Sheikh Khalifa Stroke Institute at Johns Hopkins: Transforming the Care of Patients With Stroke: Lessons Learned.

Abstract

The Sheikh Khalifa Stroke Institute (SKSI) at Johns Hopkins is pleased to present this supplement to the American Journal of Physical Medicine and Rehabilitation. We appreciate the opportunity to describe the experiences that the institute has had in pursuit of its mission. Our mission is to “transform the care of patients with stroke to facilitate optimal recovery and ultimately prevent or reduce disability.” With this in mind, a large, multidisciplinary team from Johns Hopkins and Abu Dhabi embarked on numerous activities including revising current approaches; educating patients, families, and healthcare professionals; testing novel interventions; and performing research to address knowledge gaps. These efforts targeted the entire spectrum of stroke care, from early identification to recovery and rehabilitation. In this supplement, we compiled and present most of these experiences. We want to emphasize, however, that the work is not complete. Many activities are still on the way, with additional opportunities opening up as we progress on our mission to transform the care for stroke patients. We launch this issue with a presentation of the “unified model of stroke care” that we have developed and used as a guiding principle in the SKSI. This is then followed by a series of articles that focus on specific innovations and strategies developed and implemented in the acute stroke unit. These progress from changes in the acute neurological management to the development of an acute rehabilitation team that intervenes early after stroke and to deliver appropriately titrated comprehensive rehabilitation interventions. This transformational approach, focused on restoration of neurological function from the very onset of the stroke, requires the careful coordination and complimentary effort of both a neurological and a rehabilitation team working synchronously in the acute stroke unit. We followed this section with a manuscript highlighting the current stroke care situation in Zambia. This is important because it denotes the differences and gaps from a country with fewer resources than in higher-income countries like the United States. Describing these different realities should encourage those in the first world to be appreciative of the expanded opportunities for stroke treatment, and it also highlights the need to develop interventions that can be deployed for the entire planet. We believe that there is an urgent need to share resources to help improve the conditions in underserved regions of the world. After this, we describe in detail the innovations occurring in the acute stroke unit, highlighting the details on early stroke management, the experience developing a safe space for socialization, and the effects of baseline functional levels, rehabilitation interventions, and stroke severity on long-term cognition. We then review how we developed and implemented a comprehensive rehabilitation team that delivers rehabilitation interventions geared to reduce impairment from the moment of stroke onset. This transformational development requires not only the carefully orchestrated coordination of a very large, multidisciplinary team but also the design of interventions that can be titrated to the specific patients in their different conditions at their right time. The third section of this supplement presents several innovations in the rehabilitation front that were triggered and consolidated by support through the SKSI. Here, we describe the development of the infrastructure that supports precision rehabilitation approaches to stroke care. Critical to this is how measuring human function at the physical (mobility), cognitive, and psychosocial levels allows the creation of subgroup of individuals that are likely to respond differently to medical and rehabilitation interventions. This is expanded by the description of a novel approach to measure human movement using basic and ubiquitous cameras (i.e., on a cell phone) paired with open pose software applications that allow the rapid quantification of kinematics. We then present how different technologies can be appropriate to different patients at different times in their recovery process. This section also includes the critical considerations that allow the care of patient throughout the continuum of care as well as operational and financial realities required to implement the SKSI rehabilitation approach in the Johns Hopkins healthcare system. Finally, this section describes the program we have developed to deliver noninvasive brain stimulation in the ambulatory rehabilitation setting as well as our preliminary experiences in this area. We are very appreciative to Sheikh Mohammed bin Zayed Al Nahyan, President of the United Arab Emirates, the Abu Dhabi ruling family, and the government of Abu Dhabi, acting through its embassy in Washington, DC, for their transformative gift that allowed the creation of the SKSI at Johns Hopkins. Without their vision, none of the work described in this supplement would have materialized. We are also very thankful to all the contributors to this issue and their willingness to share their respective expertise. It is our hope that colleagues in the neurology and rehabilitation fields who are dedicated to the care of patients with stroke will find this issue helpful as they explore new treatment approaches for their patients. We also hope that this issue may ignite new research ideas to continue improving and transforming the care of patients with stroke as well as other neurological conditions.