Effects of Early Childhood Strokes - Research Paper Example

1 2. The effects, lasting and non-lasting, of early childhood strokes The increase of the rate of stroke among infants and children, as a common phenomenon in the last decade, has led to the development of research on the potential effects of stroke on this part of the population, both in the short and the long term. As a health problem, stroke has been related to a series of factors, including genes, family environment but also specific health issues, such as lack of appropriate dental care (Ceglarek 21). Even if the causes of stroke in infants and children have been identified, almost precisely, still it seems to be quite difficult for the specific health problem to be effectively controlled. The lasting and non-lasting effects of early childhood strokes are presented and evaluated in this paper. Efforts have been made to focus on the cases of children aged up to 10 years; however, the empirical studies developed in regard to this subject has been rather generic, not focusing to specific parts of children population, but referring to children in general. The literature published on the specific field, as analyzed below, proves that these effects can vary in accordance with a series of criteria and conditions. The assumptions developed in the empirical research regarding these effects are critically discussed aiming to show that the development of preventive measures regarding early childhood strokes would be preferable than the effective intervention at a later stage, i.e. after the occurrence of the particular health problem, mostly since the lasting and non-lasting effects of stroke during the specific period of human life, meaning the early childhood, can be quite severe. In accordance with Aminoff, the chances for a child to face a stroke are not so high; it is explained that in a relevant research, the rate of stroke in childhood has been found to be ‘between 2.5 and 8 per 100,000’ (Aminoff 67). However, Chau, Chen and Wei (2011) claim that the rate of stroke among infants is higher; in accordance with the findings of their research, strokes are likely to appear at approximately 26 out of 100,000 infants annually. The identification of the lasting and non-lasting effects of strokes in childhood becomes emergent, taking into consideration the above figures. The findings of the research of Christerson and Stromberg (2010) further verify the view that the rate of stroke among infants is low. In the empirical study developed by the above researchers was proved that the rate of stroke among infants is approximately ‘1.8 per 100,000 children’ (Christerson and Stromberg 1641). Christerson and Stromberg (2010) tried to identify the effects, especially the short term ones, of stroke on children. Among the 51 cases reviewed, a percentage of 4% was led to a fatal outcome, i.e. the stroke led to the death of the children. The above effect has been immediate, i.e. the death occurred during the acute phase. A high percentage of children, approximately 82% had to face ‘a neurological dysfunction’ (Christerson and Stromberg 1641). At this point, it should be mentioned that the above research (the one of Christerson and Stromberg) took place in Sweden, a fact that could possibly lead to the assumption that the low rate of stroke incidents among children may be related to regional or environmental factors. It should be also noted that the average age of children participated in the study was 13 years. Usually, stroke is related to long-term heart problems, especially those that have been faced through surgery (Aminoff 67). Of particular importance are the methods used for controlling stroke in infants and children, having in mind that the reduction of the rate of strokes in childhood would be followed by the decrease of mortality and of severe health problems not only of children but also of adults, referring to the case that a child has survived from a stroke but has to cooperate with the effects of the stroke for the rest of his/ her life. It is for this reason that scientists have focused on the development of both ‘preventive and rescue strategies’ (Aminoff 67) for controlling the strokes among children. During the early childhood, strokes are likely to result to a series of severe health problems, both lasting and non-lasting. In accordance with Coffey, Brumback and Rosenberg, one of the key characteristics of childhood strokes is the development of unilateral lesions (Coffey, Brumback and Rosenberg 390). It is explained that the term ‘unilateral lesion’ in the above case focuses on the damages caused on the central nervous system, which is still immature (Coffey, Brumback and Rosenberg 390). In this context, strokes in children are likely to lead to damages, more or less severe, on the communication or the cognitive ability, meaning the ability to speak, to see or use one of the other senses, as these functions are depended on the condition of the brain. Reference should be also made to the behavioural sequences of strokes for children. The empirical research has proved that different effects exist in strokes in accordance with the side of the brain, which has been affected, by the stroke. More specifically, in adults that have suffered a stroke in the left side of the brain, difficulties have been reported in speaking and developing calculations (Coffey, Brumback and Rosenberg 