Effects of Perinatal Stroke on Executive Functioning in Children

• Author / Creator

  Li, Wan Qing

• Background: Individuals with childhood stroke often experience neurological injury that manifests as lifelong cognitive and behavioural impairment; however, research is scarce regarding the neurobehavioural outcomes of children with perinatal stroke. One important aspect of neurobehavioural functioning and cognitive development is executive functioning (EF). EF is predictive of functional life outcomes across many domains, of which include social and cognitive development, and behavioural, emotional, and mental health. EF is poorly understood in the childhood stroke population, and particularly in those with perinatal stroke (which occurs during pregnancy or within the first month after birth).
  Goals: The objectives of this research project were to: 1) elucidate the EF profiles of children with perinatal stroke from a cool and hot EF model, and 2) describe the association between demographic and clinical factors associated with EF outcomes following stroke.
  Participants: Eighteen children aged 6-16 with a diagnosis of perinatal stroke were recruited through the Alberta Perinatal Stroke Project (APSP) in Edmonton, Alberta. Participants were identified through the IRB-approved APSP stroke registry or by patient care clinics of pediatric neurologists.
  Method: Children underwent a neurobehavioural assessment, which was a measure of cool EF outcomes. Parents/guardians completed behavioural rating measures regarding their child’s EF in real-life situations, which was a measure of hot EF outcomes. Additionally, parents/guardians also filled out questionnaires that captured the child’s demographic background (age, sex, ethnicity, and family socioeconomic status) as well as medical characteristics (lesion size, lesion location, epilepsy presence).
  Results: On measures of cool EF, children with perinatal stroke were more impaired than the normative sample on almost all measures, including Animal Sorting, Response Set, Design Fluency, and Inhibition-Naming, Inhibition-Inhibition, and Inhibition-Switching (all p < 0.05). Auditory Attention was not significantly impaired in the perinatal stroke group. With regards to measures of hot EF, children with perinatal stroke were rated as significantly more impaired than the normative sample on domains of Shift, Working Memory, Task-Monitoring, Organization/Planning, and the Cognitive Regulation Index (all p < 0.05). Male children and children with a history of epilepsy demonstrated worse performance on several cool EF measures; age did not have a significant impact. At the group level, children with perinatal stroke performed within the low-average range on measures of global intellectual functioning (IQ), which was significantly lower than the normative population. Additionally, children with perinatal stroke who had a global IQ score in the below-average range had significantly worse EF outcomes than those with global IQ scores in the average range.
  Conclusions: Children with perinatal stroke demonstrated significantly more deficits than the normative population on measures of cool and hot EF. Additionally, children who were male and/or had comorbid epilepsy had more impairments in cool EF domains.

• Subjects / Keywords

  • neurobehavioural outcomes
  • perinatal stroke
  • children
  • executive functioning

• Graduation date

  Fall 2018

• Type of Item

  Thesis

• Degree

  Master of Education

• DOI

  https://doi.org/10.7939/R3RX93V96

• License

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