Introduction Considerable emphasis continues to be placed on stroke prevention by state and national organizations, yet stroke incidence remains stable and is rising in some subgroups. Concurrently, thrombolytic treatment constitutes a major focus of many stroke programs and stroke center certifications, yet only a minority of patients access these treatments. As a result of these trends, 40% of stroke patients retain moderate functional impairments, and 15-30% exhibit severe disability in the weeks and months following their acute hospitalizations. Moreover, the number of community-dwelling stroke survivors exhibiting significant impairments that undermine independence is expected to rise exponentially.