29 May 2013

Kickstart Walking System is game-changer for stroke victims

Story originally appeared on Mercury News.

SAN JOSE -- Albert Azizian had used a wheelchair to get around for more than a decade after suffering a debilitating stroke. When he did walk, a good day was making it from one room to another, dragging his right leg.

But Sunday morning, Azizian stood tall and took confident steps at the Fight Stroke Walk. Wearing a new assistive device called the Kickstart Walking System, Azizian proudly strode a half mile around the San Jose Municipal Rose Garden.

"I couldn't do this a year ago," said Azizian, 60, of Milpitas, with a wide smile. "There's been so much improvement. I'm walking so much more now."

Azizian and Redwood City's Donna Jang used the annual event to show off a device that has helped them regain a level of independence both thought had been gone forever. But all 650 participants who gathered on the cool morning to raise $135,000 for the Santa Clara County-based Stroke Awareness Foundation had been struck by the malady to some degree.

Some were survivors. Others were walking for someone who no longer cannot.

Nearly 800,000 Americans each year suffer a stroke -- which occurs when blood flow to the brain suddenly is interrupted. It is the country's No. 4 cause of death. But there also are an estimated 7 million stroke survivors in the U.S., and about two-thirds of them are disabled.

"Most people know someone who has had a stroke," said Pamela W. Duncan, a stroke researcher and professor of neurology at Wake Forest Baptist Medical Center in Winston-Salem, N.C. "And while stroke can be devastating, most people suffer mild ones. It's not just grandma always ending up in the nursing home. People do regain their lives."

Tough but effective

But rehabilitation therapy can be a grueling process. Consider Azizian, who in 2000 had a stroke so severe that doctors initially thought it would take his life.

"I refused to die," said Azizian, a former engineer who has an infectiously cheerful demeanor. "I had more life to live. Eventually I started getting better, but it didn't come overnight."

It took two years to relearn how to speak. Initially paralyzed throughout the right side of his body, it would be five years before he could move his arm or stand. For the last 11 years, Azizian has gotten around largely by wheelchair because his right leg was incapable of a normal stepping motion.

Because he ended up with significant weakness in his hip flexor muscle, Azizian was a good candidate for the Kickstart system, said Brian Glaister, co-founder of Seattle-based Cadence Biomedical.

"It's a common story with stroke survivors," Glaister added. "You go through therapy and you make good progress. But everybody plateaus at some point, and that's often because of the hip flexor."

The custom-fitted device resembles a leg brace and was designed to be low-tech with no motor, battery or electrical parts. It functions with a spring, pulley and cable system. The spring stretches and briefly stores energy when the wearer begins a step, and then it's released to help lift the leg and propel it forward for a more natural stride.

"When they told me they have something that might help me walk, I said, 'I would do anything to walk again. Anything!' " Azizian recalled. "When you're stuck in a wheelchair, you can feel sad because you can't do many of the things you want. ... Now, I can lift my leg better so I can walk."

Dream again

About three dozen of the Kickstart systems are in use so far, and Glaister said the cost varies depending on how much medical insurance will cover.

Wake Forest's Duncan said while there has been promising results for an array of assistive systems -- ranging from robotic devices to electrical stimulation of muscles -- there is not yet overwhelming evidence which ones will be helpful for most stroke survivors.

"But getting people up and working is the key," she added. "So giving patients the support they need to do that is important because research has shown very clearly that you can experience recovery after a stroke. A product like this has a place when someone needs to activate the leg and assist them to move forward."

Jang is sold. An angel investor, she has put money into the company. She suffered her stroke in 1992 and used a Segway to get around for the last five years. But now she has begun taking ballroom dancing lessons with her husband.

"We're doing the cha-cha," said Jang, 61. "I never thought I was going to dance again. Most stroke victims forget how to dream big."

Sunday, though, Jang and Azizian walked together and frequently heard encouragement from other participants.
"Pretty good, don't you think?" said Azizian, beaming.

State says 6 insurance carriers submit plans for exchange

Story originally appeared on the Chicago Tribune.

Six insurance carriers submitted 165 separate health insurance plans to be offered on the Illinois Health Insurance Marketplace, the online exchange where individuals and small businesses in October can begin buying coverage that begins next year, state officials said Wednesday.

The state did not say which insurers submitted the health plans, which must first be vetted by state and federal regulators to ensure they comply with new rules and regulations.

Almost a million Illinois residents will be eligible for a new federal income tax credit to help offset the cost of buying health insurance, a key component of President Barack Obama's health care overhaul that requires individuals to carry health insurance or pay a penalty. To receive the point-of-sale credits, consumers must buy health insurance through the exchange.

State officials expect about 486,000 Illinoisans to purchase health coverage via the exchange next year, which will be operated in a partnership between the state and federal governments in its first year. The state projects as many as 1.3 million in the state will buy an exchange-based product by 2017.

"I am very encouraged that we have seen multiple plans being offered on the Illinois Health Insurance Marketplace," said Gov. Pat Quinn, in a statement. "This means that people and families that have been struggling to obtain health coverage will have many options to choose from when we begin the open enrollment process."

Blue Cross and Blue Shield of Illinois, by far the state's largest insurer in terms of market share, and Land of Lincoln Health, one of 24 new health insurance cooperatives approved by the federal government, each have committed to offering plans on the Illinois exchange, though neither insurer would say Wednesday afternoon how many plans they submitted or in which coverage levels.

Land of Lincoln, which received $160 million in federal funding in December to form a consumer operated and oriented plan, or co-op, got the official go-ahead from Illinois regulators this week to sell health plans starting in 2014.

The number of plans submitted is short of the amount the state estimated earlier this year. Officials previously said as many as 400 commercial insurance products could be offered on the exchange.

Some of the nation's largest insurers, including Aetna Inc., UnitedHealth Group Inc. and Humana Inc., declined to say whether they submitted plans in Illinois. Aetna and Humana executives each said this week that the insurers plan to participate in exchanges in 14 states, though neither company revealed which.

Aetna Chief Executive Mark Bertolini said Tuesday in a conference call with Wall Street analysts that the company has filed applications to sell insurance plans in some of those states, and noted that premium rates in some regions reflect contracts that Aetna has negotiated with hospitals and doctor groups. Those contracts are priced between Medicare rates and the higher private commercial rates, he said.

Humana said Wednesday it plans to participate in health insurance exchanges in states where it already has a strong network of contracts with hospitals and doctors.

United, meanwhile, has only said that it was considering submitting exchange-based plans for consideration in 10 to 25 states.

Another major Illinois insurer, Centene, which operates IlliniCare, a coverage plan for the state's Medicaid program, also would not say whether it submitted plans to be included on the exchange.

All plans in the Illinois insurance exchange must provide a baseline level of coverage, dubbed essential health benefits. Mandated items and services fall under 10 categories, including ambulatory care, prescription drugs and laboratory services.

Plans on the exchange also must adhere to strict financial limits set for the actuarial value of each product, or the percentage of the cost of benefits they will pay.
Those requirements limit the variety of products insurers can offer, which the government hopes will spur more competition on cost.

The plans insurers submitted to the state include financial details, like monthly premiums, deductibles and copayment amounts, though neither the insurers nor the state would reveal those figures. Illinois expects to complete its review of the plans by late July.