The National Center for Evidence-Based Practice
in Communication Disorders
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Summary of Clinical Practice Guideline

Royal College of Physicians; The Stoke Association; Different Stokes; Boehringer Ingelheim, Merck Sharp & Dohme; Sanofi-Synthelabo & Bristol-Myers Squibb; The Haymills Charitable Trust

Stroke in Childhood: Clinical Guidelines for Diagnosis, Management, and Rehabilitation
Ganesan, V., Chong, K., et al. (2004).
London (United Kingdom): Royal College of Physicians, 82 pages.

AGREE Rating: Highly Recommended

Description:
This guideline addresses the diagnosis, investigation, and acute and long-term management of stroke in children. The guidelines are intended for professionals involved in pediatric health care, neurology, education, and social services. Recommendations are graded A, B, C, D, or "Good Practice Point" based on the strength of supporting evidence.

  • Grade A recommendations are based on evidence from systematic reviews and meta-analyses of randomized controlled trials that are directly relevant to the population.

  • Grade B recommendations include high quality case control or cohort studies or high quality systematic reviews of those studies that are directly applicable to the population, or recommendations extrapolated from Grade A evidence.

  • Grade C recommendations include well conducted case control or cohort studies or recommendations extrapolated from Grade B evidence.

  • Grade D recommendations are based on evidence from non-analytic studies or expert opinion or recommendations extrapolated from Grade C evidence.

  • Good Practice Points are recommendations based on the clinical experience of the guideline development group.

Recommendations:

Pediatric Dysphagia
  • Assessment/Diagnosis/Screening

    • Assessment Considerations

      • As soon as possible after admission, children should have an evaluation including, but not limited to, the following domains: swallowing safety (Grade D Evidence), feeding and nutrition (Good Practice Point), and communication (Good Practice Point).
Social Communication Disorders
  • Assessment/Diagnosis/Screening

    • Assessment Areas

      • Cognition/Language

        • "The medical, social, emotional and educational needs of the child affected by stroke should be considered early and systematically assessed in a co-ordinated manner when planning their subsequent care" (Level D Evidence) (p.  16).
Stroke
  • Assessment/Diagnosis/Screening

    • Assessment Areas

      • Hearing

        • “Vision and hearing should be assessed as part of the multidisciplinary assessment” (Good Practice Point) (p. 36).

      • Speech and Language

        • As soon as possible after admission, children should have an evaluation including, but not limited to, the following domains: swallowing safety (Grade D Evidence), feeding and nutrition (Good Practice Point), and communication (Good Practice Point).

        • “A detailed assessment of the child’s communication abilities should be carried out in collaboration with the child, parents/carers, teachers and other therapists to identify the child’s strengths and weaknesses and plan intervention that aims to increase functional abilities” (Grade D Evidence) (p. 38).

      • Swallowing

        • As soon as possible after admission, children should have an evaluation including, but not limited to, the following domains: swallowing safety (Grade D Evidence), feeding and nutrition (Good Practice Point), and communication (Good Practice Point).

Keywords:
Stroke

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