390). On the other hand, strokes related to the right side of the brain usually result to difficulties in attention and communication (Coffey, Brumback and Rosenberg 390). Similar results have been reported in the case of strokes in children. Additionally, in children strokes seem to cause long – term behavioural problems, such as ‘social interaction, attention and arithmetic’ (Coffey, Brumback and Rosenberg 390). In other words, the above research promotes the idea that strokes can have similar effects to adults and children, a view which seems to be verified by other empirical studies, as explained below. In the study of Slentz and Krogh (2001) emphasis is given on the relationship between specific events and a series of ‘early childhood developmental problems’ (Slentz and Krogh 25). In accordance with the above researchers, the risk of a stroke exists both during the prenatal and the perinatal periods. In the prenatal period, the stroke of the infant can be resulted because of a trauma caused to the mother (by accident or intentionally, as for example in the case of the mother’s abuse) (Slentz and Krogh 25). As for the stroke during the perinatal period, this can be also resulted because of ‘trauma or oxygen deprivation’ (Slentz and Krogh 25). On the other hand, Huttenhlocher suggests that the effects of strokes that are ‘past of the age of acquisition of language’ (Huttenhlocher 135) are different from those of adults. The specific view has been based on the findings of the research developed by Basser (1962) but also that of Woods and Teuber (1978). In accordance with the results of the above empirical studies, the effects of right hemisphere lesions can be more severe to children compared to adults. More specifically, in children these lesions can lead to severe language problems, while in adults such symptoms are limited when a stroke occurs in the right hemisphere of the brain (Huttenhlocher 135). Moreover, the above studies showed that the effects of a right hemisphere stroke can be more severe for children between 2 and 3 years, compared to elder children. The effects of stroke on infants would be also examined using appropriate literature. From another point of view, Skuse notes that the level and the duration of the effects of stroke are likely to be differentiated in accordance with the child’s age. It is explained that younger children are expected to be more vulnerable to injuries (Skuse 105). At the same time, the type of the injury is also a critical factor in order to decide both the level of the damage caused and its potential duration, in other words to decide whether the effects of the brain injury will last or not (Skuse 105). It is made clear that the above two factors, i.e. the vulnerability to injury and the type of the injury can influence the type and the duration of the effects of strokes in both the prenatal and the post-natal period (Skuse 105). In this context, ‘children that have suffered just focal injury are likely to recover rather quickly’ (Skuse 105), compared to children that have suffered a ‘diffuse damage, as in the case of radiotherapy’ (Skuse 105). Referring especially to the type and the duration of the stroke’s effects, Skuse notes that these effects can be categorized as follows: a) those effects that are directly related to the head injury, for instance tumours, and b) those indirectly related to the head injury; these effects are usually related to the methods used by parents and professionals for managing the problem but also the reaction of each children to the injury (Skuse 105). In this way, it is possible for a child that suffered a stroke to face problems of mobility while another child with the same health problem may not have to face such issue. A difference in the time of the appearance of the effects of strokes is also possible among children, taking into consideration their living environment, their access to health facilities and other similar factors. A different view regarding the type and the duration of stroke’s effects during childhood is presented in the study of Benson and Haith (2009). The above researchers note that after birth all the regions of the brain are activated and are engaged into specific activities (Benson and Haith 76). If these activities are cancelled or delayed because one or more of these regions become inactive, for instance because of a stroke, then ‘an alternate organization and developmental time course’ (Benson and Haith 76) could result. In this context, the effects of stroke are expected to be similar after birth, no matter the time point that stroke occurs. From this point of view, a stroke would have similar effects on children as on adults, with the difference that a stroke in the childhood would affect the rest of the life of the child, while in adulthood, the duration of the effects would be differentiated, especially in case that the stroke occurs late in life. The effects of strokes in infants have been set under examination by Schlager et al (2011). The above researchers focused on the effects of perinatal brain damage and came to the following conclusion: strokes in the perinatal period can result to ‘cognitive deficits and motor disabilities’ (Schlager et al. 67) but only in ‘preterm infants’ (Schlager et al. 67). On the other hand, it has been proved that the ‘treatment protocol’ (Schlager et al. 67) used for treating the stroke