Australian-first clinical guidelines for child stroke rehabilitation

Researchers and clinical experts have produced the first clinical guidelines in Australia to improve the rehabilitation of children who have a stroke.  

The guidelines, led by the Murdoch Children's Research Institute (MCRI) and published in the International Journal of Stroke, 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 Murdoch Children's Dr Mardee Greenham said without these childhood stroke guidelines there was no benchmark to compare services or set rehabilitation targets in Australia.

Each year up to 600 Australian children suffer a stroke, with one in 20 dying and more than half of survivors experiencing long-term disabilities, affecting physical functioning, communication, learning and social behaviour.

"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," Dr Greenham 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, director of the Children's Stroke Program at Murdoch Children's, 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 Victorian Subacute Childhood Stroke Advisory Committee was established to oversee the development of the guidelines. The advisory committee included clinical and research experts representing the Victorian Paediatric Rehabilitation Service, tertiary pediatric hospitals and researchers from MCRI, The Royal Children's Hospital, the University of Melbourne, Monash University and the Monash Children's Hospital. 

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. 

Publication: Greenham M, Knight S, Rodda J, Scheinberg A, Anderson V, Fahey MC, Mackay MT and the Victorian Subacute Childhood Stroke Advisory Committee. 'Australian clinical consensus guideline for the subacute rehabilitation of childhood stroke,' International Journal of Stroke. DOI: 10.1177/1747493020941279

View the rehabilitation guidelines (PDF 843KB). 

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About MCRI
The Murdoch Children's Research Institute is the largest child health research institute in Australia committed to making discoveries and developing treatments to improve child and adolescent health in Australia and around the world. They are pioneering new treatments, trialling better vaccines and improving ways of diagnosing and helping sick babies, children and adolescents. It is one of the only research institutes in Australia to offer genetic testing to find answers for families of children with previously undiagnosed conditions.

Funding
The study was funded by the Victorian Stroke Clinical Network and the Murdoch Children's Research Institute.