Subacute Rehabilitation Outcomes in Childhood Stroke: Clinical metrics and neural mechanisms

2 minute read

The deadly bacterium Coxiella burnetii injects proteins called effectors into its host to help spread disease. This project seeks to examine how these effector proteins interact with each other so that we may better understand how this pathogen causes sickness.

The goals of this project are to:

Use a systems-based approach to define physical interactions between important effector proteins.
Determine the role these interactions play during infection.
Use cell biology and biochemical approaches to decipher the function of interacting effectors.

The details

Pediatric (childhood) stroke is a leading cause of mortality and long-term morbidity. Our understanding of the outcomes of childhood stroke has improved significantly in the last 20 years. We know of several adverse long-term outcomes, including learning, academic and psychosocial impairments. Yet to date, research into the impact of a stroke on a child's speech, language and swallowing are limited. Only two studies, both conducted by our teams at Toronto and Melbourne, have reported on the acute presentation of these disorders. Half to two-thirds of children with stroke have reported swallowing, speech (dysarthria) and language impairment. These impairments go onto negatively affect the overall stroke outcome and quality of life. Furthermore, we don't know much about these impairments during the acute presentation and their eventual outcomes over the subacute course of rehabilitation. As a result, innovation in treatment is rare. Long-term difficulties surrounding a child's motor, cognitive, communication, and behavioural functions also persist. Ultimately, participation and quality of life are negatively impacted by these outcomes.

In this project, we aim to better understand the clinical and neural course of sub-acute recovery for swallowing (dysphagia), speech (dysarthria and apraxia) and language impairment in children. The findings of the project will greatly assist in the development of new rehabilitation treatments for childhood stroke.

How will we conduct our research?

Three studies will be completed as a part of this project. The studies will investigate swallowing, speech and language impairment respectively. The participants of our studies are children (term newborns of 37 weeks, to 18 years) diagnosed with stroke by a neurologist and participating in rehabilitation programming during the sub-acute period. Our participants will come from the Bloorview Research Institute in Toronto and Royal Children's Hospital in Melbourne.

Study 1 (Aim 1). Assess swallowing, speech and language impairments within one week of admission to the rehabilitation program, within one week of discharge of the program and at 3-months post-discharge.

Study 2 (Aim 2). Examine functional change scores in swallowing, speech and language skills.

Study 3 (Aim 3). All participants will undergo brain magnetic resonance imaging within 1 week of admission, discharge and at the 3-month follow-up.

Quantitative imaging methods will measure structural changes across the relevant neural networks in cortical and subcortical grey and white matter. Functional changes in relevant neural networks will be tracked via simple task-based functional MRI designs.