Pediatric stroke (PS) is an injury caused by the occlusion or rupture of a blood vessel in the central nervous system (CNS) of children, before or after birth. Hemiparesis is the most common motoric deficit associated with PS in children. Therefore, it is important to emphasize that PS is a significant challenge for rehabilitation, especially since the consequences may also appear during the child’s growth and development, reducing functional capacity. The plasticity of the child’s CNS is an important predecessor of recovery, but disruption of the neural network, specific to an immature brain, can have harmful and potentially devastating consequences. In this review, we summarize the complexity of the consequences associated with PS and the possibilities and role of modern rehabilitation. An analysis of the current literature reveals that Constraint-Induced Movement Therapy, forced-use therapy, repetitive transcranial magnetic stimulation, functional electrical stimulation and robot-assisted therapy have demonstrated at least partial improvements in motor domains related to hemiparesis or hemiplegia caused by PS, but they are supported with different levels of evidence. Due to the lack of randomized controlled studies, the optimal rehabilitation treatment is still debatable, and therefore, most recommendations are primarily based on expert consensuses, opinions and an insufficient level of evidence.

Background and aim: Cerebral palsy (CP) is a nonprogressive neurological disorder characterized by permanent developmental disorders of movement and posture. One of the most common goals of rehabilitation is the treatment of gait disorders. Ataxic gait disorder tends to worsen in the adolescent period. Research indicates a positive therapeutic effect of the combined application of conventional rehabilitation, robotic neurorehabilitation (RNR) and virtual reality, but there is no consensus on the length of treatment and frequency of application. The aim of this case report was to contribute to the definition of the RNR protocol for the treatment of ataxic gait disorder in adolescents with CP. Case report: In a female child with an ataxic form of CP who was on regular conventional kinesitherapy in the age period between 13 to 15 years, robotic-assisted gait training (RAGT) was applied for the treatment of gait disorders. The rehabilitation protocol lasted 10 weeks, 5 times a week, and included individual, conventional kinesitherapy for 30 min and RAGT for 30 min. Combined RNR treatment was conducted once a year in the period between July and September. The results of the therapeutic evaluation revealed that the functional motor level remained unchanged, while the improved functional motor status for the category of standing and gait was maintained during treatment between the patient’s 13 and 15 years age. In their 15th year, independent gait over a shorter distance (14 m) was achieved, as well as a normal gait frequency (83 steps/minute), with a desirable duration of the left leg support phase of 65% and 70% for the right leg support phase. Conclusions: The results of our research indicate that the application of conventional kinesitherapy and RAGT, over the period of 10 weeks a year, can have a positive effect on improving the postural and locomotor functions of ataxic gait in adolescents with CP.

Pediatric stroke (PS) is a rare disease with the global incidence of 1.2 -13/100,000, but nevertheless, is an important cause of disability in children. What makes it a challenging research topic is its alarming upsurge in the prevalence of 35%. The most prevalent motor deficit in that regard is hemiparesis in 50% to 80% of children with PS. The following databases were used for the purpose of this study: PubMed, Medline, Scopus, Google Scholar. Asymptomatic clinical picture and a very rare use of indicated hyperacute recanalization therapy make rehabilitation the primary therapeutic approach in children affected with PS. The present studies suggest that the greater capacity of brain neuroplasticity in children can be relevant in recovery, but also indicate some specific consequences of injury made to a developing brain. Robotic neurorehabilitation (RNR) activates brain neuroplasticity, i.e. stimulates new motor learning which contributes to motor function recovery after brain damage. RNR, in combination with virtual reality, is able to expand the effects of conventional rehabilitation, the children find it interesting, and it motivates them to be actively involved in time-consuming, specific, high-intensity exercises. Motor recovery is intensified by learning and repetition of tasks, with a robot providing additional strength in the performance of movements, with continual measurements of objective parameters.The recommendations for use of RNR in children affected with PS are based on expert consensus and weak evidence, since there is lack of randomized, controlled studies.