Early Rehabilitation in Children After Ischemic Stroke-Importance and Effects: A Scoping Review.

Background

Early rehabilitation after pediatric ischemic stroke may support neuroplasticity and improve long-term functional outcomes. However, rehabilitation practices remain heterogeneous, and evidence-based recommendations regarding the optimal timing and intensity of intervention are limited.

Objectives

This scoping review aimed to evaluate the available evidence regarding early rehabilitation after pediatric ischemic stroke, identify prognostic factors associated with functional recovery, summarize current therapeutic approaches, and highlight gaps in the existing literature. Eligibility Criteria: Eligible studies included children and adolescents aged 0-18 years diagnosed with ischemic stroke and receiving rehabilitation or therapeutic intervention. Studies addressing the timing, intensity, and effects of physiotherapy, occupational therapy, speech and language therapy, neuropsychological intervention, neuromodulation, or multidisciplinary rehabilitation were considered for inclusion. Sources of Evidence: A structured literature search was conducted in PubMed/MEDLINE, Scopus, Web of Science, the Cochrane Library, and Google Scholar for studies published between 2000 and January 2025. Charting

Methods

Data were extracted using a standardized charting form and synthesized narratively because of substantial heterogeneity in study design, populations, interventions, and outcome measures.

Results

Twenty-one sources met the inclusion criteria. Direct evidence specifically addressing early rehabilitation after pediatric ischemic stroke was limited and consisted primarily of observational studies. A substantial proportion of the available evidence was indirect, originating from studies of perinatal stroke, unilateral brain injury, cerebral palsy, and related pediatric neurorehabilitation populations, as well as clinical guidelines and expert consensus documents. The available evidence suggests potential benefits across motor, cognitive, communication, and functional domains, although the strength and directness of evidence varied substantially. Several studies identified the early post-stroke period as a potentially important window for neuroplasticity, while family involvement, individualized treatment planning, and interdisciplinary care were consistently highlighted as important components of rehabilitation. Evidence supporting neuromodulation techniques remained preliminary and was largely limited to selected pediatric populations.

Conclusions

The available evidence, although heterogeneous and largely indirect, suggests that early coordinated and multidisciplinary rehabilitation may be beneficial in pediatric ischemic stroke care. However, the current evidence base remains limited, and high-quality prospective studies are needed to establish standardized rehabilitation protocols and determine the optimal timing and intensity of therapeutic interventions.