Neurorehabilitation in children with cerebrovascular insult – why are we late?

Abstract

Pediatric stroke (PS) is a rare disease according to the global incidence of 1.2-13/100,000, but it is nevertheless an important cause of disability in children.  What makes it a challenging research topic is its alarming upsurge in prevalence of 35%. The most prevalent motor deficit in that regard is hemiparesis in 50% to 80% of children with PCI. Motor deficits limit personal independence, everyday activities and quality of life of children and frequently cause lifetime disability. An asymptomatic clinical picture and very rare use of indicated hyperacute recanalization therapy make rehabilitation the primary therapeutic approach in children affected with PS. The present studies suggest that the greater capacity of brain neuroplasticity in children can be relevant in recovery, but also indicate some specific consequences of injury made to a developing brain. Robotic neurorehabilitation (RNR) activates brain neuroplasticity, i.e. stimulates new motor learning which contributes to motor function recovery after brain damage. RNR, in combination with virtual reality, is able to expand the effects of conventional rehabilitation, the children find it interesting, and it motivates them to be actively involved in time-consuming, specific, high-intensity exercises. Motor recovery is intensified by learning and repetition of tasks, with a robot providing additional strength in the performance of movements, with continual measurements of objective parameters. Since there is lack of randomized, controlled studies, the recommendations for RNR use are based on expert consensus or weak evidence.