When we hear the word "stroke" we typically think of adults, right? We rarely associate strokes with children. However, strokes can occur before birth and in infants, children and adolescents. A stroke in a child may result in deficits such as partial or total paralysis on one side of the body, speech-language and swallowing problems, cognitive and sensory impairments, and behavioral problems. These problems could extend well into school-age years, when intervention may be needed.
Although it may seem daunting to hear that you're getting a child who has had a stroke on your caseload, the symptoms he or she exhibits will not be unfamiliar to you. Typical impairments may include varying degrees of cognitive and language disorders, feeding and swallowing issues due to dysphagia, or speech sound disorders due to dysarthria. Some children may need alternative or augmentative systems to communicate if the effects are severe.
Stroke occurs in approximately six out of every 100,000 children (although estimates vary). Common causes of stroke include:
- Congenital or acquired heart disease
- Head trauma
- Hematological disorders
- Infection, including chicken pox
- Metabolic disorders
- Sickle cell disease
- Vascular disorders
Stroke is one of the top 10 causes of death for children ages 1 to 19, according to the Children's Hemiplegia and Stroke Association. However, between 60 and 80 percent of children who have strokes survive and lead productive lives—even though they may suffer residual effects throughout their lifetime. Children with sickle cell disease and congenital or acquired heart disease carry the highest risk for stroke, according to the National Institute of Neurological Disorders and Stroke. Boys are at higher risk than girls and African-American children are at higher risk than Caucasian and Asian children, according to a study by Virginia Howard and colleagues in the journal Neurology (April 24, 2013). The same research indicates that adolescents in the southeastern United States have a 17 percent higher risk of stroke later in life.
According to the National Stroke Association, a child who has had a stroke may not receive proper treatment, because clinicians typically don't associate strokes with infants and children and don't recognize the symptoms. Children may exhibit symptoms that are similar to adults when having a stroke such as:
- Seizures (especially in newborns).
- Worsening or sudden headaches.
- Sudden difficulty speaking, slurring of words or trouble understanding speech.
- Hemiparesis (weakness on one side of the body).
- Sudden loss of vision or abnormal eye movements.
- Sudden loss of balance or trouble walking.
Mild stroke symptoms often go undiagnosed, as infants and children may not show symptoms right away. If a child is using one hand more than the other, it may be attributed to hand preference. Delays in crawling or walking may be attributed to late development. In young children, there may be delays in language development or gross motor development, or tightness or limited leg movements. In older children, symptoms may include seizures or sudden one-sided paralysis. To prevent future strokes, it's important to identify the cause of these symptoms and alert the parent if the symptoms have gone undiagnosed.
The role of the school-based speech-language pathologist may include reviewing the case history (including previous treatment information), assessing the child, participating in individualized education program meetings, writing goals, implementing treatment plans and recommending accommodations. Appropriate accommodations may include extra time to complete assignments and tests, preferential seating, and working in small groups or one on one with the teacher. Collaborating with teachers, staff and parents to ensure understanding of possible symptoms that will affect the child's educational performance is an important role. It is also helpful to share the child's progress and prognosis with others who work with the child, while challenging the child to achieve realistic and functional goals.
Young children who have had strokes likely have had numerous hours of speech-language treatment and occupational and physical therapy by the time they enter school. They may arrive with established goals and savvy parents who are familiar with medical and early-intervention lingo. As the child enters school, parents will need to become familiar with new jargon and acronyms associated with the Individuals With Disabilities Education Act: eligibility, triennial evaluation, IEPs and 504 plans. It's important for the child's early intervention team to work with the school-based team to create a seamless transition and continue progress.
School caseloads are filled with a wide variety of diagnoses and disabilities that school-based SLPs are prepared to handle. Keeping the focus on all aspects of speech, communication and swallowing that require speech-language services while maintaining educational momentum for our students is what we do best.