In The News

Critical Time Window for Rehabilitation After a Stroke

National Institutes of Health

Every 40 seconds, an American has a stroke. About 750,000 new strokes occur in the United States each year.

Restoring brain function after a stroke remains a challenge. Functional recovery from brain damage requires networks of nerves to adapt and reorganize. This “neuroplasticity” naturally occurs during early development. But studies in rodents suggest that there is a brief period of similarly high neuroplasticity after a stroke. Intensive motor training provided to rodents during this window can lead to nearly full recovery. But no evidence for a similar recovery window in humans has previously been found.

To find out if such a window exists in people, a team led by Dr. Alexander Dromerick of Georgetown University Medical Center and MedStar National Rehabilitation Hospital conducted a randomized phase II clinical trial. NIH’s National Institute of Neurological Disorders and Stroke (NINDS), Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), and National Institute on Deafness and Other Communication Disorders (NIDCD) supported the study. Results appeared in the Proceedings of the National Academy of Sciences on September 20, 2021.

The researchers recruited 72 patients from a rehabilitation hospital in Washington, DC. They randomly assigned participants to one of four groups. All participants received standard stroke rehabilitation therapy. Those in three of the four groups received an extra 20 hours of intensive motor skills therapy. In the first group, the extra therapy began within 30 days of stroke onset. In the second group, extra therapy began 2-3 months after stroke onset. In the third, it began 6-7 months after stroke onset. Participants in the fourth (control) group received no extra therapy.

The researchers assessed arm and hand function at various points before and after treatment, up to 12 months after stroke onset. People in the 2–3 month therapy group showed the greatest improvement one year after their strokes. Participants in the 30-day group showed smaller but still significant improvement. By contrast, participants in the 6-7 month group showed no significant improvement over controls.

“Our results suggest that more intensive motor rehabilitation should be provided to stroke patients at 60 to 90 days after stroke onset,” co-author Dr. Elissa Newport says.

“Previous clinical trials have found few or very small improvements in motor function post-stroke, so our research could be an important breakthrough in finding ways we can make substantial improvements in arm and hand recovery,” Dromerick says.

The results strongly suggest that there is a critical time window for rehabilitation following a stroke. For this study, that window was 2-3 months after stroke onset. Larger clinical trials are needed to better pin down the timing and duration of this critical window. A larger trial could also determine what dose of therapy would achieve the best results during this window.

—by Brian Doctrow, Ph.D.

References: Critical Period After Stroke Study (CPASS): A phase II clinical trial testing an optimal time for motor recovery after stroke in humans. Dromerick AW, Geed S, Barth J, Brady K, Giannetti ML, Mitchell A, Edwardson MA, Tan MT, Zhou Y, Newport EL, Edwards DF. Proc Natl Acad Sci U S A. 2021 Sep 28;118(39):e2026676118. doi: 10.1073/pnas.2026676118. PMID: 34544853.


What Can Providers Give to Patients?

Elizabeth A. Hogue recently sent the series of articles below about what providers can give to patients. Please do not hesitate to contact her at (877) 871-4062 or [email protected] with comments, questions, or requests for additional information.

Copyright, 2021. Elizabeth E. Hogue, Esq. All rights reserved.  No portion of this material may be reproduced in any form without the advance written permission of the author.

Part 1 – Applicable federal statutes and exceptions

Part 2 – Exception for items and services of nominal value

Part 3 – Circumstances under which free items and services may be given to patients who have a demonstrated financial need

Part 4 – Recent OIG guidance regarding incentives to promote COVID-19 vaccination

Part 5 – Exception for preventive items or services

Part 6 – Exception for free items or services that promote access to care

Part 7 – Case example from OIG Advisory Opinion No. 09-11


Pfizer Booster for High-Risk Workers

In a statement released earlier this month, the CDC said that high risk of occupational exposure, such as healthcare workers, may receive the Pfizer booster shot at least 6 months after the two-dose primary series, based on their individual benefits and risks. The agency’s Advisory Committee on Immunization Practices (ACIP) had previously voted 6-9 against recommending a booster in this population.


Home Health Value-Based Purchasing Model Could Mean a Bigger Role for Palliative Care

Home Health Care News

Earlier this year, palliative care advocates were hopeful that a formal benefit for community-based services would be coming soon.

While that hasn’t happened yet, the clear momentum around a reimbursement pathway for community-based palliative care has prompted more home health agencies and other providers to launch programs of their own. That’s a trend likely to accelerate heading into 2022, thanks to the proposed expansion of the Home Health Value-Based Purchasing (HHVBP) Model and recent legislative updates on Capitol Hill



CMS Clarification on Late or Missing Election Statement Addendum

At NHPCO’s request, the Medicare Administrative Contractors (MACs) requested clarification from CMS when a hospice does not provide a requested addendum or does not meet the timeframe requirements. NHPCO has prepared a Regulatory Alert (09/23/21) with the detailed answer from CMS. A summary of the CMS answer: If the addendum is not present or does not meet the requirements, only the claim that is flagged for review would receive a claims denial and it would not invalidate the entire election.

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