Children and Stroke

It is a myth that stroke occurs only in elderly individuals. Although less common, infants and children can be affected with stroke.

How common are strokes in children?

Stroke occurs in about 1 in every 4000 live births across the world. Population based statistics are not available for India, however, stroke is one of the leading causes of disability and death in children as well. About 50%-80% of children with stroke are left with permanent neurological deficits such as paralysis of arm, leg, cognitive impairment, speech disturbance, etc

What are the causes of stroke in children?

The risk factors for stroke in children are different from those in adults. Common risk factors include

• Heart disease
• Dehydration
• Head and Neck infections
• Trauma
• Moyamoya disease
• Systemic conditions such as inflammatory bowel disease
• Maternal infection in the fluid around the fetus
• Premature rupture of membranes during pregnancy
• Pregnancy related high blood pressure

What are the effects of strokes in children?

• Sudden onset of severe, progressive headache 
• Eye movement problems or complete or partial loss of vision 
• Sudden numbness or weakness in the face, arm or leg (especially on one side of the body) 
• Difficulty speaking or understanding words or simple sentences
• Difficulty swallowing 
• Dizziness, loss of balance or lack of coordination 
• Loss of emotional control and changes in mood.
• loss of consciousness, seizures 
• Sudden inability to move part of the body (paralysis)
• Behavior changes or personality changes, improper language or actions.

Will my child get better?

• Prompt identification, treatment of complications and prevention of another stroke is the cornerstone of treatment of a child with stroke. The clot busting drug tPA is not generally recommended in children as its efficacy has not been studied in this population.
• Recovery from stroke is different with each child.
• In general, most young people will recover more abilities than older people will. 
• Children often recover the use of their arms and legs and their ability to speak after a stroke.

List of specialists involved in management of a child with stroke

• Pediatrician - a child health specialist, can often help coordinate multiple issues with child’s general health
• Rehabilitation Specialists -  includes doctors such as physiatrists and pediatricians with expertise in child rehabilitation
• Speech Language Therapist - for assessment and help with speech or language challenges
• Neuropsychologist - for assessment and help with learning and education needs
• Psychologist -  can assist with the psychological stresses in both child and family that are common in child stroke
• Orthopedic Surgeon - expert in the “mechanical” complications of stroke such as tightness in the arm or leg that might be helped by surgery
• Hematologist -  a blood specialist who helps with testing for blood clotting disorders or occasional rare causes of stroke in children
• Neonatologist -  a pediatrician expert in newborn care is usually involved early in the care of children diagnosed with acute neonatal strokes
• Neurosurgeon - occasionally involved when certain types of stroke can be helped with surgical procedures

Stroke Support India - Supporting Stroke Survivors and Caregivers....

Stroke Support India - Supporting Stroke Survivors and Caregivers....

What is EMRI (Emergency Management and Research Institute)?

GVK EMRI (Emergency Medical Research  Institute) is a non-profit organization providing emergency medical services in India and operating and operating under a Public Private Partnership mode (PPP).

EMRI handles medical, police and fire emergencies through the “1-0-8 Emergency Service". This is a free service delivered through well organized emergency call response centers and staffed by well trained paramedical personnel that are able to dispatch over 2600 ambulances across Andhra Pradesh, Gujarat, Uttarakhand, Himachal Pradesh, Chhattisgarh, Goa, Chennai, Rajasthan, Karnataka, Assam, Meghalaya, Madhya Pradesh, Daman & Diu and Dadra & Nagar Haveli. Beginning in 2005 in Hyderabad, EMRI has become the world's largest integrated Emergency Response Services (ERS) Provider serving 40% of India's population across 12 states and two Union Territories. EMRI has signed memorandums of understanding (MOU) with over 6800 hospitals, which have agreed to provide initial stabilization of EMRI transported patients free of cost for the first 24 hours. In some other states (Rajasthan, Bihar, Punjab, and Trivandrum), Ziqitza has been contracted by the government to operate the 1-0-8 emergency service.

Each ambulance is staffed by a trained EMT (Emergency Medical Technician) who provides pre–hospital care while transporting the patient to a hospital for stabilization. If required, the EMT is able to communicate (via cell phone) with the in house ERCP (Emergency Response Care Physician) who is a qualified medical practitioner, available 24/7 to support the EMT as and when required.

When an emergency is reported through 108, the paramedic, who answers the call, gathers the needed basic information and dispatches appropriate services. Basic information obtained includes:

• Where the call is placed from (district/taluka/city/town/exact location/landmark)
• The type of emergency
• Number of people injured and the condition of the injured
• The caller's name and contact number – for location guidance if required

Emergency help dispatched through this process is expected to reach the site of the emergency in an average of 18 minutes. Pre-hospital care will be given to patients being transported to the nearest hospital.

Ziqitza 108 Emergency Response Service operates in the following states

Apps for Stroke survivors - Apps for Aphasia

Stroke survivors might face difficulties in their day-to-day life because of deficits in speech, memory, etc. There are a number of apple/android apps that are designed to assist stroke survivors in carrying their daily activities and have proven to be very useful. In this post, we discuss some of the common apps that help patients with aphasia (speech difficulty). These apps may be downloaded on iPad/Tablet/Smartphone and help in generating speech, converting text to speech, virtual keyboards, pictures, symbols and video.

