VA Maryland Health Care System
CARF International Revises Standards for Stroke Rehabilitation Using Research Findings by VA Marylan
(BALTIMORE, Md.) – Stroke survivors worldwide can expect a change in stroke rehabilitation treatment now that the Commission on Accreditation of Rehabilitation Facilities-International (CARF- International), an independent, non-profit accreditor of health and human services, has published a revised set of recommendations for best care for Stroke Specialty Program standards, effective June 30, 2011.
Patients, health care providers, researchers and other stakeholders participated in the development and review of the CARF’s new stroke standards in a process guided by the rehabilitation field. A body of research conducted at the at Veterans Affairs (VA) Maryland Health Care System, which demonstrated that structured exercise results in optimal health improvements for stroke survivors in a variety of areas, also contributed to the development of the new standards. “We at the VA Maryland Health Care Maryland System are proud of the work that our researchers are doing on stroke rehabilitation,” said Dennis H. Smith, director of the VA Maryland Health Care System.
“Stroke is one of the leading causes of long-term disabilities in the U.S. Two-thirds of stroke survivors are left with persistent neurological deficits, chiefly the hemiparetic gait that limits mobility and increases the risk of falls. These deficits often lead to a sedentary lifestyle that propagates physical disability through physical de-conditioning,” said Richard Macko, MD, one of the lead investigators of the stroke studies and the director of Rehabilitation Research & Development at the VA Maryland Health Care System’s Exercise & Robotics Center of Excellence (MERCE), associate director for the Research, Geriatrics Research, Education, and Clinical Center (GRECC) at the VA Maryland Health Care System, and professor of neurology, medicine, physical therapy & rehabilitation science at the University of Maryland School of Medicine.
“Increasing evidence links exercise for people with chronic stroke to the preventive benefits of improved cardiovascular health, physical fitness and ambulatory function,” says Dr. Macko. “Despite the potential health benefits to chronic stroke survivors offered by increased exercise, there is limited experience translating this research into community-based exercise alternatives adapted specifically for the needs of stroke survivors.”
A constellation of studies, some in collaboration with the University of Maryland School of Medicine, University of Maryland Baltimore County, National Institutes of Health, Italian Health Authority and other academic and human health service partners over more than a 20-year period, has found that structured physical activity improves elements such as gait and balance for stroke survivors, including those more than 10 years past their initial stroke event, an evidence-based way to fight back against the disability of stroke.
“Structured exercise or physical activity has been shown to prevent diabetes, improve vascular and brain function, and prevent the de-conditioning of muscles resulting from stroke,” Macko said. Studies using structured exercise programs that encompass cardiovascular training and mimic mobility activities of daily living have been found to improve impairment and reduce risk factors for having another stroke. The structured exercise programs have been successfully exported to community and senior citizen centers in Howard County, Md., and Italy, and plans are afoot to duplicate the exportation in Baltimore County, Md., Puerto Rico, and Jamaica, where stroke imposes an especially high public health burden to minorities. Studies also demonstrate that physical activity addresses the ancilliary outcomes of stroke such as physical inactivity and social isolation. The VA Maryland Health Care System plans to augment the study and treatment of stroke with a new Robotics Research Center at its Loch Raven VA campus.
“Many people spend an hour in the gym three times a week. There are no reasons that chronic stroke survivors can’t exercise for fun and all around physical health,” said Mary Stuart, ScD, a VA investigator and the director of Health Administration Public Policy at the University of Maryland Baltimore County, a principle investigator of one of the randomized controlled studies that has recently been increased to $1 million. “The study addresses social isolation and depression that plagues chronic stroke survivors because participants attend three, hour-long sessions per week, which fosters social interaction that can lift depression, and helps keep people exercising for the long-term,” she added.
Plans are now being made for the new standards for stroke rehabilitation treatment to be rolled out at the VA medical centers in Maryland, West Virginia and Washington, DC.
“Current research evidence that exercise programs combined with educational programs for stroke patients and their families have shown to be the most effective rehabilitation for individuals who have sustained a stroke,” says Christine M. MacDonell, CARF’s managing director of Medical Rehabilitation. “The new standards address stroke rehabilitation treatment throughout the phases of stroke care.”
Christine MacDonell from CARF will join Drs. Macko and Stuart at a conference in Atlanta, Georgia on Oct. 15, 2011 to discuss how the new standards could be implemented worldwide. CARF International accredits health and human service providers, including organizations providing stroke rehabilitation in the US, Canada, Europe, Asia, South America, the Middle East. More than 6,000 CARF-accredited organizations served more than 8.7 million people in 2010. For more information about CARF International visit http://www.carf.org/home.
Back to the 2011 News Releases Index
