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The Subacute Rehabilitation of Childhood Stroke
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The guideline for the subacute management of childhood stroke. has been developed with, Endorsed by, Suggested citation Victorian Subacute Childhood Stroke Advisory Committee Guideline for the subacute management. of childhood stroke 2019, Copyright information The cover image of the child may not be used or reproduced in any manner without the express. written consent of the Murdoch Children s Research Institute. Disclaimer This document has been produced by the Murdoch Children s Research Institute for use by health. professionals The statements and recommendations are evidence based unless labelled as consensus based. Recommendations are not to replace clinical judgement Interpretation of this document by those without appropriate. medical and or clinical training is not recommended unless in consultation with a relevant health professional. Despite the utmost care taken in developing this document the Murdoch Children s Research Institute cannot accept. any liability including loss or damage resulting from use of content or for its accuracy currency and completeness. Victorian Subacute Childhood Stroke Guidelines 2, 1 Quick reference guide 6. 2 Introduction 7, 3 Methodology 8, 4 Framework for providing rehabilitation 10. 5 Motor function 13, 6 Sensory function 14, 7 Pain management 15.
8 Dysphagia and nutrition 16, 9 Communication speech and language function 17. 10 Cognition 18, 11 Psychosocial emotional and behavioral function 20. 12 Activities of daily living 21, 13 Participation in recreation and leisure 22. 14 Education learning and vocation 23, 15 Family function 25. 16 Future research directions 26, 17 References 27.
Victorian Subacute Childhood Stroke Guidelines 3, ACKNOWLEDGEMENTS. The Victorian Subacute Childhood Stroke Advisory Dr Ali Crichton. Committee gratefully acknowledges the generous Clinical Neuropsychologist. contributions of the Victorian Stroke Clinical Network Monash Children s. The Department of Health and Human Services, Ms Anne Fulton. Victorian State Government and the Murdoch Children s. Speech Pathologist, Research Institute, Goulburn Valley Health. Ms Jane Galvin, Victorian Subacute Childhood Occupational Therapist. Stroke Advisory Committee The Royal Children s Hospital Melbourne. Dr Sue Greaves, Sincere thanks to all members of the steering committee Occupational Therapist.
clinical advisory group and expert Delphi panelists for their The Royal Children s Hospital Melbourne. invaluable input to the development of this guideline. Dr Lyndal Hickey, Social Worker, Steering Committee The Royal Children s Hospital Melbourne. A Prof Mark Mackay Chair MBBS PhD Dr Brian Hoare, Occupational Therapist. Dr Sarah Knight PhD Monash Children s, A Prof Adam Scheinberg MBBS MMed Dr Emily Incledon. Prof Vicki Anderson PhD Clinical Psychologist, The Royal Children s Hospital Melbourne. A Prof Michael Fahey MBBS PhD, Prof Angela Morgan, Dr Jillian Rodda PhD Speech Pathologist.
Murdoch Children s Research Institute, Project Coordinator Mrs Kathryn Newton. Occupational Therapist, Dr Mardee Greenham PhD Eastern Health. Ms Chloe Noble, Clinical Advisory Group Occupational Therapist. The Royal Children s Hospital Melbourne, Dr Kathleen Bakker. Clinical Neuropsychologist, Miss Clare O Donnell, Physiotherapist.
The Royal Children s Hospital Melbourne, The Royal Children s Hospital Melbourne. Ms Janeen Bower, Music Therapist, Ms Jillian Steadall. Speech Therapist, The Royal Children s Hospital Melbourne. The Royal Children s Hospital Melbourne, Ms Kim Cartwright. Education Consultant, Dr Jayasri Srinivasan, Paediatric Rehabilitation Consultant and Paediatric Neurologist.
The Royal Children s Hospital Melbourne, The Royal Children s Hospital Melbourne. Ms Catherine Clancy, Physiotherapist, Ms Renata Winkler. Speech Therapist, Monash Children s, Eastern Health. Dr Therese Clark, Clinical Neuropsychologist, Barwon Health. Victorian Subacute Childhood Stroke Guidelines 4, Delphi panelists Abbreviations.
