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General Rehabilitation

Is Discharge to Community a Flawed Metric for Rehab Success? A Case Report of Cerebellar Stroke

Thursday, October 23, 2025
5:00 PM - 6:30 PM MT
Location: Open Kiosks

    Primary Author(s)

  • Lilly Lerer, MD

    Resident Physician
    Shirley Ryan AbilityLab
    Chicago, Illinois

    • Poster Presenter(s)

  • Alexandra Wolfe, DO

    Resident Physician
    McGaw Medical Center of Northwestern University (SRAL) PM&R Program
    Chicago, Illinois

    • Co-Author(s)

  • Sangeeta P. Driver, MD, MPH

    Chief of Brain Injury Medicine, Shirley Ryan Abilitylab
    McGaw Medical Center of Northwestern University (RIC)
    Chicago, Illinois

Disclosure(s):
Lilly Lerer, MD: No financial relationships to disclose
Alexandra Wolfe, DO: No financial relationships to disclose
Sangeeta P. Driver, MD, MPH: No financial relationships to disclose
Case Diagnosis: A 45-year-old female with cerebellar stroke is discharged to a skilled nursing facility after making significant functional improvements in acute inpatient rehabilitation.

Case Description or Program Description: Discharge to community is widely recognized as an important outcome in acute inpatient rehabilitation, and is a publicly reported quality metric. For medically complex patients, discharging to the community requires access to significant personal resources. This case explores the benefit of acute inpatient rehabilitation for patients who are unable to discharge to the community, and asks whether some quality metrics can exacerbate health disparities.

Setting: Acute Inpatient Rehabilitation

Assessment/Results: A 45-year-old female with hypertension suddenly developed vomiting and right-sided weakness, and was found to have a cerebellar stroke. Hospital course was significant for vertebral artery occlusion with TNK and suboccipital craniectomy, agitation with use of restraints, exposure keratopathy from left lagopthalmos, and dysphagia with placement of GTube. She was subsequently admitted to acute inpatient rehabilitation. During her course, she made functional improvements in all domains of self care and mobility. She worked with a neuro-optometrist to restore her vision. She received vestibular therapy and had significant symptom reduction. Serial casting for bilateral ankle contractures allowed her to ambulate with minimal assistance. With swallowing techniques, she progressed to a general diet with gtube removal. At discharge, she required supervision for safety and minimal assistance for toileting and bathing. While multiple supportive family members lived nearby, due to their work schedules she could not secure constant supervision. She discharged to a skilled nursing facility.

Discussion (relevance): Acute inpatient rehabilitation provided significant functional benefit to this patient, reducing future morbidity and mortality, and overall care utilization.

Conclusions: Discharge to community for medically complex patients is resource intensive. Over reliance on this metric as a quality indicator for health systems may further health disparities.