Disease Management Update
Volume V, No. 21
September 18, 2008

Dear Healthcare Intelligence Network Client,

Every 40 seconds, a stroke occurs. That's just one startling statistic from the American Stroke Association. Others: Someone dies of stroke every three to four minutes; one of every 16 deaths each year is from stroke; and Americans will pay about $65.5 billion for stroke-related medical costs in 2008. This week's Disease Management Update looks at what patients are doing to better their health after surviving a stroke.

Your colleague in the business of healthcare,
Laura Greene
Editor, Disease Management Update

Please pass this along to any of your colleagues or, better yet, have them sign up to receive their own copy at http://www.hin.com/freenews2.html where you can also learn about our other complimentary news services.

Table of Contents

  1. Treadmill Exercise Retrains Brain & Body of Stroke Victims
  2. Disease Management Q&A: Geriatric Depression Scale and Mini Mental Status Exams
  3. HealthSounds Podcast: Reducing ADEs
  4. TPA Therapy OK to Lower High Blood Pressure After Stroke
  5. Survey of the Month: Healthcare Trends in 2009
  6. Caregiver Education and Support Programs Provide Positive Impact

1. Treadmill Exercise Retrains Brain & Body of Stroke Victims

People who walk on a treadmill even years after stroke damage can significantly improve their health and mobility, changes that reflect actual "rewiring" of their brains, according to research spearheaded at Johns Hopkins University School of Medicine.

The study's results suggest that patients' brains may retain the capacity to rewire through a treadmill exercise program months or years after conventional physical therapy has ended. Researchers recruited 71 patients who had a stroke at least six months earlier, with an average time lapse of nearly four years. At the study's onset, half of the subjects could walk without assistance, while the rest used a cane, a walker or a wheelchair. All of the subjects were separated into two random groups regardless of disability. One group then participated in an exercise program that principally involved walking on a treadmill three times a week for up to 40 minutes, assisted by a supporting sling and tether if needed. Physical therapists assigned to each subject increased the intensity of the workouts over time by increasing the treadmills' speed and incline, though the workouts never taxed the patients beyond a moderate level of 60 percent VO2 peak. With the second group of patients, therapists assisted the patients in performing stretching exercises for the same period of time.

After six months, patients were again tested for walking speed and VO2 peak, and the same group who had undergone fMRI was rescanned. Walking speed for the treadmill group increased 51 percent compared to about 11 percent faster for those in the stretching group. Ground walking speed among the treadmill exercisers increased 19 percent, compared to about 8 percent for the stretchers. The treadmill exercisers also were significantly more fit at study completion, with VO2 peak increasing by about 18 percent. VO2 peak decreased slightly in the stretching group.

"This is great news for stroke survivors because results clearly demonstrate that long-term stroke damage is not immutable and that with exercise it's never too late for the brain and body to recover," says Daniel Hanley, M.D., professor of neurology at the Johns Hopkins University School of Medicine.

To learn more about this research, please visit:

2. Disease Management Q&A: Geriatric Depression Scale and Mini Mental Status Exams

Each week, healthcare professionals respond to a reader's query on an industry issue. This week's expert is Gregg Lehman, Ph.D., president and chief executive officer of INSPIRIS at time of contribution and current president and CEO of Minneapolis-based HealthFitness Corp.

Question: How do you conduct your geriatric depression scale and mini mental status exams on the frail elderly? Is it telephonic? When depression is diagnosed, what steps are taken to address it?

Response: (Gregg Lehman) In many cases we work with the attending physician. When we do our assessment and identify depression, for example, we evaluate the patient, the degree of impairment and the medications. It’s important to determine if the medications are appropriate. This is a coordinated effort between the physician and the nurse practitioner.

The evaluation is conducted on site at the bedside. This frail elderly population often does not have a telephone in their room because of their high levels of dementia or cognitive impairment. In many cases, we can only do the evaluation face to face.

For more details on coordinating care transitions for the elderly, please visit:

We want to hear from you! Submit your question for Disease Management Q&A to info@hin.com.

There are other free email newsletters available from HIN!

HealthSounds Podcasts delivers a free weekly audio interview with a healthcare innovator to your e-mailbox. Listen to thought leaders answer key questions about the most pressing issues and trends in healthcare — impact of retail clinics, implications of Web 2.0 for healthcare, medical home models and much more.

To sign up for our free email newsletters, please visit http://www.hin.com/freenews2.html

3. HealthSounds Podcast: Reducing ADEs

Leanne Huminski, chief nursing officer, McLeod Regional Medical Center, comments on capitalizing on computer technology, McLeod's initiatives for eliminating adverse drug events (ADEs) and the role health IT is playing in reducing ADEs.

To listen to this complimentary HIN podcast, please visit:

4. TPA Therapy OK to Lower High Blood Pressure After Stroke

Patients who require aggressive therapy to lower their blood pressure following a stroke do not appear to be at a higher risk for bleeding or other adverse outcomes after receiving anti-clotting therapy, according to a study done by researchers at The University of Texas Medical School at Houston. The research findings could translate to a treatment option for as many as 10 percent of patients with acute ischemic stroke who previously would have been ineligible to receive tissue plasminogen activator (tPA) because of high blood pressure.

Researchers reviewed the medical records of 178 patients with acute ischemic stroke who received intravenous tPA within three hours at Memorial Hermann - TMC. Of these, 50 required treatment for lowering blood pressure before beginning tPA therapy. This included 24 (48 percent) who received the medication nicardipine, either alone or in combination with the drug labetalol.

“We observed several important differences between patients who required blood pressure–lowering treatment and those who did not,” the authors wrote. “They had more severe strokes and their blood glucose concentration was higher, predicting they would have a worse outcome if all other factors were equal. As expected, they more frequently had a history of hypertension.”

After controlling for these factors — including age, baseline stroke severity and blood glucose levels — there were no differences between patients who received antihypertensive treatments and those who didn’t in adverse events, poor outcomes or stroke severity scores at discharge.

“Overall, the results of the present study provide the first experimental support for the revised American Heart Association guidelines allowing tPA therapy in patients requiring aggressive blood pressure management and also provides support for the use of nicardipine in patients with acute ischemic stroke who are eligible for thrombolytic therapy,” the authors concluded. “Aggressive control of severely elevated blood pressure is feasible and should not automatically exclude otherwise eligible patients with acute ischemic stroke from receiving thrombolytic therapy.”

To learn more about this research, please visit:

5. Survey of the Month: Healthcare Trends in 2009

A faltering economy, a presidential election and a number of other factors continue to drive changes in the healthcare industry. Want to know how other healthcare organizations are preparing for what the healthcare industry will bring in 2009? Complete HIN's Survey of the Month on Healthcare Trends in 2009 by September 30 and you’ll get a free executive summary of the compiled results.

To participate in this survey and receive its results, please visit:

6. Caregiver Education and Support Programs Provide Positive Impact

According to statistics by the Family Caregiver Alliance, approximately 52 million informal and family caregivers provide care to an adult that is ill or disabled in the United States. The majority of caregivers are 35 to 64 years old, and an estimated 60 percent are also working outside the home. A proactive approach to this growing dilemma through caregiver education and support programs allows employers to provide an invaluable benefit, while increasing employee loyalty and productivity.

To download this complimentary white paper, please visit:
Contact HIN:
Editor: Laura M. Greene, lgreene@hin.com;
Sales & Marketing Coordinator: Deirdre McGuinness, dmcguinness@hin.com;
Publisher: Melanie Matthews, mmatthews@hin.com

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