Friday, May 2, 2014

Virtual reality games may improve stroke recovery

Virtual reality games that challenge balance may speed recovery after a stroke, a new study suggests.

The exercises appear to be a relatively inexpensive way to improve people’s ability to balance and walk following a stroke, Dr. Hillel Finestone, the study’s senior author, told Reuters Health.
Finestone directs Stroke Rehabilitation Research at Elisabeth Bruyere Hospital in Ottawa, Ontario, Canada. His small study found that stroke rehabilitation patients who played virtual reality games while on their feet could walk a little farther and maneuver a little faster than patients who sat through the exercises.

“We showed that people do improve,” Finestone said. “We saw improvements in balance. It’s not the be-all, end-all, but we see a good potential.”

For their study, the researchers randomly divided 59 patients who had recently suffered a stroke into two groups.
With the help of therapists, people in both groups participated in a series of 10 to 12 virtual reality gaming sessions lasting 20 minutes each over three weeks.

One group stood to play the games and the other sat. Games included soccer goaltending and snowboarding and were designed so that people standing needed to shift their weight by leaning and reaching to succeed.

The mobility of participants in both groups improved, but the standing participants saw larger gains. Following the therapy, people in the sitting group added 70 feet to the distance they could walk in two minutes, while the standing players added 111 feet, on average, the authors found.
Finestone said that difference could mean a recovering stroke patient being able to walk from his or her living room into the kitchen.
Standing virtual reality participants also shaved more time off a standard test of mobility that requires a participant to get up out of a chair, walk to a line on the floor and then return to the chair.
But Dr. Kara Flavin, from the Stanford School of Medicine in California, told Reuters Health the study didn’t convince her that investing in a virtual reality program would pay off in significant improvements for stroke patients.

“I definitely would want to see more data before I would incorporate it into my practice,” said the physical medicine and rehabilitation specialist, who wasn’t involved in the new research. “If I brought this study to the hospital administration, they wouldn’t be jumping to buy it for me.”

More than 795,000 Americans have a stroke each year, and nearly 130,000 of them die, according to the Centers for Disease Control and Prevention. Stroke is a leading cause of serious long-term disability, and survivors often battle paralysis, speech problems and confusion.

Once just toys for kids and teenagers, videogames have been incorporated into a variety of physical rehabilitation programs. Prior studies found virtual reality exercises improved recovery among people with traumatic brain injury and adolescents with cerebral palsy, the authors of the current study write in Stroke.

A 2011 Canadian review on virtual reality technology hinted that it might help stroke patients recover (see Reuters Health story of May 4, 2011 here:

Finestone and his team hypothesized that patients who stood and participated in the intensive virtual reality exercise program would recover movement faster than patients who sat through the exercises.

“We did show some improvement, and it was safe and feasible,” Finestone said. “It’s giving people hope that we can do this.”

Stroke patients might be able to play videogames at home, but they would need to be specially designed to help them recover, he said.

“We’re hoping we can put this into communities,” Finestone said. “We need to organize it and package it properly.”

SOURCE: Stroke, online April 24, 2014.

CMS: We intend to set ICD-10 date for October 1, 2015

Author Name Jennifer Bresnick
In an email update, CMS has finally broken its silence on the ICD-10 delay with a message that will provide some relief for providers still questioning the future of the new code set: the department intends to release guidance officially mandating October 1, 2015 as the new implementation date.
“On April 1, 2014, the Protecting Access to Medicare Act of 2014 (PAMA) (Pub. L. No. 113-93) was enacted, which said that the Secretary may not adopt ICD-10 prior to October 1, 2015,” the short news update says. “Accordingly, the U.S. Department of Health and Human Services expects to release an interim final rule in the near future that will include a new compliance date that would require the use of ICD-10 beginning October 1, 2015. The rule will also require HIPAA covered entities to continue to use ICD-9-CM through September 30, 2015.”
While many stakeholders suspected that CMS would indeed set the new date for October 1, the confirmation is the first real communication from CMS, whose silence has sparked a whirlwind of speculation and a great deal of frustration.  Providers and professional organizations alike have expressed disappointment and trepidation over the surprise delay, snuck into HR 4302 with no discussion or debate.
In the weeks since Congress enacted the ICD-10 delay, CMS has had to recalibrate its timelines, adjust its guidance, set a new direction, and deal with the undoubtedly significant sting of having the rug pulled out from under them.  Up until the very moment President Obama signed the bill, CMS was pushing hard for industry-wide compliance by 2014.
Perhaps the most interesting feature of the new announcement is the language that will require healthcare entities to continue using ICD-9 all the way up until ICD-10 comes into effect.  Many providers have expressed a wish to voluntarily move to ICD-10 before the mandated date in order to make best use of their resources and reduce the burden on organizations that prepared for 2014 in good faith.  If providers are not allowed to move forward according to the new plans formed during CMS’s silent period, the department may be facing even more discontent than they are at the moment.
The pushback is also expected to be a financial blow to providers who have already allocated resources to the transition, but may give vendors more opportunities to prepare their products and ensure a more successful switch.
“In 2012, CMS estimated the cost to the health care industry of a one year delay to be as much as $6.6 billion, or approximately 30% of the $22 billion that CMS estimated had been invested or budgeted for ICD-10 implementation,” the Coalition for ICD-10 wrote in a letter to CMS earlier in April, urging Administrator Marilyn Tavenner to announce the new compliance date.
“A 30% cost increase due to a one-year delay is consistent with the experience and observations of the coalition members. Continued uncertainty relative to the ICD-10 implementation date will add significant demands on limited resources and will measurably increase the overall cost of completing the transition.”