A matched lesion analysis of childhood versus adult-onset brain injury due to unilateral stroke: another perspective on neural plasticity and recovery of social functioning.

BACKGROUND The literature on neuroplasticity lacks a direct comparison of chronic neuropsychological and social outcomes following brain damage acquired in childhood versus adulthood, when lesions are matched across adults and children for size and location. METHODS We paired adults and children with similar unilateral stroke lesions and then compared chronic neuropsychological and social outcomes. Quantitative comparisons were conducted, as well as qualitative analyses of each subject pair, focusing on specific domains of cognitive impairment and changes in social functioning. RESULTS We found that learning and memory impairments were most common in both children and adults. Left hemisphere-lesioned children were normal on speech/language ratings, whereas their adult counterparts were borderline impaired. Impairments in social functioning were highly associated with hemispheric side of damage in adults, but not in children: Specifically, adults with right hemisphere lesions developed social defects much more frequently than adults with left hemisphere lesions, whereas this asymmetry was not evident in the children. Most importantly, though, was the overarching finding of a high degree of similarity between chronic neuropsychological and social function outcomes in adults and children with similarly located brain lesions due to unilateral stroke. CONCLUSIONS On balance, the findings suggest that lesion location and size are prepotent factors determining neuropsychological and social recovery from stroke.