can heavily impact the type and the duration of the stroke’s effects, meaning both the lasting and non-lasting effects. Govaert et al. (2008) focused on the potential effects of stroke on infants. They found that in infants aged between 2 and 6 days, a stroke can result to a secondary injury within a short period of time. For this reason, the first incident needs to be treated appropriately for avoiding the exposure of the infant to a more severe stroke (Govaert et al. 2008). It is also explained that at a first place, a stroke in infants is likely to affect their ‘cortical targets and/or their connecting axons’ (Govaert et al. 1850). Most of the studies developed in the particular field, lead to the assumption that the key effect of stroke in children is the development of functional problems. For example, the research developed by Galvin et al. (2011) showed that stroke in children affects their functional abilities, especially their mobility, and their potentials for self-care (Galvin et al. 67); these effects have been reported at least for 3 months after the stroke. As a result, children that have suffered a stroke are likely to need assistance in their self-care, a phenomenon common in adults that suffer from the same health problem. An important aspect of stroke in childhood has been examined in the study of Gardner et al. (2010). The above researchers tried to identify the financial aspects of stroke in infants and children and found that in the context of a 5-year treatment of stroke, the following funds are required: ‘$51,719 for neonatal stroke and $135,161 for childhood stroke’ (Gardner et al. 372). Not all families are expected to be able to respond to the financial demands of stroke, a fact that leads to the following assumption: not all children who face a stroke have access to appropriate treatment. From the same point of view, Lo et al. (2008) note that the cost of the treatment of stroke is quite high, a fact that leads to the assumption that cost is a factor influencing the development of the specific health problem, since there is no potential for appropriate treatment. In accordance with the issues discussed above, the effects of stroke in childhood can vary under the influence of a series of factors. In any case, a significant gap seems to exist in the empirical research developed in this field: despite the fact that the causes, the treatment and the effects of stroke have been reviewed by researchers worldwide, still the relationship between stroke and childhood has not been adequately explored, especially in regard to the lasting and non-lasting effects of stroke on children. Also, the existing literature regarding the type and the duration of effects of stroke on infants is quite limited, possibly because of the lack of empirical evidence related to the particular issue. The literature published in this field, as presented above, leads to the following assumption: the effects of stroke on infants need to be treated appropriately early, otherwise a secondary injury is likely to appear. In children a similar practice needs to be followed; however, children are less vulnerable to stroke than infants so they can face the effects of stroke more effectively, as indicated in the results of the empirical studies presented above. In regard to their type, the effects of stroke on infants and children seems to be related to specific functions, such as mobility, self-care and communication. As of their duration, these effects are more likely to be short term; however, the long-term effects of stroke in childhood cannot be ignored, since these effects are more likely to affect the children’s life in the long term, meaning especially the socialization of children and their cognitive abilities. As proved through the studies presented above, both the type and the duration of the effects of stroke in childhood are not standardized, being depended on the reaction of each child to the stroke and the support provided by the family. Works Cited Aminoff, Michael. Neurology and general medicine. Cambridge: Elsevier Health Sciences, 2008. Benson, Janette and Marshall, Haith. Language, Memory, and Cognition in Infancy and Early Childhood. New York: Academic Press, 2009. Chau M, Chen D, Wei L. “Erythropoietin attenuates inflammatory factors and cell death in neonatal rats with intracerebral hemorrhage.” Acta Neurochirurgica Supplement. 111( 2011): 299-305. Christerson S, Stromberg B. “Childhood stroke in Sweden I: incidence, symptoms, risk factors and short-term outcome.” Acta Paediatrica 99.11( 2010): 1641-9. Coffey, Edward, Brumback, Roger and David, Rosenberg. Pediatric neuropsychiatry. London: Lippincott Williams & Wilkins, 2006. 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Lo W, Zamel K, Ponnappa K, Allen A, Chisolm D, Tang M, Kerlin B, Yeates K. “The cost of pediatric stroke care and rehabilitation.” Stroke. 39.1(2008): 161-5. Schlager GW, Griesmaier E, Wegleiter K, Neubauer V, Urbanek M, Kiechl-Kohlendorfer U, Felderhoff-Mueser U, Keller M. “Systemic G-CSF treatment does not improve long-term outcomes after neonatal hypoxic-ischaemic brain injury.” Experimental Neurology. 230.1(2011): 67-74. Skuse, David. Child Psychology and Psychiatry: An Introduction. Oxford: The Medicine Publishing Company, 2003. Slentz, Kristine and Suzanne, Krogh. Early childhood development and its variations. London: Routledge, 2001. Read More