Rehabilitation and Functional Evaluation of the Stroke Survivor in New Jersey

Summary

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.