Anna N Cooper1,2, Vicki Anderson1,2,3, Stephen Hearps1,2, Mardee Greenham1,2, Michael Ditchfield4,5, Lee Coleman1,3, Rod W Hunt1,2,3, Mark T Mackay1,2,3, Paul Monagle1,2,3, Anne L Gordon6,7. 1. Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia. 2. University of Melbourne, Melbourne, Victoria, Australia. 3. The Royal Children's Hospital, Melbourne, Victoria, Australia. 4. Monash Medical Centre, Southern Health, Melbourne, Victoria, Australia. 5. Monash University, Melbourne, Victoria, Australia. 6. Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; and anne.gordon@gstt.nhs.uk. 7. Kings College London, London, United Kingdom.
Abstract
BACKGROUND: Neuromotor impairments are common after pediatric stroke, but little is known about functional motor outcomes. We evaluated motor function and how it changed over the first 12 months after diagnosis. We also examined differences in outcome according to age at diagnosis and whether fine motor (FM) or gross motor (GM) function at 12 months was associated with adaptive behavior. METHODS: This prospective, longitudinal study recruited children (N = 64) from The Royal Children's Hospital, Melbourne who were diagnosed with acute arterial ischemic stroke (AIS) between December 2007 and November 2013. Motor assessments were completed at 3 time points after the diagnosis of AIS (1, 6, and 12 months). Children were grouped as follows: neonates (n = 27), preschool-aged (n = 19), and school-aged (n = 18). RESULTS: A larger lesion size was associated with poorer GM outcomes at 12 months (P = .016). Neonatal AIS was associated with better FM and GM function initially but with a reduction in z scores over time. For the preschool- and school-aged groups, FM remained relatively stable over time. For GM outcomes, the preschool- and the school-aged age groups displayed similar profiles, with gradual recovery over time. Overall, poor FM and GM outcomes at 12 months were associated with poorer adaptive behavior scores. CONCLUSIONS: Motor outcomes and the trajectory of recovery post-AIS differed according to a child's age at stroke onset. These findings indicate that an individualized approach to surveillance and intervention may be needed that is informed in part by age at diagnosis.
BACKGROUND:Neuromotor impairments are common after pediatric stroke, but little is known about functional motor outcomes. We evaluated motor function and how it changed over the first 12 months after diagnosis. We also examined differences in outcome according to age at diagnosis and whether fine motor (FM) or gross motor (GM) function at 12 months was associated with adaptive behavior. METHODS: This prospective, longitudinal study recruited children (N = 64) from The Royal Children's Hospital, Melbourne who were diagnosed with acute arterial ischemic stroke (AIS) between December 2007 and November 2013. Motor assessments were completed at 3 time points after the diagnosis of AIS (1, 6, and 12 months). Children were grouped as follows: neonates (n = 27), preschool-aged (n = 19), and school-aged (n = 18). RESULTS: A larger lesion size was associated with poorer GM outcomes at 12 months (P = .016). Neonatal AIS was associated with better FM and GM function initially but with a reduction in z scores over time. For the preschool- and school-aged groups, FM remained relatively stable over time. For GM outcomes, the preschool- and the school-aged age groups displayed similar profiles, with gradual recovery over time. Overall, poor FM and GM outcomes at 12 months were associated with poorer adaptive behavior scores. CONCLUSIONS: Motor outcomes and the trajectory of recovery post-AIS differed according to a child's age at stroke onset. These findings indicate that an individualized approach to surveillance and intervention may be needed that is informed in part by age at diagnosis.
Authors: Bin Jiang; Nancy K Hills; Rob Forsyth; Lori C Jordan; Mahmoud Slim; Steven G Pavlakis; Neil Freidman; Nomazulu Dlamini; Osman Farooq; Ying Li; Guangming Zhu; Heather Fullerton; Max Wintermark; Warren D Lo Journal: Stroke Date: 2020-12-07 Impact factor: 7.914