The Stroke Tsunami: Is Your Clinic Prepared?
By Charles Remsberg, CEO
Tibion Corporation
Four years ago, neurologist Conrado J. Estol, writing in International Journal of Stroke, drew a powerful analogy between the December 26, 2004 tsunami that swept through Southeast Asia, leaving more than 280,000 dead or missing, and what he forecast as a “stroke tsunami” threatening the industrialized societies.
The analogy fails, of course, because, as Estol noted, the Southeast Asian tsunami came with no recognizable warning. By contrast, the stroke tsunami has been preceded by decades of escalating statistics of known stroke risk factors. Fewer than half of all patients under treatment for hypertension have their blood pressure under control. Almost a third of Americans are clinically obese, and almost the same fraction have pre-diabetic insulin resistance.
The stroke tsunami might be expected to hit with full force as the baby-boomer generation hits retirement age. But statistics suggest it might come earlier: Almost a third of all strokes occur in people between the ages of 45 and 64, at the peak of their earning years. The challenge to handle this tsunami’s acute victims will severely tax our ICUs and post-acute care facilities.
Not only will this tsunami challenge our already overburdened healthcare system, it will hit our economic system. It will move hundreds of thousands of taxpayers per year onto the rolls of the disabled and unemployed. Our current epidemic of post-recession unemployment will soon pass, and when it does, the loss of these seasoned and experienced workers/taxpayers will be painfully obvious.
However, as the economic impact of the Southeast Asian tsunami was most painful in the reconstruction period that followed, the most challenging period of the stroke tsunami will be in the post-acute rehabilitation period. Already today, approximately 50% of the nearly 6 million Americans living with a history of stroke struggle with a hemiparetic gait (CDC).
It would be nice to believe we could do something to halt the hypertension, Type 2 diabetes, obesity, and other diseases that precipitate stroke. But even if all the obese went on diets, the hypertensives took their meds, and the pre-diabetics started serious jogging, the stroke tsunami would not recede for 20 or more years. The stroke tsunami would continue – as would the need for much-improved stroke rehabilitation.
Advances in thrombolytic therapy and other acute stroke interventions show evidence of increasing the survival of stroke patients after a CVA. What is needed – and what Tibion has focused on – is improving the efficacy of rehabilitation in the post-acute and chronic periods.
Kollen and colleagues, after thorough analysis of many studies of Bobath and other stroke rehabilitation techniques (Stroke. 2009;40:e89), concluded that no form of conventional stroke therapy may actually impact functional gait recovery. Early experience with the Tibion Bionic Leg suggests it may be the first to do so. On this website, and in succeeding blogs, my team and I will discuss examples of that impact.