Pediatric Stroke Outcome Measure- A 2018 Update
The Pediatric Stroke Outcome Measure: A predictor of outcome following arterial ischemic stroke.
This is a review of a recently published article, The Pediatric Stroke Outcome Measure: A predictor of outcome following arterial ischemic stroke.
Pediatric Stroke Outcome Measure (PSOM) is commonly used throughout pediatric hospitals as a standardized neurologic outcome measure for pediatric stroke. The PSOM has been validated for this population, however the long-term predictive value is largely unknown. This article mentions that the “predictive value of the PSOM at 1-month after AIS has not previously been reported.” The purpose of this article was to evaluate the relationship between neurologic outcomes at 1-month post pediatric arterial ischemic stroke (AIS) as well as motor and adaptive behavior outcomes at 12-months. They also measured the PSOM at 4 time points within the first year following AIS.
This was a single-site, prospective, longitudinal observational cohort study in which children were assessed using multiple outcome measures at 4 time points- acute, 1-month, 6-month, and 12-months post AIS diagnosis. 64 participants completed this study, of which had received their first diagnosis of AIS (27 neonates, 19 preschool-aged, and 18 school-aged children). Neuroradiologists examined infarct laterality, lesion location, and vascular territory affected in participants. The PSOM was used to measure the neurological impairments. With documented interrater reliability and construct validity, the PSOM measures impairments across 5 domains: sensorimotor (left and right), expressive language, receptive language, behavior, and cognition. Parent report is used with cognitive and behavioral subdomains, where as clinician-rated observation is used to evaluate sensorimotor and language subdomains. During this study, if an experienced clinician was unable to administer the PSOM, the Recovery and Recurrence Questionnaire (RRQ) was administered at each time point. The parent administered RRQ is strongly correlated to the clinician administered PSOM. Gross motor and fine motor skills were assessed using the Bruininks Oseretsky Test of Motor Proficiency 2 (BOT-2) for children >42 months and the Bayley Scales of Infant and Toddler Development (BSID-III) for children <42 months. The Vineland Adaptive Behavior Scales (VABS) was administered to measure the child’s activity and participation across 4 domains: communication, daily living, and motor and social skills, in addition to adaptive behavior.
The PSOM total scores in each age group at each time point were calculated. The highest median score was occurred at the acute time point in both preschool-aged and school-aged group showing a trend in reduction over time as the lowest 12-month time point occurred at preschool-aged and school-aged groups. “Hierarchical regression analyses were conducted to examine age group, lesion size, and 1-month dichotomized PSOM impairment in the prediction of FM, GM, and adaptive behavior scores at 12-months”. There were significant relationships between the 1-month PSOM scores and 12-month fine motor and VABS scores across all groups. A significant relationship was found on fine motor, gross motor and VABS scores, suggesting that “children with PSOM impairment at 1-month are more likely to have a higher rate of FM, GM, and adaptive behavior impairments.”
Overall, this study suggests that neurologic outcome following pediatric AIS varies and differs depending on age at stroke onset. The study also supports the predictive value of 1-month PSOM outcomes for motor and adaptive outcomes at 12-months, primarily for older children (> 5 years old at stroke onset). Lower fine and gross motor function and adaptive abilities at 12-months was associated with neurological impairments identified by the PSOM at 1-month. Furthermore, children over 5 years old in the nonimpaired range of the PSOM at 1-month post stroke are less likely to develop gross motor or adaptive impairments at 12-months.
Article Strengths and Limitations:
In regards to strengths, this study uses multiple outcome measures and evaluated its’ participants at 4 time points during recovery post-AIS diagnosis. Another strength is that they assessed 64 children of varying age ranges and that they conducted in-depth lesion measurements for comparisons to the outcome measures.
This study recognizes that there were limitations in regards to assessing the correlation with fine motor such as: a weak but significant relationship between 1-month PSOM and fine motor outcomes. This could be due to fine motor tasks on BSID-III and BOT-2 primarily requiring unimanual ability allowing a child to complete the task using the less-affected limb. Also, this study only examined outcomes up to 12-month post pediatric AIS, which may be too early to evaluate functional outcomes in this population.
In conclusion, when used at 1-month post-AIS diagnosis, the PSOM was predictive of adaptive behavior, and fine and gross motor outcomes at 12-months.
Cooper, A. N., Anderson, V., Hearps, S., Greenham, M., Hunt, R. W., Mackay, M. T., Monagle, P., & Gordon, A. L. (2018). The Pediatric Stroke Outcome Measure: A predictor of outcome following arterial ischemic stroke. Neurology, 90(5), e365-e372.