Australian clinical guideline released for rehabilitation of childhood stroke


By Michael Woodhead

14 Aug 2020

The first Australian clinical guidelines to improve the rehabilitation of children who have a stroke have been launched by clinicians from the Murdoch Children’s Research Institute (MCRI) in Victoria.

Produced in co-operation with  the Victorian Stroke Clinical Network the guidelines provide 56 clinical practice recommendations for Australian health professionals to guide the subacute rehabilitation of childhood stroke across service delivery and treatment strategies.

The guidelines cover motor and sensory function, pain management, nutrition, speech and language function, recreation and leisure activities and education.

The authors say optimal rehabilitation reduces the long-term financial, psychological and physical effects of a stroke, especially important in children and young people. They note that up to 600 Australian children suffer a stroke every year, with one in 20 dying and more than half of survivors experiencing long-term disabilities, affecting physical functioning, communication, learning and social behaviour.

Lead author Dr Mardee Greenham, a Research Officer in the Brain and Mind group at MCRI, said that without these childhood stroke guidelines there was no benchmark to compare services or set rehabilitation targets in Australia.

“The lifelong burden of stroke is greater for children than adults. More than half of strokes occur in children under five years of age and they face decades of living with a disability,” she said.

“But perhaps the most crucial difference between paediatric and adult stroke is that the child will face difficulties achieving an independent life because the stroke happens while the child’s brain is still developing.”

Associate Professor Mark MacKay

Associate Professor Mark MacKay, paediatric neurologist and director of the Children’s Stroke Program at MCRI, said in adults, early, multidisciplinary rehabilitation was recognised as aiding early stroke recovery and was linked to improved psychological and physical health outcomes.

“Implementing a standardised approach for rehabilitation will ensure children are not being left behind in the advances in stroke care which have transformed outcomes for adults,” he said. “The causes of stroke are different in children and therefore adult care pathways need to be modified for children.”

“Research has improved the understanding of the incidence and range of impairments following childhood stroke, but studies into the best intervention strategies to target these areas are lacking.”

The guidelines are published in the International Journal of Stroke. 

Developed by the Victorian Subacute Childhood Stroke Advisory Committee,  the guidelines authors acknowledge that they are limited by reliance on consensus-based recommendations, and the lack of evidence for particular types of therapy in different functional domains.

“Botox, for example, has been examined in cerebral palsy and mixed acquired brain injury populations, yet there is a lack of data in the child stroke population,” they wrote.

Associate Professor Mackay will also lead a new $4 million child stroke research study of time-critical adult stroke treatments in babies and children. The recently announced MRFF’s Mission for Cardiovascular Health grant will be administered by the Stroke Foundation, and involves research sites at major paediatric hospitals around Australia.

The Australian Paediatric Acute Code Stroke (PACS) study aims to design, develop and evaluate a national protocol to increase stroke diagnosis within 4.5 hours for infants, children and teenagers. The study will use clinical decision support tools and advanced brain imaging.

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