Little is known about resilience after paediatric stroke (PS), or the factors that contribute to better outcomes. Rather, research emphasis has been on impairment, measured through cross-sectional or retrospective designs, often heavily weighted to children presenting for clinical or rehabilitation follow-up. Implementing a resilience framework, this study aimed to investigate cognitive recovery post-stroke and factors that contribute to cognitive resilience at 12 months following PS. In a single site, prospective, longitudinal study (baseline, 1, 6, 12 months post-stroke), 61 children (55.7% male) aged 0-18 years, with a diagnosis of acute arterial ischemic stroke were recruited. Neurological status, lesion and child characteristics were collected at diagnosis. Cognitive, language and motor skills were assessed directly using age-appropriate, standardised tools. Parents rated their mental health, and child social and adaptive abilities. Participants were classified as 'resilient' (74%) or 'vulnerable' based on 12-month cognitive scores. The resilient group demonstrated more intact acute neurological status and higher language and adaptive abilities 1-month post-stroke; 88% of the vulnerable group had strokes involving both cortical and subcortical regions. Neonatal stroke, large lesions, cortical-only lesions, and middle cerebral artery involvement were associated with poorer cognition over the 12 months post-stroke. Absence of seizures and older age at stroke predicted better cognitive outcomes. In summary, most children surviving PS are cognitively resilient at 12 months post-insult. Risk and protective factors identified may guide targeted clinical intervention for more vulnerable children. Future research is needed to explore cognitive resilience trajectories beyond 12 months post-stroke.

中文翻译：

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小儿中风后的认知弹性：生物学和环境预测因子

对小儿中风 (PS) 后的恢复力或有助于改善结果的因素知之甚少。相反，研究重点一直放在通过横断面或回顾性设计测量的损伤上，通常对临床或康复随访的儿童有很大的影响。本研究实施弹性框架，旨在调查中风后的认知恢复以及导致 PS 后 12 个月认知弹性的因素。在一个单一地点、前瞻性、纵向研究（基线，中风后 1、6、12 个月），招募了 61 名 0-18 岁的儿童（55.7% 男性），被诊断为急性动脉缺血性中风。在诊断时收集神经学状态、病变和儿童特征。认知、语言和运动技能直接使用适合年龄的、标准化工具。父母对他们的心理健康以及孩子的社交和适应能力进行评分。根据 12 个月的认知评分，参与者被归类为“有弹性”（74%）或“易受伤害”。有弹性的组在中风后 1 个月表现出更完整的急性神经系统状态和更高的语言和适应能力；88% 的易感人群中风涉及皮层和皮层下区域。新生儿卒中、大病灶、仅皮质损伤和大脑中动脉受累与卒中后 12 个月内认知能力较差有关。没有癫痫发作和中风时年龄较大可预测更好的认知结果。总之，大多数幸存 PS 的儿童在受到侮辱后的 12 个月内具有认知弹性。确定的风险和保护因素可以指导对更脆弱儿童的有针对性的临床干预。未来的研究需要探索中风后 12 个月后的认知弹性轨迹。