New Biomarker Recommendations Aim to Personalize Stroke Rehabilitation

Because rehabilitation outcomes vary widely, clinicians still face challenges in individualizing the timing and intensity of therapy. Blood-based molecular biomarkers could help identify recovery trajectories and guide treatment decisions, but standardized longitudinal approaches remain limited. New recommendations now aim to advance precision medicine in stroke rehabilitation by harmonizing biomarker collection with detailed recovery assessments over time.

A 17-member international task force has developed methodological recommendations for studying molecular biomarkers after stroke. Published on August 19 in the International Journal of Stroke, the guidance outlines a framework for large-scale longitudinal studies that pair serial blood sampling with detailed recovery assessments. The aim is to identify biological signals that can indicate which therapies are most effective and when patients are most likely to benefit. The effort was led by specialists from the University of Maryland School of Medicine (UMSOM) and Georgetown University School of Medicine.

The task force highlighted priority biomarkers for continued investigation, including neurofilament light chain (NfL), brain-derived neurotrophic factor (BDNF), brain-derived tau, glial fibrillary acidic protein (GFAP), and interleukin-6 (IL-6). The recommendations call for characterizing how these molecular profiles evolve across post-stroke time windows and relate to brain repair, particularly in response to interventions such as physical therapy. By standardizing biospecimen collection alongside granular, time-resolved clinical assessments, the framework seeks to map individual recovery trajectories that single 90-day outcome measures may overlook.

To accelerate progress, the report recommends creating national biomarker centers, building international data repositories, and establishing funding programs capable of supporting cohorts involving thousands of stroke survivors. The authors also emphasize ethical safeguards to ensure biomarker information is not used to restrict access to rehabilitation services. UMSOM notes existing resources that could support these efforts, including the University of Maryland–Medicine Institute for Neuroscience Discovery (UM‑MIND), the University of Maryland Rehabilitation & Orthopaedic Institute’s stroke recovery program, and the University of Maryland Comprehensive Stroke Center.

“For 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,” said Robynne Braun, MD, PhD, UMSOM Associate Professor of Neurology and a stroke rehabilitation specialist at the University of Maryland Rehabilitation & Orthopaedic Institute.

“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. 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,” said Braun.

Related Links:
University of Maryland School of Medicine (UMSOM)
Georgetown University School of Medicine