185 thousand people in Italy are affected by strokes every year and 45 thousand survive with highly disabling outcomes, with 1 in 4 patients complaining of a poor quality of life in post-rehabilitation. Because, although there are about 200 Stroke Units among the most efficient in the world in our country, there is a gap in rehabilitation. To report it is ISA | AII Italian Stroke Association – Italian Stroke Association, on the eve of 29 October, world day against stroke, which relaunches the “Strike on stroke” project.
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The Pdta for rehabilitation and the Drg for spasticity are missing
About a hundred more Stroke Units would be needed on our territory, says the President of ISA | AII Mauro Silvestrini, but this is not the only problem: “Only 18% of patients undergo recovery treatment – he underlines – while spasticity, present in about 19% of cases 3 months after the stroke and from 17 % to 38% one year after the acute event, sees less than 10% of patients treated compared to those who would be candidates for therapy: only 5,000 out of 55,000 ”. And it is precisely post-stroke spasticity, characterized by a pathological alteration of muscle tone, does not yet have its own DRG that allows it to be inserted into dedicated paths, despite the botulinum toxin, used for its treatment, both in the Essential Levels. of Assistance (LEA). “In 2 out of 3 cases – continues Silvestrini – the Diagnostic-Therapeutic Assistance Pathways (PDTA) and regional protocols for sending to dedicated rehabilitation departments are missing”. The difficulty in accessing care and this inhomogeneity in procedures cause enormous delays, when instead time is “the” determining factor for stroke, both in the acute phase and in the days following diagnosis.
The Strike on Stroke project
The “Strike on Stroke” campaign aims to raise awareness among clinicians and patients themselves on the disease and on the need to administer and receive, respectively, the right therapies. “The project was born in 2021 and we decided to relaunch it this year – says Paola Santalucia, President-elect of ISA | AII: “Interviews will be carried out with the specialists who revolve around the Neurovascular Unit, such as neurologists, neuroradiologists, physiatrists, nurses, speech therapists, clinical nutritionists, cardiologists and, in a broader vision and governance, with heads of the Hospital Health Departments and Regional Regulatory Bodies, and obviously patients will be involved. The goal is to draw up proposals for overcoming the current critical issues, which will be collected and relaunched through ISA’s social channels “.
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Obstacles, difficulties, barriers
People with stroke often have a sensorimotor disability and a multitude of cognitive, emotional, and relational consequences. “But in addition to the obstacles they encounter with respect to therapies and treatments, in Europe they are forced to confront every day with visible barriers such as architectural ones and invisible as the stigma that persists around the disease”, says Francesca Romana Pezzella Secretary of ISA-AII and co- chair Action Plan in Europe by ESO | European Stroke Organization: “We ask member states to develop coordinated national stroke plans, to finance, implement and monitor them”.
The role of telemedicine
The “Strike on stroke” campaign therefore aims to request urgent actions to raise awareness of the disease at a social level and improve the health services available to patients, both for the acute phase and during the rehabilitation period. “In both scenarios – continues Pezzella – a great help can come from telemedicine, which makes it possible to share patient data in real time. In Lazio, for example, we use a platform through which the spoke centers in the area can send images to the Hub center, and which allows us to give consultations that are recorded on the patient’s medical record or give indications for her transfer “.
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Symptoms and the importance of the time factor
It remains essential to keep the attention on the symptoms high, in order to be able to intervene as soon as possible. Minutes can save lives is, in fact, also this year the theme of the World Stroke Day. “For every second that passes after the attack, 32 thousand neurons are burned and 1.9 million for every minute”, recalls Nicoletta Reale, past president of ALICe., Association for the Fight against Cerebral Stroke: “80% of all cases can be avoided by treating the pathologies that can lead to stroke and by modifying one’s lifestyle”. So what are the signs that should alert us? “Crooked mouth, difficulty speaking and understanding, loss of balance, reduction or loss of strength in the limbs of one half of the body, impaired vision – replies Danilo Toni, Past President ISA | AII – are all highly evocative symptoms of an ongoing stroke. In this case it is necessary to immediately call 118 which will take the patient to the Neurovascular Units, equipped centers with specialized teams ”.
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The new “Strike on Stroke” awareness campaign is realized thanks to the unconditional contribution of Ipsen SpA: “We are proud to support” Strike on Stroke “- comments Patrizia Olivari, President and CEO of Ipsen SpA: Our goal as a company is to continue to collaborate with the main stakeholders to support the development and updating of policies that can improve and simplify the vital path of rehabilitation “.