Discourse plasticity in children after stroke: age at injury and lesion effects.

Studies of children with stroke indicate remarkable recovery of language after some initial delay. However, complex language abilities as measured by discourse (connected language) may be required to detect the full impact of stroke on subsequent cognitive-linguistic development. This study examined discourse ability in children with stroke as compared with orthopedic controls, age-at-injury, and lesion effects. Discourse between two groups of children was compared [stroke (n = 17) vs orthopedic control (n = 17)]. The stroke group was subdivided into early age at stroke (<1 year) and late age at stroke (>1 year). The discourse samples were analyzed along two dimensions: language and information structure. Results revealed that the stroke group performed at significantly lower levels than the orthopedic control group across discourse measures. The most important finding was a poorer outcome for early age at stroke as compared with later age at stroke. These findings alter the widespread belief of optimistic language outcomes after childhood stroke. Interestingly, no site or size-of-lesion effects, common to adult stroke, were identified. These findings identify poor long-term outcome with early brain insults at stages far removed from the onset of injury. The implication is that childhood stroke management should be revised to provide protracted follow-up and treatment.