THE MOTOR DEFICIT IN CHILDREN WITH STROKE
Background: Motor deficiency (MD) is the most common symptom of stroke. The incidence of stroke in children is estimated to be 1.3-13 per 100,000 children/ year and is steadily increasing. Stroke is the main cause of unilateral cerebral palsy in term-born children.
Material and method: An analysis of the latest researches has been carried out using the PubMed, „HINARI” and Google Academic search engines.
Results: MD is the partial or total loss of active movements of a part of the body. In stroke, MD may be mono / hemiparesis or mono / hemiplegia. MD severity depends on the topography and stroke size. Although post-stroke mortality in children is lower – around 10%, compared with 20% in adults, many children remain with different degrees of disability: from lack of walking ability and the need for permanent care, to motor deficits that, although lighter, interfere with day-to-day activities. Thus, according to the studies, a complete recovery was observed only in 25-30% of the children who suffered stroke, the remaining 70-80% suffered long-term disabilities persisting into adulthood. The prognosis of MD depends on the age at which stroke started (premature, newborn or small child), type of stroke (ischemic or haemorrhagic), severity and topography of stroke, and immediate complications (coma, seizures).
Conclusions: Although children have a high degree of neuroplasticity, a big number of patients remain with long-term post-stroke motor disabilities. MD has a significant negative impact for the autonomy of children with stroke for basic activities in everyday life as well as on social integration.
BACKGROUND
The incidence of stroke in children is estimated to be 1.3-13 per 100,000 copies / year and is steadily increasing. Frequently this occurs in children with risk factors such as congenital heart disease, anemia, although it may also occur in previously healthy children [1].
Although post-stroke mortality in children is lower – around 10%, compared with 20% in adults, many children remain with different degrees of disability: from the lack of ability to walk and necessity of assistance for child care, to motor deficits that interfere with day-to-day activities. Thus, according to the studies, a complete recovery was observed only in 25-30% of children with stroke, 70-80% exhibited long-term disabilities persisting in adulthood [2].
One of the most common disabilities of stroke is the motor deficit (MD), which has a significant impact on patient autonomy for basic activities in everyday life as well as on social integration. MD outcome depends on the age at which stroke started (preterm, newborn or small child), type of stroke (ischemic or haemorrhagic), severity and topography of stroke, and immediate complications (coma, seizures) [3]. Other disabilities that may develop in these children are: epilepsy, cognitive impairment, mental retardation, speech retardation, behavioral and adaptation disorders [2,4,5,6].
RESULTS
MD is the partial or total loss of active movements of a part of the body. In stroke, MD can be manifested through mono / hemiparesis or mono / hemiplegia, diparesis / diplegia, paraparesis / paraplegia or tertrapareza / tetraplegie.
Pediatric stroke is more likely to develop in the middle cerebral artery vascular bed, and the most common clinical manifestation is acute hemiparesis [1]. In children with perinatal stroke, only the upper limb may be affected. In these children MD emerges in the first year of life – an asymmetry between limbs can be observed when they begin to grasp. The majority of children with unilateral infarctions manage to walk alone around the age of 14 months. MD may vary during development of the child because its outcome is a complex integration between purely motor factors (such as weakness, dystonia, spasticity, orthopedic complications), motor development during childhood, and the influence of behavioral factors [7]. In preschool children, MD may be associated with convulsions, fever, headache, and lethargy, while bigger children may only have MD [8]. Cerebral infarction in the basal ganglia region may be associated with dystonia. Extensive lesions in the basal ganglia, cortex and back of the internal capsule are consistently associated with cerebral palsy (CP) [9]. According to some studies, the stroke is the main cause of unilateral CP in term-born children [10] It was found by Chambriet et al. in their study that 30% of children developed unilateral CP because of neonatal ischemic stroke [11].
The stroke outcome depends on the child’s age onset, thereby stroke in a premature baby increases the CP risk by 2 times versus term-born children. As a consequence of preterm infant stroke, half of the children will develop unilateral CP and half-bilateral CP. As a consequence of term-born child stroke 94% of children will develop unilateral CP and only 6% bilateral [9].
CONCLUSION
Although children have a high degree of neuroplasticity, a big number of patients remain with longterm post-stroke motor disabilities. MD has a significant negative impact on the autonomy of children for basic activities in everyday life as well as on social integration.
Correspondence to:
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