Biomarkers of stroke recovery: Consensus-based core recommendations from the Stroke Recovery and Rehabilitation Roundtable

Lara A Boyd¹, Kathryn S Hayward², Nick S Ward³, Cathy M Stinear⁴, Charlotte Rosso^{5

6}, Rebecca J Fisher⁷, Alexandre R Carter⁸, Alex P Leff⁹, David A Copland¹⁰, Leeanne M Carey¹¹, Leonardo G Cohen¹², D Michele Basso¹³, Jane M Maguire¹⁴, Steven C Cramer¹⁵

Affiliations

¹ 1 Department of Physical Therapy & the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada.
² 2 Department of Physical Therapy, University of British Columbia, Vancouver, Canada; Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia.
³ 3 Sobell Department of Motor Neuroscience, UCL Institute of Neurology, Queen Square, London, UK.
⁴ 4 Department of Medicine and Centre for Brain Research, University of Auckland, Auckland, New Zealand.
⁵ 5 Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France.
⁶ 6 AP-HP, Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Paris, France.
⁷ 7 Division of Rehabilitation & Ageing, University of Nottingham, Nottingham, UK.
⁸ 8 Department of Neurology, Washington University in Saint Louis, St Louis, MO, USA.
⁹ 9 Department of Brain Repair and Rehabilitation, Institute of Neurology & Institute of Cognitive Neuroscience, University College London, Queens Square, London, UK.
¹⁰ 10 School of Health & Rehabilitation Sciences, University of Queensland, Brisbane, Australia; and University of Queensland Centre for Clinical Research, Brisbane, Australia.
¹¹ 11 School of Allied Health, College of Science, Health and Engineering, La Trobe, University, Bundoora, Australia; and Neurorehabilitation and Recovery, Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia.
¹² 12 Human Cortical Physiology and Neurorehabilitation Section, NINDS, NIH, Bethesda, MD, USA.
¹³ 13 School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, USA.
¹⁴ 14 Faculty of Health, University of Technology, Ultimo, Sydney, Australia.
¹⁵ 15 University of California, Irvine, CA, USA; Depts. Neurology, Anatomy & Neurobiology, and Physical Medicine & Rehabilitation, Irvine, CA, USA.

PMID: 28697711
PMCID: PMC6791523
DOI: 10.1177/1747493017714176

Biomarkers of stroke recovery: Consensus-based core recommendations from the Stroke Recovery and Rehabilitation Roundtable

Lara A Boyd et al. Int J Stroke. 2017 Jul.

. 2017 Jul;12(5):480-493.

doi: 10.1177/1747493017714176.

Authors

Affiliations

¹ 1 Department of Physical Therapy & the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada.
² 2 Department of Physical Therapy, University of British Columbia, Vancouver, Canada; Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia.
³ 3 Sobell Department of Motor Neuroscience, UCL Institute of Neurology, Queen Square, London, UK.
⁴ 4 Department of Medicine and Centre for Brain Research, University of Auckland, Auckland, New Zealand.
⁵ 5 Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France.
⁶ 6 AP-HP, Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Paris, France.
⁷ 7 Division of Rehabilitation & Ageing, University of Nottingham, Nottingham, UK.
⁸ 8 Department of Neurology, Washington University in Saint Louis, St Louis, MO, USA.
⁹ 9 Department of Brain Repair and Rehabilitation, Institute of Neurology & Institute of Cognitive Neuroscience, University College London, Queens Square, London, UK.
¹⁰ 10 School of Health & Rehabilitation Sciences, University of Queensland, Brisbane, Australia; and University of Queensland Centre for Clinical Research, Brisbane, Australia.
¹¹ 11 School of Allied Health, College of Science, Health and Engineering, La Trobe, University, Bundoora, Australia; and Neurorehabilitation and Recovery, Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia.
¹² 12 Human Cortical Physiology and Neurorehabilitation Section, NINDS, NIH, Bethesda, MD, USA.
¹³ 13 School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, USA.
¹⁴ 14 Faculty of Health, University of Technology, Ultimo, Sydney, Australia.
¹⁵ 15 University of California, Irvine, CA, USA; Depts. Neurology, Anatomy & Neurobiology, and Physical Medicine & Rehabilitation, Irvine, CA, USA.

PMID: 28697711
PMCID: PMC6791523
DOI: 10.1177/1747493017714176

Abstract

The most difficult clinical questions in stroke rehabilitation are "What is this patient's potential for recovery?" and "What is the best rehabilitation strategy for this person, given her/his clinical profile?" Without answers to these questions, clinicians struggle to make decisions regarding the content and focus of therapy, and researchers design studies that inadvertently mix participants who have a high likelihood of responding with those who do not. Developing and implementing biomarkers that distinguish patient subgroups will help address these issues and unravel the factors important to the recovery process. The goal of the present paper is to provide a consensus statement regarding the current state of the evidence for stroke recovery biomarkers. Biomarkers of motor, somatosensory, cognitive and language domains across the recovery timeline post-stroke are considered; with focus on brain structure and function, and exclusion of blood markers and genetics. We provide evidence for biomarkers that are considered ready to be included in clinical trials, as well as others that are promising but not ready and so represent a developmental priority. We conclude with an example that illustrates the utility of biomarkers in recovery and rehabilitation research, demonstrating how the inclusion of a biomarker may enhance future clinical trials. In this way, we propose a way forward for when and where we can include biomarkers to advance the efficacy of the practice of, and research into, rehabilitation and recovery after stroke.

Keywords: Biomarker; clinical trial; cognition; function; human; language; motor; neuroimaging; somatosensory; stratification.

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Conflict of interest statement

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

References

1. Bernhardt J, Borschmann K, Boyd L, et al. Moving rehabilitation research forward: developing consensus statements for rehabilitation and recovery research. Int J Stroke 2016; 11: 454–458. - PubMed
1. Cramer SC, Koroshetz WJ and Finklestein SP. The case for modality-specific outcome measures in clinical trials of stroke recovery-promoting agents. Stroke 2007; 38: 1393–1395. - PubMed
1. Krakauer JW and Marshall RS. The proportional recovery rule for stroke revisited. Ann Neurol 2015; 78: 845–847. - PubMed
1. Winters C, Heymans MW, van Wegen EE and Kwakkel G. How to design clinical rehabilitation trials for the upper paretic limb early post stroke? Trials 2016; 17: 468. - PMC - PubMed
1. Milot MH and Cramer SC. Biomarkers of recovery after stroke. Curr Opin Neurol 2008; 21: 654–659. - PMC - PubMed

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Biomarkers of stroke recovery: Consensus-based core recommendations from the Stroke Recovery and Rehabilitation Roundtable

Affiliations

Biomarkers of stroke recovery: Consensus-based core recommendations from the Stroke Recovery and Rehabilitation Roundtable

Authors

Affiliations

Abstract

Conflict of interest statement

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical