Subacute Rehabilitation Outcomes in Childhood Stroke: Clinical metrics and neural mechanisms
This PhD project will be based at the University of Toronto with a 12-24 month stay at the University of Melbourne.
Speech, Language and Swallowing Outcomes in Childhood Stroke
Background: Pediatric stroke is a leading cause of mortality and long-term morbidity. Significant progress has been made in understanding outcomes of pediatric stroke in the last two decades. Long-term adverse outcome from pediatric acute ischaemic stroke include learning, academic and psychosocial impairments. Yet to date, there has been limited investigation specific to speech, language and swallowing outcomes in paediatric stroke. Only two studies, conducted by our respective teams in Toronto and Melbourne, have reported on the acute presentation of these disorders. Swallowing, speech (dysarthria) and language impairment are reported in as many as half to two thirds of children with stroke and are known to adversely affect overall stroke outcome and quality of life. Further, little is known about these impairments during the acute presentation and their eventual outcomes over the subacute course of rehabilitation. As a result, innovation in treatment is rare and long-term difficulties persist across motor, cognitive, communication, and behavioural domains of function that negatively impact participation and quality of life.
Objectives: Our aim is to understand the clinical and neural course of sub-acute recovery for swallowing (dysphagia), speech (dysarthria and apraxia) and language impairment in children with stroke to inform future innovation of novel treatments. Our work will establish an international Toronto-Melbourne stroke cluster of excellence with future projects planned to examine cognitive, fine- and gross-motor clinical and neural outcomes as well as clinical trials of neuromodulation enhanced rehabilitation informed by our early work.
Specific aims (SA) are to:
1) identify the frequency of swallowing, speech and language impairment upon admission to, and discharge from, intensive paediatric stroke rehabilitation programs;
2) examine how swallowing, speech and language clinical function changes over the course of treatment;
3) identify the neural mechanisms associated with these functional changes.
In line with our objectives, the doctoral student will complete 3 projects investigating swallowing, speech and language impairment in children (term newborns of 37 weeks, to 18 years) diagnosed with stroke by a neurologist and participating in rehabilitation programming during the sub-acute time period.
Eligible patients admitted to the sub-acute paediatric rehabilitation programs at the Bloorview Research Institute in Toronto and Royal Children’s Hospital in Melbourne will be enrolled in all studies.
Study 1 (Aim 1). Assess swallowing, speech and language impairments within one week of admission to the rehabilitation program, within one week of discharge of the program and at 3-months post discharge.
Study 2 (Aim 2). Examine functional change scores in swallowing, speech and language skills.
Study 3 (Aim 3). All participants will undergo brain magnetic resonance imaging within 1 week of admission, discharge and at the 3-month follow-up. Quantitative imaging methods will measure structural changes across the relevant neural networks in cortical and subcortical grey and white matter. Functional changes in relevant neural networks will be tracked via simple task-based functional MRI designs.
Expected Outcomes: This research will yield important novel findings related to swallowing, speech and language impairment recovery in the sub-acute stage of paediatric stroke rehabilitation across clinical and neural levels thus informing future innovation of novel neurorehabilitation treatments.
A/Prof Deryk S Beal, Mahendranath Moharir (University of Toronto)
How to Apply