Pediatric stroke is a rare occurrence in which blood flow to a region of the brain is inhibited, either by a blood clot or a broken blood vessel. When one of these occurs, brain tissue begins to die and the brain may incur permanent damage. This can lead to neurologic disability risking permanent long-term cognitive and motor impairment. While the likelihood of a child suffering a pediatric stroke is rare, affecting one in every 4,000 newborns and an additional 2,000 older children annually, it remains the sixth leading cause of premature death in children. As with adults, a pediatric stroke is life-threatening and requires immediate medical attention. Treatments and long-term outcomes differ between cases, but many can benefit from occupational and other types of therapies.
Rehabilitation after a pediatric stroke usually includes occupational therapy (OT) to help the child regain the skills necessary for independence. Occupational therapy tackles a variety of daily living tasks, targeting the areas of children’s lives where they may need additional assistance. Anything that can help the child succeed in their “occupation” of learning, playing, and growing can be implemented through OT to help them learn to be self-sufficient. Therapists will evaluate the child’s ability to perform age-appropriate self-care, play, and school skills. The ultimate goal of OT is to prepare the child for a future where they can participate as actively and fully as possible in each of these areas while remaining self-directed.
OT can be integral in helping a child restore upper extremity functioning that may have been lost after a stroke. Patients often experience limited mobility in their shoulders, arms, hands, and wrists; OT can help manage this and teach children how to adjust their lifestyles and learn what the affected upper body region still can do. While it can be difficult initially to urge the child to use the newly affected extremities, OTs recognize that doing so can elevate self-esteem and strengthen a child’s willingness to adjust to a new way of living.
Occupational therapy for pediatric stroke utilizes a variety of strategies and targeted therapies to cater to each individual patient’s needs. Typical treatments may include:
Goal-directed therapy: Sometimes referred to as a task-oriented approach, this evidence-based therapy utilizes strategic practices to achieve meaningful goals for both the caregiver and child.
Bimanual therapy: Focuses on using both hands in natural patterns through motivating activities. Examples of this may include coordinating hands together to zip a coat, pour a beverage, or play cards.
Splints and braces (orthoses) may be introduced to treat and prevent soft tissue contractures (tight muscles and tendons) or to encourage hand usage and strengthening.
Compensatory and/or adaptive techniques: This involves relearning tasks and how the child can do them in new ways that adapt better to their needs.
Aquatic therapy: Specialized occupational therapists can use water to assist with movements and skills in ways that may be difficult to achieve on land. Aquatic therapy can assist children in their coordination abilities and bodily awareness in a fun and relaxing environment.
Sensory processing: After a pediatric stroke, children may experience different levels of sensitivity to touch against their weaker upper extremities. OTs can help children become more comfortable with touch.
Therapies to help with play and cognitive skills (thinking and reasoning).
Assistance with individualized school and work plans.
Many of these OT treatments can be implemented in the home environment. Activities and exercises can be done under parental supervision and can help the child gain comfortability in practicing with the affected areas of their body in a real-world setting, outside of the therapy office.