Objective
Paediatric stroke is a relatively rare medical condition, but it
often leads to long lasting motor and cognitive impairments.
Rehabilitation of motor impairments has been widely studied, with most
studies performed in children with cerebral palsy (CP). However, CP
covers a variety of medical conditions, including brain lesions due to
paediatric stroke occurring early in life, but not stroke occurring
later on during childhood. The specificity of rehabilitation after
paediatric stroke remains understudied. This paper aims to present
current motor rehabilitation practices (from birth to age 18) and
examine which of these techniques are applicable and efficient for
paediatric stroke.
Materials/Patients and methods
We first conducted searches using Ovid Database, for motor
rehabilitation techniques used in childhood hemiplegia and/or CP. As a
second step, a systematic search was conducted up to March 2016,
combining the therapies retrieved in the first search AND key words
referring to paediatric stroke. Separate searches were conducted for
each rehabilitation technique previously identified, namely: constraint
induced movement therapy (CIMT), hand arm bimanual training (HABIT),
occupational therapy combined with botulinum toxin injections,
non-invasive brain stimulation, virtual reality, robotics,
action-observation therapy, functional electric stimulation and
prismatic or mirror adaptations.
Results
In paediatric stroke, studies on rehabilitation of lower limb present
low or insufficient evidence, whereas most studies refer to
rehabilitation of upper-limb disabilities. CIMT presents moderate to
strong evidence, sometimes coupled with imaging studies examining the
associated brain changes. Individual case studies propose CIMT for
toddlers or infants, both for motor rehabilitation or unilateral spatial
neglect. Contrary to CP literature, there is no available evidence on
bimanual training or botulinum toxin injections, whereas there is a
growing body of research on non-invasive brain stimulation, (tDCS or
TMS) providing preliminary evidence on the efficacy, as well as safety
and feasibility of such methods for older children. Novel approaches
such as functional electric stimulation, robotic therapy, virtual
reality and action–observation therapy present low or insufficient
evidence, but may be promising for more severe upper limb deficits or
early intervention.
Discussion/Conclusion
Rehabilitation of motor deficits following paediatric stroke remains
understudied, but a number of promising therapies are emerging.
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