Johns Hopkins PM&R at the International Stroke Conference

Drs. Marlis Gonzalez-Fernandez and Richard Zorowitz of the JHU Department of PM&R presented papers at the International Stroke Conference sponsored by the American Stroke Association in New Orleans, LA, on February 20-22, 2008. Dr. Gonzalez-Fernandez presented data to identify regions of interest that might be related to swallowing disorders in acute stroke patients, with a focus on subcortical structures. In 29 acute dysphagic stroke survivors who underwent magnetic resonance imaging (MRI) of the brain within 24 hours, she found that the risk of swallowing disorders significantly increased in stroke survivors who had lesions in the primary somatosensory, motor and motor supplementary areas; the orbitofrontal cortex; the putamen, caudate, and basal ganglia; and the internal capsule. She concluded that studies with larger sample sizes were needed to better elucidate the swallowing control mechanism better define the model of swallowing control.

Dr. Zorowitz used a 5% national random sample of all Medicare beneficiaries to examine the costs and physical therapy and rehabilitation (PTR) utilization in stroke survivors with and without hemiparesis over a 3-year period following their first strokes. In 1,070 stroke survivors and 779 non-hemiparetic stroke survivors, the average Medicare payments during the 3-year period were $75,793 for the hemiparesis cohort and $44,544 for the nonhemiparesis cohort. The hemiparesis cohort incurred significantly higher costs than the non-hemiparesis cohort during the study period over all care settings. Significantly more patients in the hemiparesis cohort received some form of PTR than those in the non-hemiparesis cohort. In the hemiparesis cohort, the costs of PTR incurred in a hospital inpatient setting during the first year, but shifted to skilled nursing facilities and home health agencies in the second and third years. He concluded that long-term care and rehabilitation services constitute a significant proportion of total medical costs, especially in stroke survivors with hemiparesis.

The abstracts are published in Stroke, Vol 39, No.2, pages 548 and 550.