Stroke in Childhood: Clinical Guideline for Diagnosis, Management, and Rehabilitation

Guideline Development Group, Royal College of Paediatrics and Child Health. (2017).

London (United Kingdom): Royal College of Paediatrics and Child Health, i-169.

<p>This guideline provides recommendations on the identification, diagnosis, and acute and long-term management of stroke in children until their transition to adult care. The guidelines are intended for professionals involved in pediatric health care including neurologists, educators, social workers, audiologists, and speech-language pathologists. This guideline updates and expands upon the following guideline:</p> <ul> <li>Paediatric Stroke Working Group, Royal College of Physicians of London. (2004). <em>Stroke in Childhood: Clinical Guidelines for Diagnosis, Management, and Rehabilitation.</em> London, United Kingdom: Royal College of Physicians.</li> </ul>

Royal College of Paediatrics and Child Health (United Kingdom); Stroke Association (United Kingdom)

Association of Ambulance Chief Executives (United Kingdom); Association of Paediatric Chartered Physiotherapists (United Kingdom); British Association for Community Child Health; British Academy of Childhood Disability; British Association of General Paed

<div>Referral to augmentative and alternative communication (AAC) services should be offered for children experiencing significantly impaired language comprehension and/or expression of speech/language.</div>

<div>Eating, drinking, and swallowing should receive ongoing management in the presence of aspiration. "Offer access to specialist multidisciplinary feeding services when children and&nbsp;young people have complex dysphagia (including when there is consideration&nbsp;of non-oral feeding)" (p. 119).</div>

<div>The child/young person and caregivers should receive cognitive skills training addressing meta-cognitive skills, problem solving across settings, daily life activities, and compensatory strategies.</div>

<p>Care of children after stroke should be collaborative and involve relevant multidisciplinary team (MDT) members including medical, nursing and allied health professionals (e.g., education staff, occupational therapists, physiotherapists, orthopedists, psychologists, audiologists, speech and language therapists). Responsibilities of the MDT include:</p> <ul> <li>delivering prompt and timely assessment and intervention services;</li> <li>designating a central point of contact for the team;</li> <li>providing young people and their caregivers accessible information at their communication level;</li> <li>establishing communication channels between medical and educational personnel and the child&rsquo;s family to allow access to information and encourage integration of supports;</li> <li>assessing the child across domains using the International Classification of Functioning (ICF) framework to identify function and limitation baselines;</li> <li>using both functional and developmental tools or quality of life measures, with psychometric properties when available, to describe and monitor the child&rsquo;s abilities and limitations;</li> <li>re-evaluating the child as his or her functional abilities change or at times of transition (e.g., entering school, graduation);</li> <li>prioritizing functional goals using goal-setting tools and the principles of being SMART (i.e., Specific, Measurable, Agreed, Realistic and Time-bound) and reviewing those goals at least annually; and</li> <li>supporting transitions between settings (e.g., medical to school, school to workplace) by providing information about available resources.</li> </ul>

<p>Refer for comprehensive speech-language therapist for assessment when there are parental or professional concerns about speech, language or communication limitations such as:</p> <ul> <li>difficulties understanding or expressing language;</li> <li>decreased speech intelligibility or persisting motor speech disorders (e.g., dysarthria and dyspraxia);</li> <li>dysfluency; or</li> <li>voice disorders.</li> </ul> <p>Speech and language assessment should include baseline and outcome measures and evaluation of high-level language processing&nbsp;difficulties affecting educational performance, communication, and/or social participation.</p>

<div>Hearing should be assessed as part of the multidisciplinary team assessment following pediatric stroke. Children with hearing loss may benefit from support(s) to improve function and participation. The impact of hearing loss and other sensory conditions should be taken into consideration when selecting appropriate interventions for other domains.</div>

<div>"Refer for [speech and language therapist] SLT assessment and advice if parents/carers have concerns about coughing or choking on eating and drinking, frequent chest infections, or failure to move through the typical stages of eating and drinking development. Use SLT assessment as the first line of investigation" (p. 119). "Provide access to videofluoroscopy (VF) with a specialist paediatric team, including speech and language therapist and radiographer, if there is uncertainty about swallow safety after clinical assessment" (p. 119).</div>