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Nonpharmacological rehabilitation interventions for motor and cognitive outcomes following pediatric stroke: a systematic review

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Abstract

The aim of this review was to evaluate the evidence for nonpharmacological rehabilitation interventions for motor and cognitive impairment following pediatric stroke. A literature search was conducted using multiple scientific databases. Studies were included if (1) the study population was > 50% pediatric (< 18 years) stroke, (2) a diagnosis of stroke was explicitly stated, (3) there were ≥ 3 pediatric stroke participants included in the study sample, and (4) motor or cognitive outcome measures were used to assess effect of treatment. Levels of evidence were assigned to each study to determine the strength of the evidence for each intervention. A total of 18 articles met inclusion criteria. Most studies (N = 14) examined rehabilitation of the upper limb, with constraint-induced movement therapy (CIMT) as the most common intervention. Overall, the evidence supports the use of CIMT, forced use therapy, repetitive transcranial magnetic stimulation, functional electrical stimulation, and robotics, but suggests no beneficial effect of transcranial direct current stimulation. Very few studies assessed interventions for the lower limb (N = 1) or cognitive impairment (N = 3).

Conclusion: Effective rehabilitation approaches are important for optimizing outcomes in children who have had a stroke. Although the number of published clinical trials has increased in recent years, little evidence-based guidance exists for this clinical population.

What is Known:

• Pediatric stroke is a significant cause of disability in children that is often associated with long-term motor and cognitive sequelae.

• There is a need to establish a knowledge base regarding available evidence-based rehabilitation therapies for this clinical population.

What is New:

• Most studies examining interventions for motor function focus on upper limb rehabilitation, whereas few studies have investigated interventions for improving lower limb or cognitive impairment.

• An important gap exists regarding evidence-based rehabilitative treatment approaches for pediatric stroke.

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Abbreviations

AHA:

Assisting Hand Assessment

BBT:

Box and Blocks Test

CIMT:

Constraint-induced movement therapy

COPM:

Canadian Occupational Performance Measure

FES:

Functional electrical stimulation

MA:

Melbourne Assessment

PAFT:

Pediatric Arm Function Test

PCT:

Prospective controlled trial

PDMS:

Peabody Developmental Motor Scale

PEDro:

Physiotherapy evidence database

PMAL:

Pediatric Motor Activity Log

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

RCT:

Randomized controlled trial

rTMS:

Repetitive transcranial magnetic stimulation

tDCS:

Transcranial direct current stimulation

WMTB-C:

Working Memory Test Battery for Children

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Funding

This project was funded by the Heart and Stroke Foundation of Canada and the Canadian Partnership for Stroke Recovery.

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Authors and Affiliations

  1. Parkwood Institute Research, Lawson Health Research Institute, Parkwood Institute, London, ON, Canada

    Magdalena Mirkowski, Amanda McIntyre, Pavlina Faltynek, Nicholas Sequeira & Robert Teasell

  2. Parkwood Institute, St. Joseph’s Health Care London, London, ON, Canada

    Caitlin Cassidy & Robert Teasell

  3. Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada

    Caitlin Cassidy & Robert Teasell

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  1. Magdalena Mirkowski
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Contributions

MM was responsible for manuscript conceptualization, literature search, article selection, quality assessment, data extraction, table and figure creation, manuscript drafting and editing, and preparation of the final manuscript for submission; MM wrote the abstract, methods, and results, and contributed to the introduction and discussion. AMc assisted with article selection and wrote the discussion. PF contributed to writing the introduction. NS assisted with article selection, quality assessment, and data extraction. CC and RT provided clinical expertise about stroke rehabilitation throughout the manuscript. AMc, PF, NS, CC, and RT all contributed to manuscript editing.

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Correspondence to Magdalena Mirkowski.

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Communicated by Mario Bianchetti

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Mirkowski, M., McIntyre, A., Faltynek, P. et al. Nonpharmacological rehabilitation interventions for motor and cognitive outcomes following pediatric stroke: a systematic review. Eur J Pediatr 178, 433–454 (2019). https://doi.org/10.1007/s00431-019-03350-7

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