The Subacute Rehabilitation of Childhood Stroke—Clinical Guideline 2019
Victorian Subacute Childhood Stroke Advisory Committee. (2019).
Victoria (Australia): Victorian Stroke Clinical Network, 1-29.
This is a guideline created for health professionals to assist in the rehabilitative treatment of individuals following the diagnosis of childhood stroke.
Murdoch Children's Research Institute (Australia); Victorian Subacute Childhood Stroke Advisory Committee (Australia)
Stroke Foundation (Australia)
<div>Compensation strategies such as the use of written instructions, verbal/visual cues, chunking information, electronic memory aids, and/or environmental adaptation (e.g., reducing stimuli, lighting, decreasing distraction in the classroom, incorporating rest periods to reduce fatigue) should be considered to assist children with cognitive difficulties after childhood stroke (Ungraded).</div>
<div>A number of swallowing treatments should be considered to manage dysphagia after childhood stroke in the subacute phase, including:</div>
<ul>
<li>dietary modifications and adjustment of food consistency;</li>
<li>environmental modifications/adjustment;</li>
<li>use of equipment; and</li>
<li>use of strategies or techniques (e.g., chin tuck, jaw support, head rotation, double swallow, effortful swallow, oral motor exercises, thermal stimulation, pacing, visual feedback).</li>
</ul>
<div>Nonoral feeding strategies should only be considered to manage severe dysphagia (Ungraded).</div>
<div>The child's family should be involved in all stages of rehabilitation, particularly:</div>
<ul>
<li>creation of the individual plan of care;</li>
<li>setting goals; and</li>
<li>active involvement in therapy sessions. </li>
</ul>
<div>In addition, "the quality of rehabilitation services for children with stroke should be actively monitored. This should include service level outcome measures as well as consumer satisfaction surveys. Outcome measures should be benchmarked against similar services and quality improvement projects should be encouraged" (Ungraded, p. 12).</div>
<div>"An interdisciplinary team (defined as a group of health professionals from diverse fields who work in a coordinated fashion with the parent and child toward a common goal) is the most appropriate model to achieve optimal outcomes for the child and family after childhood stroke for both inpatient and outpatient rehabilitation" (Ungraded, p. 10).</div>
<div>"Individualized therapy is most appropriate when:</div>
<ul>
<li>Goals are specific to the child.</li>
<li>There are issues with distractibility, cognitive dysfunction, and psychological issues and/or over-stimulation.</li>
<li>There is a need to frequently modify therapy to address gains.</li>
<li>Privacy is required" (Ungraded, p. 11).</li>
</ul>
<div>Strategy training interventions may be considered to improve short term memory and delayed cued recall for children with memory impairments after childhood stroke (Grade D, p. 19).</div>
<div>Group therapy should be considered in addition to standard individualized therapy when:</div>
<ul>
<li>Goals are broad or generic.</li>
<li>There are sufficient numbers of children working toward similar goals at the same time.</li>
<li>Goals focus on social and communication skills (Ungraded).</li>
</ul>
<div>Language therapy, articulation or phonological therapy, and augmentative and alternative communication should be considered according to a child's specific communication deficits. "Functional communication practice should be considered to improve communication difficulties after childhood stroke" (Ungraded, p. 17).</div>
