Improving stroke care focus of new collaboration

The road to recovery often takes stroke patients through multiple departments at multiple health-care institutions. Their journey can include time spent in inpatient and outpatient treatment and rehabilitation services, seeing radiologists, neurologists, neurosurgeons and rehabilitation specialists.

Stroke experts at Washington University in St. Louis, Barnes-Jewish Hospital and The Rehabilitation Institute of St. Louis (TRISL) are forming a collaborative group to ensure that the participants in this journey communicate and share data to improve patient care and advance the development of new treatments. The group is known as the Brain Recovery Core (BRC).

“At every stage of treatment, clinicians acquire a great deal of quantitative information from stroke patients, but in most institutions, this information is neither standardized nor shared,” says Maurizio Corbetta, MD, the Norman J. Stupp Professor of Neurology and clinical director of the Rehabilitation Institute of St. Louis’ Stroke and Brain Injury Program.


“Because of these failures, patients receive interventions on a case-by-case basis with little reference to prior experiences treating similar patients,” he says. “The BRC’s goal is to collect and use data, such as what cognitive abilities are impaired by a stroke and how well patients are responding to therapy, in order to develop techniques that let us predict the likely course of a patient’s recovery.”

This will allow better clinical decision-making and allocation of resources, according to Corbetta, and make it possible to scientifically assess the effectiveness of new treatments.

Typically, a person having an acute stroke enters the emergency room and is admitted to a stroke unit, where he or she receives tests to determine the stroke’s impact on motor, cognitive and language functions. About 30 percent to 40 percent of patients then enter inpatient rehabilitation. However, tests at the stroke unit are often different from those employed on inpatient treatment units, which in turn may differ from those at outpatient rehabilitation centers, making data sharing and tracking of patients’ progress difficult.

Through the BRC, patients will be followed from admission at the Barnes-Jewish Hospital emergency room; to the stroke unit, which treats more than 1,000 stroke patients every year; to TRISL, a joint venture between HealthSouth and BJC HealthCare; to recovery several months later. Clinicians and researchers involved in stroke care will have access to a well-standardized set of measures that track patients’ progress through the different phases of their care all the way to their full return to home and community.

Gathering information on patients also will become more objective. Therapists who are treating a patient no longer will administer that patient’s assessments. Instead, a therapist from another part of the treatment process who is not involved with the patient will conduct the testing. BRC organizers believe this standardized view of patients’ responses to treatment soon will affect decisions in the clinic.

“As we build the database over time, the treatment team can look at how a patient is doing and predict where he or she will be six months from now,” says Clay Karr, director of inpatient therapy operations at TRISL. “We can make informed decisions about what resources and treatments to use for that patient.”

When the BRC is fully online, researchers can use the standardized, objective data they gather on stroke patients to begin testing new rehabilitation techniques suggested by neuroscience research.

“The goal is to develop a model system of organized stroke rehabilitation across a continuum of care from the acute stroke service to the return to home and community,” says Catherine Lang, PhD, assistant professor of physical therapy, of occupational therapy and of neurology. “None of this could happen if all the players — Washington University, Barnes-Jewish and the Rehabilitation Institute — were not willing to come to the table for these important goals.”