Young stroke survivors are interesting to those of us in stroke-specific rehabilitation research because there is so much raw material and raw potential. Many younger stroke survivors have the effects of the stroke as the only problem they have. They are often not on meds, they have tons of energy, and they are not willing to give up the balance of their life.
Here is the gist:
Stroke in adulthood: A normal architecture, altered. Imagine building a new house. You build a good foundation, a solid frame, a strong roof, etc. You put in the plumbing, electrical, and walls. Your new house is done. Then one day you have an accident! You back your car into the corner of the house. That part of the house needs to be fixed. The foundation is still there, the solid frame still exist in most of the house, the roof is still good; plumbing, wiring, everything is still good. You only need to fix that one room.
• A stroke in adulthood affects a normally developed brain. The size and location of the stroke determines what skills are lost.
• Stroke in childhood: An altered architecture. Now imagine you neighbor builds a house, but he’s not a very good builder. The foundation is uneven and the frame is crooked. Everything that is built around the foundation and frame is affected by the poor basic architecture of the building. To “fix” the house would require starting from scratch.
• A stroke in childhood affects how the brain develops. The brain in childhood is a blank slate. Neurons (nerve cells in the brain) haven’t “decided what they want to be when they grow up,” and whatever is imprinted on that blank slate affects the way the brain develops. Children have an immense amount of brain plasticity available to them. After stroke, children often do amazing things, given the amount of brain injury they have. There are classic examples of children who have a complete hemisphere (half of their brain) destroyed by stroke. In an adult, such a stroke would institutionalize the person for the rest of his or her life, but some children survive and thrive with half a brain. They are able to learn to read, write, have a sense of humor, be productive, and enjoy life. So it is unfair to describe the brain after a childhood stroke as having “poor architecture.” In fact, it could be considered “excellent architecture” given the amount of brain damage they have.
The impact of stroke before the brain is fully developed is much different than the impact of stroke after the brain is fully developed. The process of recovery in the two is very different, as well. In fact, it is only in the adult brain that is truly “recovery.” In childhood stroke becomes a part of development.