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.