National Panel Headed By UB Specialist to Release Stroke-Rehabilitation Guidelines

WASHINGTON, D.C. -- A national panel of stroke-rehabilitation experts today released the first comprehensive guidelines for stroke recovery, recommendations that will provide survivors, families and health professionals across the U.S. with a common blueprint for returning stroke patients to optimum health.

The guidelines, three years in the making, were presented at a 10 a.m. press conference in the Hubert H. Humphrey Building Auditorium. Glen E. Gresham, M.D., a rehabilitation-medicine specialist from the University at Buffalo, is chair of the panel, which was commissioned by the Agency For Health Care Policy and Research.

"This is a national consensus document, something we have never had before," said Gresham, professor and chair of the UB Department of Rehabilitation Medicine. "There are hundreds of articles and reviews about stroke rehabilitation, but this is the first set of guidelines agreed upon by all professionals in the field, through us.

"These guidelines are a treasure house of information," Gresham said. "For the patient and family, it tells what stroke rehabilitation is and how you go about finding it. It will help the physician make an informed decision with the family on which setting is the most appropriate. For the professional, it provides assessment techniques to monitor patients¹ progress and make decisions about discharge or moving to another level."

The estimated direct costs for stroke rehabilitation annually in the U.S. is $7.6 billion. More than 500,000 people experience stroke in the U.S. each year. There are 3 million survivors living with stroke-related disabilities. It is the leading cause of disability in adults in the U.S., and accounts for the largest portion of Medicare rehabilitation dollars.

The new guidelines designate four types of institutions as proper sites for stroke rehabilitation, depending on the severity of the disability -- hospitals/ hospital rehabilitation centers, nursing homes, home care and out-patient centers.

It establishes a clear role for the family in every level of rehabilitation, and stipulates that the needs of the family or caregiver should be considered when selecting a rehabilitation site.

€ Evaluate rehabilitation options as soon as the patient is stable.

€ Administer standardized assessment tests to evaluate the stroke survivor¹s medical, psychological and neurological condition, level of disability, and family support.

€ Make sure all persons involved agree on the treatment goals and services.

€ Perform a baseline assessment at the start of rehabilitation and fully-document progress throughout recovery.

€ Designate one member of the rehabilitation team to coordinate of all services.

€ Involve the patient¹s primary-care provider to coordinate care during transition from rehabilitation into the community.

€ Discharge when patient meets reasonable goals or shows no further progress.

For consumers, the guidelines list several factors to be considered when survivors and families are selecting a rehabilitation program: services provided; reputation; convenience for the family; involvement of both survivor and family in decisions; inclusion of family in rehabilitation and practice sessions; and extent of insurance coverage.

Outpatient or home programs require a capable person at home to provide care, the guidelines note, and outpatient programs also require transportation.

"This is a thorough document, which should be very useful to a wide variety of people," Gresham said.

Physically, the guidelines take three forms: the full document, with extensive recommendations for anything having to do with stroke rehabilitation; a summary for health care providers, and a brochure for patients and families. The consumer piece is free and will be available at health-care facilities dealing with stroke patients.

Pamela W. Duncan, Ph.D., of the University of Kansas, is panel co-chair.

Other members of the panel are: Carl Granger, M.D., professor of rehabilitation medicine at the University at Buffalo; Harold P. Adams, Jr., M.D., University of Iowa College of Medicine; Alan M. Adelman, M.D., Pennsylvania State University; David N. Alexander, M.D., UCLA Medical School; Duane S. Bishop, M.D., Brown University; Leonard Diller, Ph.D., New York University Medical Center; Nancy E. Donaldson, consumer, Newport Beach, Calif.; Audrey L. Holland, Ph.D., University of Arizona.

Also, Margaret Kelly-Haynes, Ed.D., Boston University School of Medicine; Fletcher H. McDowell, M.D., Cornell University Medical College; Larry Meyers, M.D., family practitioner, Mansfield Texas; Marion A. Phipps, Beth Israel Hospital, Boston; Elliott J. Roth, M.D., Northwestern University Medical School; Hilary C. Siebens, M.D., UCLA; Gloria A. Tarvin, Rehabilitation Institute of Chicago, and Catherine Anne Trombly, Sc.D., Boston University.