Augmentative and Alternative Communication (AAC) is the term used to describe a set of tools and strategies that an individual uses to solve everyday communication challenges. Communication can be in the form of speech, glance, text, gestures, facial expressions, touch, sign language, symbols, pictures, speech-generating devices, etc


Free Apps

• Vox4all® - Android/Apple - is an augmentative and alternative communication (AAC) system for tablets and smartphones. Aims to give voice to those who cannot speak, bridging communication barriers. Using a system of symbols, images, synthesis and voice recording, you can create and configure an environment totally adapted to each user. Available in four languages - English, Spanish, Portuguese, Portuguese.
• Aac Talking Tabs - Android - Uses pictures & symbols-Tap and talk or build phrases. You can create tables or tales and books as well.
• Voice4u - Android/Apple - is an simple application that consists numerous of fun and memorable images that can help assist and improve language. There are over 170 icons consisting of pictures with it’s corresponding word. The icons are included with clear, easy-to-listen audios.
• JABtalk - Android - is a free speech communication application designed to help non-verbal children and adults communicate.
• TapToTalk - Android/Apple -  makes communication fun, like another “game” on on an iPad/Tablet. Just tap a picture and TapToTalk speaks. Each picture can lead to another screen of pictures 
• SmallTalk - Android/Apple - The SmallTalk™ Family of Communication apps are FREE and offer users extreme portability for practicing speech and communicating on the go
• Dragon Dictation - Android/Apple - Can be used as a therapy device for articulation (feedback on intelligibility) or for people with writing impairment (i.e speech to text)

Paid Apps

• Proloquo2Go ($190) - Apple - It provides natural sounding text-to-speech voices (American, British, and Indian English), high-resolution symbols, automatic conjugations, a default vocabulary of over 7000 items, word prediction, expandability, and accepts your own pictures.
• RocketKeys ($160) - Apple - customizable talking keyboard. This app lets you build the keyboard by choosing the exact keys, size, layout, colors, prediction, and voices you want.
• MyTalk Tools ($49.99) - Android/Apple -  helps people with communication difficulties say what they want with sequences of words, sounds and images. You choose the content (simple grids or boards with bold images) and play recorded
• TalkTablet - Android/Apple - for people who have difficulty communicating as a result of autism, aphasia, Down Syndrome, stroke, laryngectomy or any other condition that affects a persons ability to communicate effectively.TalkTablet is the only fully featured AAC speech solution that is compatible with Apple iOS, Android and Kindle handheld and tablet devices.
• Assistive Express ($25) - Apple - is designed to be simple and efficient, allowing users to express their views and thoughts at the most express manner, with natural sounding voices.

There are many more apps available depending upon the need of patients. For a complete list of apps, click on the links below

http://www.stroke.org/sites/default/files/resources/iHOPE-Aphasia-Apps-List.pdf

http://www.stroke.org/stroke-resources/resource-library/aphasia-apps

Stroke burden and prevention

Feedback Survey

Dear All,
              It has been 7 months since this blog was started with the intention of sensitizing the people and physicians to stroke. To be able to serve the audience better, I would like you all to take this short survey. In addition, we are working on creating a forum to connect stroke survivors and publish their experiences so as to benefit others. A link to the survey is here (it should not take more than 2 minutes to complete the survey):

https://docs.google.com/forms/d/1eJXB3iAU2bYzUIP_yPCfQ_832ISsxQfSIPSKVXGvUMM/edit

Thank you

Does Air Pollution Affect the Risk of Stroke?

The World Health Organization (WHO) recently published data on air pollution in various cities across the world focussing on airborne particles smaller than 2.5 micrometers known as PM2.5. The report ranked cities after studying their air for the presence of harmful gases, such as nitrogen dioxide, carbon monoxide and sulphur dioxide, besides particulate matter (PM) 10 and 2.5. 13 of the world's 20 most polluted cities are in India, New Delhi being the most polluted of all. Smaller airborne particles or particulate matter is among the most dangerous of all these pollutants. New Delhi, Patna, Gwalior, Raipur, Ahmedabad, Lucknow, Kanpur, Amritsar, Ludhiana, Allahbad, Agra and Khanna are included among the top 20 most polluted cities in the world. 

High levels of air pollution has been linked to increased rate of chronic bronchitis, lung cancer and heart disease. Long term exposure to air pollution has also been associated with higher risk of stroke and impaired cognition. Following are the effects of air pollution on brain and central nervous system:

• Increased risk of carotid atherosclerosis
• Decreased cognition in older people
• Every 2 microgram per meter cube increase in PM 2.5 leads to 1 year of accelerated brain aging and atrophy (degeneration)
• Increased risk of death from stroke among people living in areas with high air pollution, especially in people aged >60 years and non-smokers
•  In Tokyo, the risk increase for subarachnoid hemorrhage mortality per 10 μg/m3 PM2.5 or NO2 has been associated with double the risk increase for ischemic or intracerebral hemorrhage mortality
•  Stronger associations between short-term air pollution exposure and stroke mortality are observed in elderly, women, and individuals with a history of diabetes mellitus or cardiac disease
• Air pollution on warm days has been more strongly associated with both hemorrhagic and ischemic stroke