Perinatal Stroke: Functional Abilities, Executive Function, and Modifiable Environmental Factors
Creators: Hammond, Leah M 
Publisher: name: University of Alberta Library
Year: 2022

<p>Background: Perinatal stroke is a vascular brain injury between the 20th gestational week and the 28th postnatal day. Perinatal stroke can lead to significant impairments to daily functional abilities and executive functions (EF: inhibition, working memory, and shifting). Longitudinal research indicates that children with perinatal stroke do not display cognitive deficits until school age, but it is unclear if deficits to EF and functional abilities also change with age. </p>

<p>Modifiable environmental factors, including use of supportive services and movement behaviors (sleep, physical activity, and screen time), may influence EF and functional outcomes for children with perinatal stroke. However, movement behaviors and access to supportive services have been disrupted for many children during the COVID-19 pandemic. Characterizing the engagement of children with perinatal stroke with these modifiable factors, both before and during the COVID-19 pandemic, offers valuable context to developmental trajectories for EF and functional abilities. </p>

<p>Objective I: To describe longitudinal changes to functional abilities and EF behaviors among children with perinatal stroke.    </p>

<p>Objective II: To describe engagement with supportive services and movement behaviors among children with perinatal stroke, before and during the COVID-19 pandemic.</p>

<p>Methods: Participants for both studies were identified through the Alberta Perinatal Stroke Project (APSP), a population-based research cohort of individuals with a confirmed diagnosis of perinatal stroke. </p>

<p>For Objective 1: Eight caregivers completed neurobehavioral ratings of their children. At baseline, their children were aged 6-16 years. Caregivers completed follow-up ratings 2.1-3.9 years later. The BRIEF2 was used as the primary measure of EF behaviors and the PEDI-CAT was used as the primary measure of functional abilities. To account for potential impacts of the COVID-19 pandemic, caregivers were also asked to rate the overall impact of the pandemic on their family.</p>

<p>For Objective 2: Thirty-four caregivers of children aged 5-19 years from the APSP completed an online survey: the Wellness Activities Questionnaire (WAQ). The WAQ asks about participation in supportive services and movement behaviors, and about the impact of COVID-19 on these activities. </p>

<p>Results I: All participants displayed reliable worsening of T scores on at least two PEDI-CAT domains. Although participants displayed clinically significant impairment on some BRIEF2 subscales, most changes to BRIEF2 T scores were unreliable. Among this sample, 75% of participants rated the pandemic as having had a negative impact on their family. </p>

<p>Results II: Before the COVID-19 pandemic, 82.4% of children with perinatal stroke had utilized at least one allied health service, while 55.9% typically received some type of educational support. Roughly half of participants indicated that access to allied health services was negatively impacted during the pandemic, whereas 73.5% indicated that access to educational supports did not change during the pandemic. Most children were meeting guidelines for daily sleep and physical activity time before the pandemic, but 63.6% were engaged in more screen time than recommended. During the COVID-19 pandemic, daily sleep and physical activity significantly decreased (p&lt;0.05) and daily recreational screen time significantly increased (p&lt;0.05). </p>

<p>Conclusions: Children with perinatal stroke displayed slowed development of functional abilities, compared to normative peers. In contrast, development of EF behaviors was more comparable to that of normative peers, as specific deficits persisted but did not worsen over time. Although pre-pandemic patterns of service use and movement behaviors likely provide robust environmental supports for functional and EF development, many of these services and routines were disrupted during the COVID-19 pandemic. It is likely that disruptions to service use and movement behaviors during the pandemic substantially impacted the longitudinal trajectories of EF behaviors and functional abilities reported here.</p>