Paediatric stroke rehabilitation guidelines published

Researchers and clinical experts led by the Murdoch Children’s Research Institute (MCRI) have produced Australian clinical guidelines to improve the rehabilitation of children who have a stroke. The guidelines cover motor and sensory function, pain management, nutrition, speech and language function, recreation and leisure activities, and education.

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

Published in the International Journal of Stroke, 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.

MCRI’s Dr Mardee Greenham 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. 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,” Dr Greenham said.

MCRI Director of the Children’s Stroke Program Associate Professor Mark MacKay explained that, in adults, early, multidisciplinary rehabilitation is recognised as aiding early stroke recovery and is 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 paediatric 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 $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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