Neural mechanisms driving speech and language recovery following childhood stroke: a scoping review

PurposeThis scoping review aimed to inform future research priorities by collating evidence on neural correlates of speech and language recovery following childhood stroke.MethodsNeuroimaging, motor speech, or language outcomes following childhood stroke (28 days to 18 years age) in the subacute to chronic community stages (care occurring after acute medical management, including inpatient and outpatient rehabilitation, and community-based programs) were identified and extracted from Medline, Embase, PsycInfo, and Clinical databases.ResultsOf the 3990 studies screened, 11 met the inclusion criteria. Of the included articles, no papers formally assessed speech outcomes, 11 articles reported language outcomes through standardized testing, 11 utilized structural imaging (CT, MRI), and four reported functional neuroimaging outcomes (fMRI).InterpretationThis review revealed a rudimentary accounting of speech and language profiles in children post-stroke; limited by the use of varied and incomplete speech and language assessment batteries, inconsistent reporting of lesion locations associated with speech and language outcomes, a dearth of functional neuroimaging studies, and lack of information about speech and language function throughout the rehabilitation period, a time when the brain is most plastic and receptive to therapy. Future research should provide complete and accurate accounts of speech and language function and their neural correlates throughout rehabilitation and recovery to inform care, education, and employment planning. Although stroke is a top 10 cause of mortality in children, the current literature contains a rudimentary accounting of the speech and language profiles, and their neural correlates, following stroke in children.For rehabilitation professionals, our review demonstrates the need for comprehensive speech and language assessment in the subacute stage of recovery from childhood stroke.A complete and accurate account of speech and language functions, and their neural correlates, spanning recovery from childhood stroke is needed to inform clinical care.