Vicki Anderson Kath Bakker Ella Barry Sally Bletcher AIS Arterial ischaemic stroke. Sanjay Bhate Janeen Bower Sarah Burney Frances Burns. CBR Consensus based recommendation, Jo Butchart Michelle Buttler Di Cameron Kim Cartwright. Rachael Cavanagh Catherine Clancy Therese Clark EBR Evidence based recommendation. Ali Crichton Alana Cummins Mahek Dudhwala, GDC Guideline Development Committee. Suzanne Edelmaier Adrienne Epps Michael Fahey, Allesha Fecondo Michelle Fisher Rob Forsyth mCIMT Modified constraint induced movement therapy. Adrienne Fosang Anne Fulton Jane Galvin, NHMRC National Health and Medical Research Council. Vigeya Ganesan Karen Garthwaite Anne Gordon, Sue Greaves Fay Guyatt Chatwell Hababa PSD Program for Students with Disabilities.
Monika Hasnat Michele Hervatin Lyndal Hickey, Brian Hoare Deb Houston Kate Hunter Emily Incledon PNF Proprioceptive Neuromuscular Facilitation. Jacqueline Irlam Helen Jeges Renee Jenkins rTMS Repetitive transcranial magnetic stimulation. Sonia McCall White Angela Morgan Tamara Moritz, Angie Morrow Melissa Murphy Emma Naughtin SCD Sickle cell disease. Kathryn Newton Chloe Noble Jennifer Papoutsis VPRS Victorian Paediatric Rehabilitation Service. Barry Rawicki Jill Rodda Kirrily Rogers Rita Rosa, Maree Ryan Adam Scheinberg Emily Schofield Jen Sharp. Heather Sheridan Suzie Smith Karen Speedy, Tanja Spencer Jayarsi Srinivasan Jill Steadall. Michael Takagi Wendy Taverna Abby Thevarajah, Kelly Thompson Lauren Thompson Glennen Claire Toolis.
Rachel Toovey Melanie Tozer Joannah Tozer Sue Tupper. Stephen Wainrib Natalie Weekley Kirsten Wilken, Fiona Wilkinson Teresa Williams Neil Wimalasundera. Renata Winkler Felicity Wood Bianca Worboyes, Meredith Wynter Suzy Young. Only names of those who consented for their names, to be acknowledged in publications are printed here. We would also like to acknowledge the guidance provided. by Tanya Medley in the development of the methodology. for this guideline, Victorian Subacute Childhood Stroke Guidelines 5. 1 QUICK REFERENCE GUIDE, Figure 1 Quick reference guide to key recommendations for the subacute rehabilitation of childhood stroke.
Involvement of an interdisciplinary team, Active partnership with family. Frameworrk Criteria for determining appropriate settings for service delivery. rehabilitation Quality evaluation of service delivery. Criteria for transfer Creation of Approach, from acute hospital individualised to therapy Transition to. to subacute care plan and individual adult services. rehabilitation care goal setting and or group, Motor function Section 5 Psychological emotional and. behavioural function Section 11, Sensory function Section 6. Activities of daily living Section 12, Pain management Section 7.
Interventions Participation in recreation, Dysphagia and nutrition Section 8. Sections 5 15 and leisure Section 13, Communication speech. Education learning, and language Section 9, and vocation Section 14. Cognition Section 10, Family function Section 15, Victorian Subacute Childhood Stroke Guidelines 6. 2 INTRODUCTION, 2 1 Background 2 3 Clinical need for.
Stroke is among the top ten causes of death in children this guideline. and more than half of survivors have long term disabilities. There is substantial evidence that coordinated, resulting in a need for high quality specialist sub acute. individualised interdisciplinary approaches to stroke. medical and rehabilitation services Contrary to commonly. rehabilitation improve outcomes in adults but no such. held views children do not recover better than adults1. systems currently exist for childhood stroke1 7 9 Further. While relatively rare estimated incidence 1 2 7 9 per 100. there are currently no available clinical guidelines for the. 0002 4 the economic cost of childhood stroke is, subacute care of childhood stroke in Australia Anecdotal. substantial5 The lifelong individual family and societal. reports from treating clinicians and parent members of the. burden of early stroke is likely to be greater than in adults. StroKidz childhood stroke advocacy support group suggest. because children surviving stroke face many more years. there is currently considerable variation in quality of. living with disability A U S case control study estimated. subacute care The development of clinical care guidelines. an average five year medical cost of 110 921 per child. and the statewide standardisation of referral and service. representing a 15 fold cost increase compared to controls5. delivery pathways across the Victorian Paediatric, Of note this figure does not capture costs of families. Rehabilitation Service VPRS will improve consistency. including loss of income reduced employment, of subacute childhood stroke care. rehabilitation expenses and psychosocial consequences. for child and family Costs are higher for childhood than. for neonatal stroke and higher for haemorrhagic than. ischaemic stroke5 Higher costs correlate with worse. 2 4 Scope and intended users, impairment emphasising the importance of rehabilitation of this guideline.
