Category: 46 Pediatric Stroke Outcome Measure

Archive for the ‘46 Pediatric Stroke Outcome Measure’ Category

Mar 15 2015

Pediatric Stroke Outcome Measure

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Mar 07 2016

Pediatric Stroke Outcome Measure

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All information was reviewed and appears up to date.


Lo, W., A. L. Gordon, C. Hajek, A. Gomes, M. Greenham, V. Anderson, K. O. Yeates, and M. T. Mackay. “Pediatric Stroke Outcome Measure: Predictor of Multiple Impairments in Childhood Stroke.” Journal of Child Neurology 29.11 (2013): 1524-530. Web.

The purpose of this study was to examine the relationship between the scores on the pediatric stroke outcome measure (PSOM) and other functional psychometric outcomes: cognitive ability, problem behavior, adaptive behavior, and social participation. 36 stroke subjects  were identified retrospectively and recruited from the Nationwide Children’s Hospital and Royal Children’s Hospital. Inclusion criteria featured 1. clinically symptomatic stroke with radiological confirmation 2. stroke occurring between birth and age 17 3. stroke occurring 1 year prior to evaluation 4. subject must be able to complete test battery. Exclusion criteria included strokes due to sickle cell disease, brain neoplasm, watershed infarcts, hydrocephalus, and genetic disorders. Subjects were then assessed with the PSOM and brain infarct volume. Furthermore, cognition and processing speed were measured with the Wechsler Abbreviated Scale of Intelligence, behavior was assessed with the Childhood Behavior Checklist, adaptive behavior was assessed with the Adaptive Behavior Assessment System II, and social participation was assessed with the Child and Adolescent Scale of Participation.

Generally, a higher total on the PSOM moderately correlated with cognitive function, behavioral problems, poorer adaptive behavior on the communication, functional academics, health & safety, and self-care sub scales, moderately to strongly correlated with Adaptive Behavior Overall, Conceptual, and Practical composite scales, and STRONGLY correlated with poor social participation. In more detail, greater impairment of the left sensorimotor, language production, and language comprehension subscales were associated with poorer Intelligence Quotient and processing speed, poorer conceptual and practical adaptive behavior, and poorer self-care adaptive behavior. Also, greater impairment on the cognitive/behavior subscale was associated with poorer outcomes in conceptual adaptive behavior and in the functional academics subdomain, but no impairment in Intelligence Quotient or problem behaviors. Finally, impaired language production and cognition was most strongly associated with poor social participation. It appears that this study contributes additional layers of information to the clinical utility of the PSOM, which can be used to help anticipate psychosocial complications in pediatric patients with stroke.





Feb 27 2017

The Pediatric Stroke Outcome Measure: A Validation and Reliability Study

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Introduction/Background: The Pediatric Stroke Outcome Measure (PSOM) is appropriate for newborn to adult age for determining stroke-specific outcomes through 115 test items in 5 functional and neurological deficit subscales including: right sensorimotor, left sensorimotor, language production, language comprehension and cognitive/behavior. The PSOM is chronologically organized across the development spectrum. For instance, primitive reflexes are included for children <2 years. Scores for each item range from 0 (no deficit) to 10 (maximum deficit), and are summed to infer the total score. Administration time for this measure is approximately 20 minutes.

 Purpose: The purpose of this study was to examine the PSOM’s construct validity in measuring neurological outcomes in pediatric stroke survivors and interrater reliability for both prospective and retrospective scoring. When using this objective measure in a prospective study, one would evaluate a like group of individuals to determine how differing factors affect rates of certain outcomes. Whereas a retrospective study would compare those with a specific impairment following pediatric stroke to those who’ve not been exposed. The study verified the PSOM is valid and reliable for pediatric stroke in both types of studies, but is especially useful in scoring prospective clinical trials.

 Methods: Children, newborn to 18 years, diagnosed with arterial ischemic stroke (AIS) or cerebral sinovenous thrombosis (CSVT), at the Hospital for Sick Children (Toronto, CA), from 1994 to 2010 were included in this study. 203 Participants were serially examined with PSOM at 3, 6 and 12 months poststroke and at 2-5 year intervals until the age of 18. QoL and standardized neuropsychological outcomes were assessed in addition to the PSOM. Construct validity (for prospective study) was evaluated against the standardized neurophysiological measures and statistically analyzed through Spearman correlation, linear regression (95% CI), and an alternative chance-corrected statistical test. PSOM scores from medical records were scored by 3 raters and compared with “live” in-clinic PSOM exams completed by those same raters. This information was statistically analyzed to determine both retrospective validity and inter-rater reliability. The range for inter-rater agreement ranged from 0.0-0.2= poor to >0.8= almost perfect.

 Results/Limitations/Conclusion: The results indicate PSOM is both valid and reliable for use in children poststroke. These findings are relevant because the PSOM is the only measure of neurological outcomes for this population and is currently being or has been used in many research studies. Construct validity proved to highlight relevant impairments in all 5 subcategories including significant correlation between the cognitive-behavioral subscale and standardized neuropsychological measures of overall intellect, verbal/perceptual reasoning and parental/behavior questionnaires. Additionally, both in-clinic and health record-based scoring was found to have excellent reliability. Some limitations of this study were not all children consented to neuropsychological testing and normally distributed statistics potentially downplayed concerns regarding referral bias. Another shortcoming is that the PSOM is likely to be biased toward motor and sensory deficits over cognitive, language and behavioral impairments. Despite these limitations, the PSOM has proven to be a strong outcome measure, both valid and reliable for prospective and retrospective studies geared towards improving pediatric poststroke outcomes.


Kitchen L, Westmacott R, Friefeld S, et al. The Pediatric Stroke Outcome Measure. Stroke. 2012;43(6):1602-1608.

Mar 08 2018

The Pediatric Stroke Outcome Measure- A 2018 Update

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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.


Article Summary:

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. Neurology90(5), e365-e372.