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Stroke Smart Magazine


September/October 2007
Q & A

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Stroke Rehab for Children


With Dr. Deb Gaebler,
Pediatric Rehabilitation Medicine Physician at the Rehabilitation Institute of Chicago


SS: How does rehab differ for children versus adults?


Rehabilitation for children is different because a child is still developing. For example, an infant may have a stroke before he is able to sit or stand. Since strokes can occur at any age, it is important to know which developmental milestones have already been reached. Another major difference is the "functional sphere," or environment. For the child, this is school or another educational setting. If a child has some sort of problem that interferes with learning in school then physical, occupational and speech therapy are available to address the problem in the educational setting. Finally, therapy often occurs in a less structured but still goal-oriented fashion with children to engage the child at the appropriate developmental level, including play-based therapy.


Remember, the goals of rehabilitation are two-fold: to maximize abilities and reduce complications. For example, children with spasticity, or tightness of the muscles, might need therapy to help with movement but also special care to help prevent future deformities. That's because the tight muscle does not grow at the same rate as the bone. Parents must pay special attention as the child grows, and surgery may be needed to improve alignment and gait (how a person walks). Splinting and casting may be necessary down the road.


SS: Are rehab treatments used in the same way?


All rehabilitation begins with figuring out what the problems are and identifying goals to address them. Therapists use strength training and stretching to improve movement. Many of the therapy techniques used on child stroke survivors come from the cerebral palsy literature.


SS: Are the rehab treatments tested on children?


Many of the adult treatments are used with children, but few are tested with kids in the same rigorous way. Examples of treatments that have been explored include botulinum toxins (Botox©) for use with hemiplegia or paralysis in children as well as constraint-induced treatment, which involves getting a patient to use the weaker arm or leg in therapy. In pediatrics FDA approval is less common so many treatments are not technically approved but are safe for children.


SS: So how do you know what rehab treatments to consider?


All treatments should be considered but you also must take into account the child's thinking abilities, behavior and health condition. Be sure to work with a doctor who can coordinate treatment and advise you. Complications can occur so it is important to have your doctors supervise the treatment. Actually, you will probably work with a team of rehab professionals, and it is often the therapists who have the most contact with the family and child. They will be an important link to the doctor, with feedback on impairment and function. In turn, treatment decisions will be made based on that feedback.



  

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