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Dr Elizabeth Barton, MD and Holly G. Holland, OTR/L, ATP, C/NDT

May is Pediatric Stroke Awareness Month. At our UNC Center for Rehabilitation Care (CRC) in Chapel Hill, Dr Elizabeth Barton, MD and Holly Holland, OTR/L, ATP, C/NDT specialize in care for children diagnosed with hemiplegia.

Dr. Barton is a a Clinical Assistant Professor at the UNC Department of Physical Medicine and Rehabilitation. She received her medical degree from the University of Kansas. Dr. Barton sees patients at the UNC Center for Rehabilitation Care (CRC) and UNC Children’s Hospital. Her areas of interest include cerebral palsy, spasticity management, neuromuscular disorders, limb differences, pediatric musculoskeletal medicine, and injury prevention.

Holly Holland is an Occupational Therapist. She holds a Master of Science from Texas Woman’s University. She is the founder of Helping Kids with Hemiplegia, a day camp for children with a diagnosis of hemiplegic cerebral palsy.


What do you want people to know about Pediatric Stroke? 

EB: Children typically have strokes for different reasons than adults do, and these drivers are important to understand so that treatment and rehabilitation can be tailored to each individual. The cause for some pediatric strokes is not yet understood. Children have an incredible ability to adapt and recover after a stroke. It is really neat to see their progress over time. We expect great things for a child’s future!

HH: First, that pediatric strokes happen.  Many people have no idea that infants and children have strokes.  The incidence of strokes in utero is approximately 1/2200 live births.  Evidence based therapy intervention and national support groups exist to support both the infants/children and their families.  Evidence based intervention includes Constraint Induced Movement Therapy and Bimanual Intensive Intervention.  CHASA is a national support organization.


What do you like best about working with children and families? 

EB: I really enjoy partnering with parents to provide the tools a child might need to develop, explore their environment, and have fun being a kid! It is a team effort, bringing doctors, nurses, therapists, neuropsychologists, social workers, school teams, and community resources together to help each child reach his or her potential.

HH: The rewards are endless.  I love being a small part of helping children learn new skills that enable them to be more independent, have more confidence and improve their quality of life.  The families are eager to learn and implement activities that support the functional status of their children.


What can people do to help you in caring for these children? 

EB: Believe that each child who has had a stroke has a bright future. Advocate for them. Give them grace. Encourage their families.

HH: At UNC we have a summer camp for children diagnosed with hemiplegia secondary to a stroke called Helping Kids with Hemiplegia.  In the camp, we provide evidence-based intervention to approximately 40 children ages 4 – 10.  We are always seeking college volunteers to assist at the camp.  Referring college students who might be interested in volunteering at the camp would be wonderful.


What are common challenges faced by these children and families?

EB: After a stroke, a child commonly may have difficulty with strength, coordination, mobility, and increased muscle tone. Despite these challenges, most children who have had a stroke affecting one side of their body will continue to walk, and will find new ways to do familiar tasks. Communication may be affected in some children, as well as swallowing, visual, and cognitive abilities. New learning or behavioral concerns may arise. Seizures can develop in some children. Typically there is great functional improvement observed over the first 1-2 years after a pediatric stroke.

HH: Common challenges for the children include the obvious motor control impairment in their upper and lower extremity on the side of their body affected by stroke.  When one side of your body does not work well challenges are faced with completing 2 handed tasks all day every day.  As the children grow, they face issues with their confidence with social interactions because they “are different”.  They can be dependent on the family because of the extreme difficulty that completion of age appropriate daily tasks present.  Families want to support their children, but they also want to see them develop independence and healthy social relationships with their peers.


Are there future advances in the field?

EB: Treatment and secondary prevention for pediatric stroke continue to evolve. Emphasis on early detection of pediatric stroke has emerged, which allows therapies to be implemented as soon as possible to help a child with recovery. We continue to learn about best approaches for tone management after a stroke, including use of medications, injection, and in some cases, surgical options. There are excellent opportunities for participation in community activities such as adaptive sports, play, and the involvement in the arts.