New stroke guidelines could help pave the way for precision rehabilitation

Robynne Braun, MD, PhD, UMSOM Associate Professor of Neurology and stroke rehabilitation specialist, University of Maryland Rehabilitation & Orthopaedic InstituteFor a long time, stroke recovery studies have used 'outcome' measures at a single 90-day timepoint. But that approach misses the peaks and valleys that define a patient's unique recovery profile."

The task force identified several important candidate biomarkers for ongoing study, including neurofilament light chain (NfL), brain-derived neurotrophic factor (BDNF), brain-derived tau, glial fibrillary acidic protein (GFAP), and interleukin-6 (IL-6). These biological molecules are associated with cell damage, nerve cell growth, and inflammation in many other disease states, and in normal physiology. The recommendations emphasized that researchers still need to understand, for example, how molecular profiles of these biomarkers change over time following a stroke, and how those changes relate to the brain's ability to repair itself, especially in response to interventions like physical therapy.

"The evidence shows that trying to do intensive rehabilitation too soon after a stroke, while the brain may still be dealing with inflammation and injury, can actually make things worse. But research also shows that you get diminishing returns with rehabilitation if you wait too long to intervene," Dr. Braun said. "That window is likely different for every person. So the goal is identifying molecular signposts that can tell us where an individual patient is in that recovery journey so we can intervene at the most effective time, targeting the most appropriate biology for each individual patient."

To support progress, the report recommends creating national biomarker centers, international data repositories, and dedicated funding programs capable of supporting studies involving thousands of stroke survivors. The recommendations also highlight the importance of ethical safeguards to ensure biomarker information is never used to limit patients' access to rehabilitation services.

"I would love to see Maryland become a hub for this work," she said. "We have outstanding precision medicine infrastructure and neurorehabilitation programs. By bringing together expertise in neuroscience, rehabilitation, molecular biology, and data science, we can help accelerate discoveries that ultimately improve outcomes for stroke survivors."

Source:

University of Maryland School of Medicine

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