deveber G. The Pediatric Stroke Recurrence and Recovery Questionnaire: validation in a prospective cohort. Neurology 2012; 79:864-70. [PMID: 22895580 DOI: 10.1212/wnl.0b013e318266fc9a] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We developed the Recurrence and Recovery Questionnaire (RRQ) by converting the Pediatric Stroke Outcome Measure (PSOM) to a questionnaire for telephone interview and sought to validate the RRQ in a large cohort. METHOD We analyzed parents' RRQ responses and same-day PSOM assessments for 232 children who had arterial ischemic stroke, cerebral sinovenous thrombosis, or presumed perinatal ischemic stroke. We assessed the agreement and consistency of the PSOM and RRQ, and we identified conditions that contributed to differences between the 2 measures. We tested selected factors as predictors of differences between the total PSOM and total RRQ (tPSOM and tRRQ) scores. RESULTS Median PSOM score was 1.5 and median RRQ score was 1.5. There was good agreement between tPSOM and tRRQ, and RRQ was a reliable estimator of PSOM at the total and component level. Preexisting neurologic deficits or chronic illnesses increased the difference between the tPSOM and tRRQ; the chronic illness effect was confirmed with univariate analysis. CONCLUSIONS The RRQ can characterize poststroke function when a child cannot return for examination. While the RRQ is not identical to the PSOM, the 2 measures likely assess closely related aspects of recovery. The RRQ is particularly useful when assessing outcomes of large cohorts, and will be useful in performing long-term follow-up studies of pediatric stroke.
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Affiliation(s)
- Warren D Lo
- Departments of Neurology and Pediatrics, The Ohio State University, Columbus, OH,
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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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