PM.20.019 – Novel biomarkers to predict individual arm-hand recovery and improve functional outcome after stroke

Route: Personalised medicine: the individual at the centre

Cluster question: 095 How can we personalise health care, for example by using biomarkers?

Post-stroke recovery of upper-limb capacity is crucial for independence and quality of life. Due to improved acute care, the number of patients surviving with arm-hand motor impairments is rising, posing a burden on individual patients, their families, the healthcare system, and society as a whole. While ~70% of patients show moderate or good neurobiological recovery of upper-limb capacity within the first three months post-stroke, it is currently impossible to predict outcome for individual patients with severe symptoms early-post-stroke, making it hard to decide on the best discharge policy and most adequate treatment. This is problematic because severely affected patients may end up getting the wrong or no treatment at all. It also negatively impacts stroke research: the large heterogeneity in recovery profiles does not allow selecting the right patients for innovative rehabilitation interventions, masking potential effects. This main hurdle in stroke rehabilitation will be tackled in this multicentre project. Upper-limb recovery will be tracked longitudinally in a large heterogeneous sample of patients with severe hemiparesis in the acute phase post-stroke. State-of-the-art neuroimaging biomarkers of brain tissue integrity and longitudinal kinetic and kinematic biomarkers will be acquired in large subsamples, assessing the potential for neurological recovery and behavioural restitution. With the acquired data, prediction models featuring the most promising biomarkers will be developed and implemented in a web-based infrastructure, enabling reliable personalised predictions for shared decision making about the required rehabilitation services post-stroke. As proof-of-principle, the prediction models will be used to randomise patients with similar prognosis to upper-limb capacity training with or without an actuated hand orthosis. Finally, we will disseminate findings through educational workshops, and explore the commercial potential of neuroimaging pipelines, orthosis-supported training, prediction models, and the web-based decision-support tool. Realising above milestones represents a breakthrough in stroke rehabilitation, also profoundly impacting other rehabilitation domains.

Keywords

arm-hand rehabilitation, dynamic hand orthosis, MRI, somatosensory, stroke

Other organisations

Adelante Rehabilitation Centre, Amsterdam UMC Dept. of Biomedical Engineering & Physics, Amsterdam UMC Dept. of Neurology, Amsterdam UMC Dept. of Radiology, Amsterdam UMC Dept. Of Rehabilitation Medicine, Brain foundation of the Netherlands, BrainInnovation, Dutch Institute of Allied Health Care, Erasmus MC Dept. of Epidemiology, Erasmus MC Dept. of Neurology, Erasmus MC Dept. of Radiology, Erasmus MC Dept. of Rehabilitation Medicine and Plastic and Reconstructive Surgery, ETH Z�rich Rehabilitation Engineering Laboratory., Hankamp Rehab BV, Hersenletsel.nl, IMDI CoRE neurocontrol, Maastricht University Dept. of Neurology, Maastricht University Dept. of Radiology, Maastricht University Dept. of Rehabilitation Medicine, Maastricht University School for Mental Health & Neuroscience, Reade Rehabilitation Centre, Rijndam Rehabilitation Centre, Santeon OLVG Dept. of Neurology, Utrecht University (UU-EP) Experimental Psychology

Submitter

Organisation Maastricht University (UM)
Name Dr. A. (Amanda) Kaas
E-mail a.kaas@maastrichtuniversity.nl