Pediatric ischemic stroke can affect children of all ages often leading to motor impairment. Early identification of children at risk of permanent motor impairments such as cerebral palsy (CP) or hemiparesis is crucial to enable timely interventions optimizing their functional outcomes. One method for early assessment in infants is Prechtl’s qualitative assessment of General movements (GMA), along with an early motor intervention applied before 12 months of age: Baby-mCIMT.  The aim of the thesis was to identify adverse motor outcomes after pediatric ischemic stroke, assess potential risk factors and explore the feasibility of early identification and intervention in infants at high risk of CP using remote eHealth approaches.  

Study I is an epidemiological study using a national register-based cohort of individuals with pediatric ischemic stroke and matched controls, investigating the risk and contributing factors for adverse motor outcomes. The study found that in children affected by ischemic stroke, 32% were diagnosed with adverse motor outcomes, with a higher risk in childhood stroke compared to perinatal stroke. No other significant risk factors such as gestational age, sex or parental age were identified.  

Study II evaluates remote GMA in a neonatal risk group, focusing on inter-rater reliability and smartphone app usability, as part of the methodological approach in an ongoing nationwide study. Caregivers filmed their infants’ spontaneous movements with a smartphone app. The films were analyzed by certified assessors blinded to the infants’ medical history. Inter-rater reliability was moderate between assessors but substantial when the assessors’ final group consensus was compared to a GMA expert’s assessment. The app was rated highly for usability according to film quality and parental satisfaction.  

Study III examines early intervention in infants at risk of unilateral CP using the Baby-mCIMT program comparing two groups with different parental coaching approaches: remote and in-person. The outcome was evaluated based on the infants’ development of hand function, assessed before and after the intervention. The result showed that the infants’ hand function developed equally, regardless of the coaching approach used.  

Study IV describes parental experiences of implementing training according to the Baby-mCIMT program with remote coaching. The findings highlighted that the remote approach offered parents as primary trainers opportunities for learning and empowerment. The responsive professional guidance and a strong therapist-parent relationship were found to be important for implementing the intervention.  

This thesis highlights the substantial risk of motor impairment following pediatric ischemic stroke, emphasizing the need of targeted actions, regardless of the child’s age at the time of the ischemic stroke. Parents can effectively engage in remote assessment and early intervention with professional support, even at a geographical distance.