Mobility and dexterity after childhood stroke

Stroke can affect a child's mobility, coordination and dexterity. For some children the effects can last a long time, and they may affect development in younger children. However, with the right support many children make progress and gain physical skills they need to live an active, healthy life.

How can stroke affect mobility and dexterity?

The physical effects of a stroke can affect a child or young person in two main ways:

Directly

The stroke may affect the muscles and parts of the nervous system that enable movement. It happens on the opposite side of the body to where the stroke was in the brain. This is because the right side of the brain controls the left side of the body, and vice versa. These effects include:

Weakness on one side, known as hemiparesis.
Paralysis down one side, known as hemiplegia.
Problems with balance and coordination, and a reduced range of motion.
Problems with planning and coordinating muscle movements (apraxia or dyspraxia)
Spasticity: a tightness of the muscles (hypertonia) that can range from mild stiffness to severe spasms. It can cause soreness and pain.
Less muscle development on the weaker side.
Reduced gross motor skills, such as walking or lifting things.
Reduced fine motor skills, such as writing or doing up buttons.
Reduced or increased tactile sensitivity.

Indirectly

Daily activities can take more energy and cause fatigue.
Problems with vision and perception (visual neglect) can make it hard for a child to navigate and move around.
Problems with memory and thinking may affect their ability to carry out activities and get around.
Children may lose confidence and feel uncomfortable taking part in active play, sports or PE.
Feeling or looking different may affect body image and self-consciousness. This is especially the case once they move into puberty or want to start dating.

For a young person impacted by stroke it can be incredibly frustrating to be dependent on someone else.

What are the signs of mobility and dexterity problems?

Children' motor control and muscle strength develops continuously from the early years until adulthood, so the signs of these problems will vary depending on your child's age and stage of development. It might be difficult to predict how their future mobility will be affected.

It may be easy to spot a change in a child who could previously dress independently and no longer can.
An older child may try to hide their difficulties, so if they seem reluctant to do something, they may be trying to conceal an impairment.
Younger children and babies may not meet milestones such as lifting their head, rolling or walking at the usual time. Most babies who have a stroke go on to walk independently but they may walk with an imbalanced gait or use one hand far more than the other. If they have spasticity, you may notice tightness in their hands, arms or feet - for example, clenched fists.
If your child is at nursery, school or college, ask staff if they have noticed any differences.

If your child is self-conscious about looking different, talk to school about adjustments, such as permission to wear long sleeves or trousers to cover up a smaller arm or foot splints.
Parent

What can help?

Difficulties with mobility (gross motor skills) and dexterity (fine motor skills) can interfere with a child's ability to carry out everyday activities, such as eating, dressing, or walking.

Treatments include regular physiotherapy and occupational therapy and regular exercises or activities to practise through the day.

Your child's therapist will play a key role in encouraging your child to improve their skills. They may also suggest adaptive strategies to help them get the most out of daily life, including:

Supportive shoes to aid posture.
Stretchy foot and ankle supports (orthoses) to improve their stability and function.
Easy-to-grip pencils to make writing easier.
Braces, walkers or leg splints to help them move around.
Adaptations to the environment such as a more supportive chair or sitting in a different position in the classroom.
Transport to and from school or college (find out more from your local authority website).

Look on YouTube and Tiktok for videos on doing things one-handed, such as putting on makeup.
Parent

Go to Youtube to search for videos on doing things one-handed.

Frequently asked questions

What is the best treatment for spasticity?

If you think your child may have spasticity, it is very important to discuss this with the physiotherapist and consultant to prevent long-term changes to the muscles known as contractures. The treatment may include:

Physiotherapy.
Botulinum toxin type A injections combined with physiotherapy.
Muscle relaxant medications.
Splints or casts.

Apraxia or dyspraxia

Apraxia, or dyspraxia if it is less severe, means having problems with planning and coordinating muscle movements. This can mean that a child may have trouble with intentional movements. So this could make it difficult to control a pen or kick a ball. It could take them longer to respond to requests such as picking up an object.

It can also affect the muscles of the throat and mouth causing apraxia of speech. Read more about communication problems after childhood stroke.

Motivating a child or young person to do their therapy activities

Therapy can sometimes be tiring or uncomfortable, and may need to be done long term. If your child is struggling to keep going with their exercises at home, ask their therapist for advice. Some tips include:

Building a routine by habit stacking, which involves planning existing routines close together, such as always doing exercises right after toothbrushing.
For a younger child, try linking exercises to a reward chart, trips to the park or computer time.
An older child or teen might be able to use reminder apps on a mobile device, or may do their exercises at a local gym.
Get the family involved. Fun activities can be beneficial, like football or swimming. The therapist can advise on the types of movement that your child needs to practise, and how to make it part of their normal routine.

...[try to] find ways for your child to resume elements of their normal life to keep motivated.
Parent

How to get more therapy for your child

If you feel your child needs more therapy, or they develop new needs as they get older, you can ask your consultant or GP for a referral at any time. Alternatively, talk to your child's SENCO, or the teacher responsible for additional support needs. If your child has a support plan in place at school, this may include physical therapies and should specify how often these should be provided.

If private sessions are an option for you, you might want to find your own provider. Find details at the Chartered Society of Physiotherapists and Chartered Society of Occupational Therapists websites.