Optimising functional recovery after paediatric stroke: Complications, non-pharmacological management and neurorehabilitative strategies: A comprehensive literature review

Paediatric stroke (PS) is an uncommon but serious medical emergency and a major cause of long-term disability in children around the world. It affects approximately 1 in 25,000 children per year, with the incidence seen more in the neonatal period. PS is different from adult stroke in both aetiology and clinical presentation. Causes can vary from congenital heart disease, cerebral arteriopathies, to vascular malformations. Clinical features vary with age, ranging from seizures and non-specific systemic symptoms in infants to focal neurological deficits in older children, and are associated with delayed diagnosis. MRI, along with vascular imaging techniques, is the preferred diagnostic modality in children due to its superior sensitivity. Neurorehabilitation is fundamental to improving functional recovery and quality of life post-PS. The heightened neuroplasticity of the developing brain highlights the importance of early, intensive, and task-oriented rehabilitation. Emerging non-pharmacological interventions are structured physical exercise, occupational and cognitive therapy, neuromuscular electrical stimulation, robotic-assisted rehabilitation, and virtual reality. This review highlights current advances in PS management with a focus on neurorehabilitation and non-pharmacological management.