Background: Paediatric stroke is a significant cause of disability in children that is often associated with long-term sequelae, such as motor and cognitive deficits. This review evaluated the evidence for nonpharmacological rehabilitation interventions for motor and cognitive impairment following paediatric stroke.
Methods: A comprehensive literature search for journal articles published from January 1, 1980 to December 8, 2017 was conducted using multiple scientific databases. Studies were included if: (1) the study population was >50% paediatric (<18 years) stroke; (2) a diagnosis of stroke was explicitly stated; (3) there were ≥3 paediatric stroke participants; (4) motor or cognitive outcome measures were used to assess effect of treatment. Methodological quality of randomized controlled trials (RCTs) was assessed using the Physiotherapy Evidence Database tool. Levels of evidence were assigned to each study to determine the strength of the evidence for each intervention.
Results: A total of 18 articles (7 primary RCTs) met inclusion criteria. Most studies (N=14) examined rehabilitation of the upper limb, with constraint-induced movement therapy (CIMT) as the most common intervention. Overall, the evidence supports the use of CIMT, repetitive transcranial magnetic stimulation, functional electrical stimulation, and robotics, but suggests no beneficial effect of transcranial direct current stimulation. Very few studies assessed interventions for the lower limb (N=1) or cognitive impairment (N=3). 
Conclusion: Effective rehabilitation approaches are important for optimizing outcomes in children who have had a stroke. Although the number of published clinical trials has increased in recent years, little evidence-based guidance exists for this clinical population.

NONPHARMACOLOGICAL REHABILITATION INTERVENTIONS FOR MOTOR AND COGNITIVE OUTCOMES FOLLOWING PAEDIATRIC STROKE: A SYSTEMATIC REVIEW