to maximise recovery6, This guideline is aimed at hospital and community based. The key difference between children and adults is that healthcare professionals involved in the rehabilitative. paediatric stroke results in the inability to achieve rather management of children after stroke including. than lose functional independence Therefore the occupational therapists physiotherapists education. functional behavioural and social consequences may not consultants clinical psychologists clinical. be apparent at the time of the stroke event particularly in neuropsychologists speech pathologists social workers. very young children who typically grow into their deficits1 dietitians music therapists doctors and nurses This. guideline is intended to be used by appropriately qualified. health professionals to guide clinical management of. 2 2 Purpose rehabilitative care following childhood stroke Further. details on the guideline scope can be found in Appendix 1. The purpose of this guideline is to improve the care of. children with stroke by providing health professionals with. evidence based and consensus based recommendations. to assist in rehabilitative treatment following diagnosis of. 2 5 Target population, childhood stroke This guideline addresses the subacute management and. care of acute arterial ischaemic stroke and non traumatic. intracranial haemorrhage in children aged 29 days to 18. years or until school completion The scope of this. guideline does not include perinatal aged 28 days or. younger at stroke onset subdural haemorrhage secondary. to trauma spinal stroke syndromes or cerebral venous. thrombosis without infarction, Victorian Subacute Childhood Stroke Guidelines 7. 3 METHODOLOGY, 3 1 Guideline development 3 2 Clinical questions. committee The GDC identified clinical areas to be covered by the. guideline and the project coordinator formulated these. A multidisciplinary guideline development committee. into structured questions in consultation with the steering. GDC was convened to oversee the development of the. committee The clinical questions were developed based. guideline The GDC consisted of a panel of clinical and. on a framework of Population Intervention Comparison. research experts representing the Victorian Paediatric. and Outcome PICO The clinical questions addressed, Rehabilitation Service tertiary paediatric hospitals and.
by this guideline are detailed in Table 2 1, researchers in Victoria Members of the GDC are listed. on page 4 under Steering Committee and Clinical Advisory. Group The GDC developed the purpose scope and clinical. questions of the guideline and carried out critical appraisal. and data extraction of publications All conflicts of interest. were declared by the GDC and are recorded in Appendix 2. A copy of the conflict of interest form can be found in. Appendix 3, Table 2 1 Clinical questions, Clinical question. 1 What is the most appropriate framework for providing rehabilitation to children with stroke. 2 In children with stroke and motor difficulties which interventions improve outcome. 3 In children with stroke and sensory deficits which interventions improve outcome. 4 In children with stroke and pain which interventions improve outcome. 5 In children with stroke and dysphagia or poor nutrition status which interventions improve outcome. In children with stroke and speech language or communication difficulties which interventions. improve outcome, 7 In children with stroke and cognitive difficulties which interventions improve outcome. In children with stroke and psychosocial emotional or behavioural difficulties which interventions. improve outcome, 9 In children with stroke and difficulties with activities of daily living which interventions improve outcome. In children with stroke and reduced participation in recreation or leisure activities which interventions. improve outcome, 11 In children with stroke which interventions improve education learning and vocation outcomes.
12 In children with stroke which interventions improve family function. Victorian Subacute Childhood Stroke Guidelines 8, 3 3 Systematic review 3 6 Development of evidence<. Systematic reviews were conducted to identify studies relevant to the clinical questions to be addressed by the guideline The search strategies used for the systematic reviews are detailed in Appendix 4 All literature searches were conducted on core databases including MEDLINE Embase Cochrane Library and PsycInfo Searches were

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