Exploring the impact of perinatal stroke on children’s cognitive abilities

Carmen Rasmussen

A new study by an Edmonton developmental psychology researcher is leading to a better understanding of the long-term cognitive effects of perinatal stroke on children, especially functions that play a role in mathematics ability.

Carmen Rasmussen, an associate professor in the University of Alberta’s Department of Pediatrics, is working with a group of children aged six to 16 who suffered a perinatal stroke. Many of these children now live with cerebral palsy, a condition that can involve a range of lifelong neuromotor, cognitive and behavioural difficulties.

Perinatal stroke is a brain injury that happens between 20 weeks of gestation and 28 days of life. It is estimated to occur in about one in 1,100 live births and accounts for most cases of hemiparetic cerebral palsy—the most common form of the disorder—in which one arm and leg on either the right or left side of the body is affected. In addition to how their bodies move, children with perinatal stroke often face lifelong differences in how they learn and communicate.

“Families experience distress when faced with their child's resulting struggles from perinatal stroke and fear for what their future holds as an adult,” explains John Andersen, a developmental pediatrician and co-lead of the northern section of the Alberta Perinatal Stroke Project.

Rasmussen’s studies are part of the project, a province-wide collaboration of clinical and applied technology research programs that collect and examine data from 800 children who suffered a stroke.

She says there has been a lot of research worldwide on perinatal stroke and cerebral palsy but most of it has focused on motor outcomes “most likely because those are really visual and apparent, and there are various types of therapies to assist with those issues.”

There has been less research examining executive functioning in the perinatal stroke population, which is Rasmussen’s area of focus. Executive functioning includes inhibitory control, planning and reasoning, attention, working memory and cognitive flexibility—all critical for day-to-day functioning and decision-making. Executive functioning is particularly important in mathematics development in young children.

"Their research found a high prevalence of impairment across many elements of executive functioning among the children, as well as significant math difficulties."

In 2017, Rasmussen and her team began studying executive functioning and its link to mathematics abilities in 18 Alberta children who had suffered a perinatal stroke. Their research found a high prevalence of impairment across many elements of executive functioning among the children, as well as significant math difficulties. She said it was the first study to show the link between math and executive functioning in this population.

“Math is really important for so many things in life, from telling time to budgeting money to paying for things and knowing how much money you need to get out of your wallet, even cooking and measurement,” explains Rasmussen. “Math is really important for day-to-day functioning and difficulties in math can affect many other areas.”

Her most recent project is aimed at studying how a mathematics intervention program—called the Math Interactive Learning Experience—could help children improve their mathematics skills by focusing on their underlying cognitive deficits and offering targeted interventions.

“Interventions could include a child using manipulatives, such as coloured cubes, to connect more challenging math concepts to physical objects while their classmates use pencil and paper,” says Rasmussen. The program’s FAR approach—focus, act and reflect—helps children to understand the math tasks at the beginning of their work and reflect on what they did to achieve the result. Rasmussen feels that this approach has broader impact and could benefit all children.

A diagnosis of perinatal stroke or cerebral palsy can place significant demands on parents and caregivers, says Rasmussen. Her research has also looked at the psychosocial impacts on caregivers and the supports and programming available to help them. Leah Hammond, a student that Rasmussen supervises, has added to this research as part of her graduate studies. Hammond has analyzed responses from caregivers about the effects of the pandemic on support services, as well as whether there had been an increase in screen time and a decrease in physical activity among their children during the pandemic.

Rasmussen says her future research will likely focus on the impact of various math interventions and other programs targeting executive functioning skills in children who had a perinatal stroke, as well as examining support and services for their caregivers.

“Understanding these areas of difficulty can help parents and teachers best support the child, whether that’s at home or at school.”

Carmen Rasmussen and Leah Hammond are supported by the Stollery Children’s Hospital Foundation through WCHRI.