The Case for Replication

Quotation from the Congressional Record.A quotation from a speech by Congressman Sam Farr from the Congressional Record of the 107th Congress: ". . . as a result of this meeting, the Cabrillo College Stroke Center has been designated a federal demonstration project. Mr. Speaker, it is my hope that stroke centers like it will spring up across the nation.

It is much easier to make the case for replication at the beginning of the 21st century, than it was to make the original case for the Center 30 years ago. Demographic, social and economic changes, combined with the increase in knowledge about the rehabilitation process mandate that innovative changes be made in our health-care system. The Center’s long history (detailed in the next section of this website) of innovation and rehabilitation success can almost make the case alone.

Cartoon showing broken health care system.Broken Health Care System: There is no longer any question that America is reaching a tipping point in healthcare where the system, as we know it, is no longer sustainable. Costs are continuing to rise; increasing numbers of services are being cut or constrained; and there are just too many people that are uninsured to maintain a healthy population. We need to find cost-effective and, more importantly, service-effective methods of meeting health care needs. The Center model is a powerful example of a partial solution to the problems posed by increasing demands for long-term rehabilitation.

Changing demographics are making the looming healthcare crisis more dire. With the aging of the baby boom generation, the need for more services instead of less will quite probably break the system entirely unless fresh thinking is brought to fore. Just as the 60s were an era of youth, the 90s an era of adults, the first decades of the new century will be an era of seniors.

The advances of medical science and its commitment to keeping people alive mean that more and more of individuals are differently-abled. Accommodations are becoming increasingly important to many.

Half of people over 40 and 73% over 75 have functional disabilities. These numbers will only increase; as will the numbers of those who require more extensive rehabilitation services. All those who could benefit from rehabilitation now are not being served. When more people require services, the choice can only be further rationing of service or innovative solutions. Innovative solutions is the only ethical choice.

The aging of the boomer and the looming crisis in healthcare are certainly sufficient reasons for serious consideration of replicating models like the Center. The wealth of new findings and advances in rehabilitative medicine and psycho-social treatment modalities only strengthen the case.

Over the years, stroke clubs, similar to the one that gave birth to the Center have multiplied and flourished. Given an opportunity they too could become full blown rehabilitative services. The model is there.

The scientific findings about the power of social support and new research in positive psychology and quality of life underscore the importance of rehabilitative communities as extensions of medically based rehabilitation centers.

The Center is Replicable

The Center provides a unique, cost effective solution to the challenges of long term rehabilitation. And, it is replicable. The DeAnza Foothill Community College District successfully replicated the program ten years ago. The model for the program at Foothill College came directly from the Cabrillo model. It was founded by Linda Dinuchi, who had worked as a speech therapist at the Center and took the model to the neighboring county. The program , known as the REACH Program, has evolved somewhat differently and has confined its services to individuals with stroke.

Other Non-traditional Programs

There are very few examples of non-traditional rehabilitation programs reported in the literature. This finding alone emphasizes the uniqueness of the Center. Kernich and Robb (Kernich and Robb 1988) described the development of a stroke and TBI family support and education program. It was a hospital based multi-disciplinary lecture format program consisting of four 90-minute modules. A few reports of Stroke Clubs are found in the literature, but no studies of their effectiveness.

One significant study demonstrated the multiple benefits to be gained by using art in the rehabilitation process (Adsit and Lee, 1986). The use of art with individuals experiencing language impairments facilitates alternative communication methods. Art groups have also proved to be successful in eliciting expression of emotional needs and goals for therapy. Art projects allow patients to express expectations, goals and feelings regarding themselves, their families, friends, and environmental needs. Patients also express feeling about their rehabilitation program and their adjustment to policies and procedures.

Several medical centers report the success of support groups, both self-help and with professional facilitators. That support groups improve quality of life and extend survival for a variety of illnesses is well documented in the literature.


We are grateful to Congressman Sam Farr and the US Department of Education,
Office of Special Education and Rehabilitation for the funding support that made this website possible.