Rehabilitation and Functional Evaluation of the Stroke Survivor in New Jersey

  • Thomas W. Findley
  • Richard D. Zorowitz
  • Miriam Maney
  • Mark V. Johnston


The care of stroke survivors presents significant challenges both in the state of New Jersey and in the United States. Over 500 000 new cases of stroke yearly join the nearly three million stroke survivors in the United States. Stroke rehabilitation must address the medical, functional, vocational, avocational, and psychological issues of the stroke survivor using an interdisciplinary team of skilled professionals. This chapter describes admission criteria for inpatient stroke rehabilitation and guidelines for the assessment and treatment of the stroke survivor in various areas such as mobility and locomotion, activities of daily living (ADLs), community management, speech-language and cognitive disorders, and common medical complications. A model for functional evaluation used in the stroke rehabilitation program is described. Finally, functional data from 1900 stroke survivors admitted to the stroke rehabilitation program between January 1, 1992, and June 30, 1994, are described. While onset-to-admission intervals and legnth of stay have declined over the period, the functional status of the stroke survivors at discharge has remained constant. The efficiency of functional gains attained during the rehabilitation stay, as well as the efficiency of cost relative to these functional gains increased during the study period. The trends illustrated by these data reflect a movement by third-party payers to cap patient care costs by imposing shorter rehabilitation stays and shifting care to less intensive settings such as subacute units, nursing home facilities, and home care. However, rehabilitation professionals still must address the continuing need to maximize function and the safety of stroke survivors while meeting the demands of the government and insurance industry.


Stroke Patient Stroke Survivor Functional Independence Measure Stroke Rehabilitation Rehabilitation Hospital 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Dombovy ML, Sandok BA, Basford JA (1986) Rehabilitation for stroke: a review. Stroke 17(3):363–369PubMedCrossRefGoogle Scholar
  2. 2.
    Lehmann JF, DeLateur BJ, Fowler RS, et al (1975) Stroke rehabilitation: outcome and prediction. Arch Phys Med Rehabil 56:383–389PubMedGoogle Scholar
  3. 3.
    Matcher DB, Duncan PW (1994) Cost of stroke. Stroke: Clinical Updates 5(3):9–12Google Scholar
  4. 4.
    Johnston MV, Zorowitz RD, Nash B (1994) Family help available. Top Geriatr Rehabil 9(3):38–53Google Scholar
  5. 5.
    Johnston MV, Kirshblum S, Zorowitz RD, Shiflett SC (1992) Prediction of outcomes following rehabilitation of stroke patients. NeuroRehabilitation 2(4):71–96Google Scholar
  6. 6.
    Harbison JW (1992) Ticlopidine versus aspirin for the prevention of recurrent stroke. Stroke 23:1723–1727PubMedCrossRefGoogle Scholar
  7. 7.
    Bellavance A (1993) Efficacy of ticlopidine and aspirin for prevention of reversible cerebrovascular ischemic events: the ticlopidine aspirin study. Stroke 24:1452–1457PubMedCrossRefGoogle Scholar
  8. 8.
    Grotta JC, Noms JW, Kamm B (1992) Prevention of stroke with ticlopidine: who benefits most? Neurology 42(1):111–115PubMedGoogle Scholar
  9. 9.
    Acheson J, Danta G, Hutchinson EC (1969) Controlled trial of dipyridamole in cerebral vascular disease. Br Med J 1:614–615PubMedCrossRefGoogle Scholar
  10. 10.
    The American-Canadian Cooperative Study Group (1985) Persantine aspirin trial in cerebral ischemia. Part II: Endpoint results. Stroke 16:406–415CrossRefGoogle Scholar
  11. 11.
    Bowton DL, Stump DA, Prough DS, Toole JF, Lefkowitz DS, Coker L (1989) Pentoxifylline increases cerebral blood flow in patients with cerebrovascular disease. Stroke 20:1662–1666PubMedCrossRefGoogle Scholar
  12. 12.
    Irie K, Yamaguchi T, Minematus K, Omae T (1993) The j-curve phenomenon in stroke recurrence. Stroke 24:1844–1849PubMedCrossRefGoogle Scholar
  13. 13.
    Bromfield EB, Reding MB (1988) Relative risk of deep venous thrombosis or pulmonary embolism post-stroke based upon ambulatory status. J Neuro Rehabil 2(2):51–56Google Scholar
  14. 14.
    Linsenmeyer TA, Zorowitz RD (1992) Urodynamic findings of patients with urinary incontinence following cerebrovascular accident. NeuroRehabilitation 2(4):23–26Google Scholar
  15. 15.
    Veis SL, Logemann JA (1985) Swallowing disorders in persons with cerebrovascular accident. Arch Phys Med Rehabil 66(6):372–375PubMedGoogle Scholar
  16. 16.
    Horner J, Massey EW, Riski JE, Lathrop DL, Chase KN (1988) Aspiration following stroke: clinical correlates and outcome. Neurology 38:1359–1362PubMedGoogle Scholar
  17. 17.
    Horner J, Massey EW (1988) Silent aspiration following stroke. Neurology 38:317–319PubMedGoogle Scholar
  18. 18.
    Granger CV, Cotter AC, Hamilton BB, Fielder RC (1993) Functional assessment scales: a study of persons after stroke. Arch Phys Med Rehabil 74:133–138PubMedGoogle Scholar
  19. 19.
    Granger CV, Ottenbacher KJ, Fiedler RC (1993) The Uniform Data System for Medical Rehabilitation: report of first admissions for 1993. Am J Phys Med Rehabil 74(1):62–66CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Tokyo 1996

Authors and Affiliations

  • Thomas W. Findley
    • 1
    • 2
  • Richard D. Zorowitz
    • 1
    • 2
  • Miriam Maney
    • 2
  • Mark V. Johnston
    • 1
    • 2
  1. 1.Department of Physical Medicine and RehabilitationUniversity of Medicine and Dentistry (UMDNJ)-New Jersey Medical SchoolNewarkUSA
  2. 2.Kessler Institute for RehabilitationWest OrangeUSA

Personalised recommendations