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August 22, 2005

Penn Expert in Stroke Rehabilitation Helps Shape
Next-Generation, Comprehensive Stroke Center

Multidisciplinary Team Published Recommendations For Center That Encompasses Various Facets of Stroke Care

(Philadelphia, PA) –According to the American Heart Association, about 700,000 people suffer from strokes every year in the United States – and there are 5.4 million stroke survivors alive today, many with stroke-related disabilities. With the number of hospitalizations attributed to stroke on the rise, stroke remains a significant health care issue… for those that suffer from stroke, their families, and their communities. In order to help address the complex and continuing needs of stroke survivors, Richard D. Zorowitz, MD, Medical Director of Inpatient Rehabilitation and Director of Stroke Rehabilitation at the Hospital of the University of Pennsylvania (HUP), was part of the multidisciplinary team recently published “Recommendations for Comprehensive Stroke Centers” in the July issue of Stroke, which that envisioned a stroke center capable of delivering a full spectrum of care to seriously ill patients with stroke and cerebrovascular disease. According to the report, the integration of multiple facets of stroke care into a coordinated, hospital-based Comprehensive Stroke Center would likely improve the outcomes for patients who suffer from stroke.

The concept of the Comprehensive Stroke Center was born in 2000, when the Brain Attack Coalition – a multidisciplinary group of representatives from major professional organizations involved with delivering stroke care – first discussed the concept of stroke centers. At the time, the group found that although an estimated 700,000 to 750,000 strokes occur each year in the United States, many hospitals didn’t have the necessary personnel, equipment, and organization to rapidly and effectively treat patients with stroke. A study published in Stroke that year had found that 66% of hospitals surveyed didn’t have stroke protocols, and 82% percent didn’t have rapid identification for patients experiencing acute stroke. The Coalition published “Recommendations for the Establishment of Primary Stroke Centers” in the Journal of the American Medical Association in June 2000 in order to address the need for improvements in stroke care. Many of the elements outlined in the article – including the creation of acute stroke teams, written care protocols, and a stroke unit – are now criteria for Primary Stroke Center certification by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), which HUP received in September 2004.

The Comprehensive Stroke Center (CSC) builds upon the foundation laid by the recommendations for the Primary Stroke Center (PSC) by recognizing the needs of patients who suffer from complex stroke types, severe deficits, or multi-organ disease. Such patients could include those with large ischemic (produced by clots) or hemorrhagic (produced by ruptured blood vessels) strokes. This increased level of care would make the CSC an ideal educational resource for other medical centers and PSCs – therefore taking the positive medical benefits of the CSC beyond its hospital walls. Indeed, this increased focus on education is one of the elements of the PSC that has been expanded: CSCs should also have more specialized medical staff available usually within an hour’s notice, offer more non-invasive imaging techniques, and offer various forms of endovascular therapy, including microsurgical neurovascular clipping, neuroendovascular coiling and intracranial angioplasty.

“Much of what will distinguish a CSC from other facilities lies in diagnostic radiology, endovascular surgery, and surgery,” notes Zorowitz. “But what is also key is greater emphasis on rehabilitation and post-stroke care. A well-organized and multidisciplinary stroke rehabilitation team not only reduces the risk of death, but may increase the patient’s quality of life and reduce the financial and physical burden on the patient’s family and society.”

The Brain Attack Coalition recommends that a consultation for rehabilitation, physical therapy, occupational therapy, and speech therapy should be completed within 24 hours of admission – so that mobilization and the resumption of self-care activities can resume as soon as possible. The crucial role of rehabilitation cannot be understated: according to the National Heart, Lung, and Blood Institute, 50-70% of stroke survivors regain functional independence. However, 15-30% of survivors remain permanently disabled. Since motor recovery can begin within 48 hours after a stroke, and follows well-described patterns, access to rehabilitative therapies is crucial for improving chances for survival, independence, and a better quality of life.

“It is not only the motor deficiencies that have to be addressed,” explains Zorowitz. “Stroke victims can also suffer from sensory deficits – sense perception, as well as speech and language problems. Each of these issues will have an impact on the patient’s mobility, including the ability to avoid falls, and overall health. There are many other medical complications of stroke: aspiration pneumonia and other infections, which can stem from difficulty in breathing and swallowing; deep vein thrombosis (DVT); and edema, or swelling, and the chronic loss of joint motion. This is why the multidisciplinary aspect of the CSC is so important.”

Zorowitz Biosketch
Zorowitz is a graduate of the Tulane University School of Medicine. He completed an internship in internal medicine at the Long Island Jewish Medical Center, New Hyde Park, NY, and a residency in physical medicine and rehabilitation at the Rehabilitation Institute of Chicago, Northwestern University, IL. Zorowitz’s research interests include rehabilitation outcomes, dysphagia, spasticity, and the hemiplegic shoulder. He has published articles in peer-reviewed journals and has written chapters about stroke rehabilitation internationally.

He is a member of the American Academy of Physical Medicine and Rehabilitation (AAPM&R), Association of Academic Physiatrists (AAP), National Stroke Association, and the American Heart Association Stroke Council. He is a member of the Stroke Rehabilitation and Professional Advisory Boards of the National Stroke Association, a member of the Pennsylvania-Delaware affiliate Stroke Advisory Committee of the American Stroke (Heart) Association, chairman of the Rehabilitation/Recovery Subcommittee of Philadelphia Operation Stroke, and chairman of the rehabilitation subsection of the Philadelphia Stroke Council.

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