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Post-Stroke Recovery: How Precision Medicine can Support Rehabilitation

Nearly 800,000 people in the U.S. suffer from stroke each year, according to the American Heart Association, and a third of American adults have at least one increased risk factor for stroke, including high blood pressure, high cholesterol, diabetes, obesity, and smoking. Despite medical advances in stroke recovery and management, more than half of stroke survivors experience long-term disability, with 80% experiencing lasting difficulties with upper limb movement and walking.

The development of effective treatments for long-term stroke-related impairments has been challenging, but emerging research on the use of biomarkers to predict stroke recovery outcomes has been promising. Biomarkers are tools used in precision medicine to help optimize treatment strategies based on a patient’s individual characteristics. Here, experts from Private Health Management (PHM) review the latest advancements in biomarker-based studies, offering insights into personalized strategies that can enhance stroke recovery and provide patients with renewed hope.

What is a stroke?
A stroke is a brain injury caused by a blocked artery (ischemic stroke) or a burst blood vessel (hemorrhagic stroke), leading to bleeding in or around the brain.1 Because strokes vary in type and severity, predicting recovery and choosing the right treatment can be challenging. Since each case is different, a one-size-fits-all approach to care simply does not work.

How can biomarkers help with stroke recovery?
Biomarkers are precision medicine tools that can be used to measure certain indicators of disease or underlying cellular or molecular processes to help optimize treatment strategies.2 In stroke care, they can help assess the brain’s recovery potential while guiding healthcare providers to choose which treatments are optimal for each individual at the right time.

Some biomarkers are molecular in nature, such as proteins derived from stroke-related clots that circulate in the blood, as well as genetic characteristics unique to each individual.2 These molecular markers have shown promise in stroke management, including predicting risk, aiding drug development, and improving recovery.3–5

But, the most reliable biomarkers for stroke recovery to date are those that combine neuroimaging and neurophysiology techniques to assess and predict the extent of motor damage in certain areas of the brain.2 These cutting-edge technologies include diffusion tensor imaging, a specialized type of MRI, and transcranial magnetic stimulation (TMS), a non-invasive method that evaluates the health of the neural pathway connecting the brain to the muscles, known as the corticospinal tract. These biomarkers measure the extent of motor system damage, providing crucial insight to identify individuals at high risk of long-term disability.

How can biomarkers help optimize stroke rehabilitation?
Clinicians assess a patient’s motor function by observing their movements during a series of tests that evaluate muscle strength, coordination, range of motion, and their ability to do specific tasks. Biomarker testing complements these clinical assessments. For example, combining clinical assessment with TMS testing can predict the recovery of arm function with about 88% accuracy.6 Biomarkers assist in identifying individuals that may not respond to traditional therapy, allowing clinicians to bolster treatment with other interventions, such as non-invasive brain stimulation, that may further enhance the ability to reach, grasp, and manipulate objects.7

The latest biomarker research is focused on helping stroke survivors recover movement in their legs. An emerging research interest is correlating stroke lesions with walking impairments, with the goal of implementing optimized/personalized rehabilitation approaches such as high-intensity interval training. These interventions have significantly improved gait during immediate and long-term recovery,8,9 possibly through mechanisms related to the brain’s ability to adapt (neuroplasticity).10 While the results are still unfolding, this level of personalized care could have the potential to boost the chances of healing and adaptation in the recovering brain.2

Precision rehabilitation for personalized strategies
Clinicians often prescribe exercise as medicine during the post-stroke recovery period. By deploying precision rehabilitation strategies to make treatment decisions, such as the type, dosage, and timing of interventions, exercise can be tailored to the individual’s specific functional needs and goals. Adjustments are made in real-time during therapy sessions based on positive response and improvements in physical performance.11

Biomarkers can enhance this precision by offering more detailed insights to help clinicians determine the most effective interventions from a wide range of rehabilitation options. Combining precision rehabilitation with medical approaches is an exciting prospect, as it has the potential to optimize function, reduce disability, and improve quality of life during stroke recovery.

References

  1. Sacco, R. L. et al. An Updated Definition of Stroke for the 21st Century. Stroke 44, 2064–2089 (2013).
  2. Boyd, L. A. et al. Biomarkers of Stroke Recovery: Consensus-Based Core Recommendations from the Stroke Recovery and Rehabilitation Roundtable. Neurorehabil Neural Repair 31, 864–876 (2017).
  3. Maglinger, B. et al. Intracranial VCAM1 at time of mechanical thrombectomy predicts ischemic stroke severity. J Neuroinflammation 18, 109 (2021).
  4. Mishra, A. et al. Stroke genetics informs drug discovery and risk prediction across ancestries. Nature 611, 115–123 (2022).
  5. Cramer, S. C. et al. Genetic Variation and Stroke Recovery: The STRONG Study. Stroke 55, 2094–2102 (2024).
  6. Stinear, C. M., Barber, P. A., Petoe, M., Anwar, S. & Byblow, W. D. The PREP algorithm predicts potential for upper limb recovery after stroke. Brain 135, 2527–2535 (2012).
  7. Ahmed, I. et al. Non-invasive Brain Stimulation Techniques for the Improvement of Upper Limb Motor Function and Performance in Activities of Daily Living After Stroke: A Systematic Review and Network Meta-analysis. Archives of Physical Medicine and Rehabilitation 104, 1683–1697 (2023).
  8. Moore, J. L. et al. Implementation of High-Intensity Stepping Training During Inpatient Stroke Rehabilitation Improves Functional Outcomes. Stroke 51, 563–570 (2020).
  9. Boyne, P. et al. Optimal Intensity and Duration of Walking Rehabilitation in Patients With Chronic Stroke: A Randomized Clinical Trial. JAMA Neurology 80, 342–351 (2023).
  10. Boyne, P. et al. Exercise intensity affects acute neurotrophic and neurophysiological responses poststroke. J Appl Physiol (1985) 126, 431–443 (2019).
  11. French, M. A. et al. Precision Rehabilitation: Optimizing Function, Adding Value to Health Care. Arch Phys Med Rehabil 103, 1233–1239 (2022).
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Patrick Knox

Patrick Knox

Associate Research Director

Pat is an Associate Research Director at Private Health Management. He has nearly a decade of experience as a clinician-scientist focused on researching chronic pain mechanisms in aging populations. Pat’s postdoctoral research at Emory University explored the neurophysiology of altered pain perception, and his graduate work culminated in a dissertation on psychosocial and physiological factors that contribute to chronic low back pain in older adults. He earned his PhD in Biomechanics and Movement Science and Doctor of Physical Therapy degrees from the University of Delaware, and holds a Bachelor of Science in Exercise Science from the University of South Carolina.
Annie Garske

Annie Garske

Physical Wellness and Rehabilitation Clinical Director

Annie is a highly experienced healthcare professional specializing in Physical Therapy and Lifestyle Medicine to enhance patient outcomes. Since 2022, she has collaborated with PHM, applying a multidisciplinary and holistic approach to complex cases. With a Doctorate in Physical Therapy from the University of Washington (2005) and 18 years of prior experience in Seattle, she has treated patients with complex orthopedic diagnoses, chronic pain, and severe illnesses. Annie is also a Fellow of the American Academy of Orthopedic Manual Physical Therapists, a distinction held by only 2% of PTs nationwide. In her free time, she enjoys outdoor activities like hiking, skiing, fly-fishing, and surfing and coaches for the Mission Ridge Ski Team in Wenatchee, WA.