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Cognitive Functioning, Behavior, and Quality of Life After Stroke in Childhood

机译：儿童中风后的认知功能，行为和生活质量

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摘要

Rationale: To provide a better understanding of cognitive functioning, motor outcome, behavior and quality of life after childhood stroke and to study the relationship between variables expected to influence rehabilitation and outcome (age at stroke, time elapsed since stroke, lateralization, location and size of lesion). Methods: Children who suffered from stroke between birth and their eighteenth year of life underwent an assessment consisting of cognitive tests (WISC-III, WAIS-R, K-ABC, TAP, Rey-Figure, German Version of the CVLT) and questionnaires (Conner's Scales, KIDSCREEN). Results: Twenty-one patients after stroke in childhood (15 males, mean 11;11 years, SD 4;3, range 6;10-21;2) participated in the study. Mean Intelligence Quotients (IQ) were situated within the normal range (mean Full Scale IQ 96.5, range IQ 79-129). However, significantly more patients showed deficits in various cognitive domains than expected from a healthy population (Performance IQ p = .000; Digit Span p = .000, Arithmetic's p = .007, Divided Attention p = .028, Alertness p = .002). Verbal IQ was significantly better than Performance IQ in 13 of 17 patients, independent of the hemispheric side of lesion. Symptoms of ADHD occurred more often in the patients' sample than in a healthy population (learning difficulties/inattention p = .000; impulsivity/hyperactivity p = .006; psychosomatics p = .006). Certain aspects of quality of life were reduced (autonomy p = .003; parents' relation p = .003; social acceptance p = .037). Three patients had a right-sided hemiparesis, mean values of motor functions of the other patients were slightly impaired (sequential finger movements p = .000, hand alternation p = .001, foot tapping p = .043). In patients without hemiparesis, there was no relation between the lateralization of lesion and motor outcome. Lesion that occurred in the midst of childhood (5-10 years) led to better cognitive outcome than lesion in the very early (0-5 years) or late childhood (10-18 years). Other variables such as presence of seizure, elapsed time since stroke and size of lesion had a small to no impact on prognosis. Conclusion: Moderate cognitive and motor deficits, behavioral problems, and impairment in some aspects of quality of life frequently remain after stroke in childhood. Visuospatial functions are more often reduced than verbal functions, independent of the hemispheric side of lesion. This indicates a functional superiority of verbal skills compared to visuospatial skills in the process of recovery after brain injury. Compared to the cognitive outcome following stroke in adults, cognitive sequelae after childhood stroke do indicate neither the lateralization nor the location of the lesion focus. Age at stroke seems to be the only determining factor influencing cognitive outcome.
机译：理由：为了更好地理解儿童中风后的认知功能，运动结果，行为和生活质量，并研究预期影响康复和结果的变量之间的关系（中风年龄，中风后经过的时间，偏侧，位置和大小病变）。方法：出生至十八岁之间患有中风的儿童接受了一项包括认知测验（WISC-III，WAIS-R，K-ABC，TAP，Rey-Figure，CVLT的德语版）和问卷调查的评估（ Conner的秤，KIDSCREEN）。结果：21名儿童中风后患者（15名男性，平均11; 11岁，SD 4; 3，范围6; 10-21; 2）参加了研究。平均智商（IQ）处于正常范围内（平均智商96.5，智商79-129）。但是，与健康人群相比，在各个认知领域的缺陷明显多于预期（性能智商p = .000；数字跨度p = .000，算术p = .007，分散注意力p = .028，警觉性p = .002 ）。在17例患者中，有13例患者的言语智商明显优于绩效智商，而与病变的半球侧无关。患者样本中多动症的症状多于健康人群（学习困难/注意力不集中p = .000；冲动性/多动性p = .006；心身疾病p = .006）。生活质量的某些方面有所降低（自主权p = .003；父母关系p = .003；社会接受度p = .037）。三例患者出现右侧偏瘫，其他患者的运动功能平均值稍有受损（顺序手指运动p = .000，手交替p = .001，轻拍p = .043）。在没有偏瘫的患者中，病灶的侧偏与运动预后之间没有关系。与儿童早期（0-5岁）或儿童晚期（10-18岁）相比，儿童期（5-10岁）发生的病变导致更好的认知结果。其他变量，例如癫痫发作的存在，自中风以来的经过时间和病变的大小对预后影响很小甚至没有影响。结论：儿童中风后经常存在中等程度的认知和运动缺陷，行为问题以及生活质量某些方面的障碍。独立于病变的半球侧，视觉空间功能通常比言语功能减少。这表明在脑损伤后的恢复过程中，与视觉空间技能相比，语言技能在功能上具有优势。与成人中风后的认知结果相比，儿童中风后的认知后遗症确实没有表明病灶的侧偏和位置。中风年龄似乎是影响认知结果的唯一决定性因素。

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  • 来源
    《Child Neuropsychology》 |2008年第4期|323-338|共16页
  • 作者

    Regula Everts; Julia Pavlovic; Franz Kaufmann; Birgit Uhlenberg; Ulrich Seidel; Krassen Nedeltchev; Walter Perrig; Maja Steinlin;

  • 作者单位

    Division of Neuropediatrics, University Children's Hospital Inselspital, University of Bern, Switzerland;

    Division of Neuropediatrics, University Children's Hospital Inselspital, University of Bern, Switzerland;

    Division of Neuropediatrics, University Children's Hospital Inselspital, University of Bern, Switzerland;

    Division of Neuropediatrics, University Children's Hospital, Charit, Berlin, Germany;

    Division of Neuropediatrics, University Children's Hospital, Charit, Berlin, Germany;

    Institute of Diagnostic and Interventional Neuroradiology, University Hospital Inselspital, University of Bern, Switzerland;

    Institute of Psychology, University of Bern, Switzerland;

    Division of Neuropediatrics, University Children's Hospital Inselspital, University of Bern, Switzerland;

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  • 正文语种 eng
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  • 关键词

    Cognitive functioning; Behavior; Quality of life; Pediatric stroke;

    机译：认知功能;行为;生活质量;小儿中风;

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