Towards Personalized Precision Medicine for Stroke Recovery: A Multi‐Modal, Multidomain Longitudinal Approach (TiMeS) – PHRT
Towards Personalized Precision Medicine for Stroke Recovery: A Multi‐Modal, Multidomain Longitudinal Approach (TiMeS)
Stroke is the main course of long-term disability leaving more than 80% of patients with long-term deficits impacting on their daily professional and private life, health care systems and on society. Despite novel developments in neuro-rehabilitative therapy the outcome remains still unsatisfactory. Reasons for unsatisfactory recovery after are (i) stroke is a heterogenous disorder, (ii) insufficient understanding of processes relevant for recovery, (iii) lack of prediction of degree and course of recovery of individual patients and (iv) lack of patient-tailored personalized neuro-rehabilitative treatment to maximize individual treatment effects for patients. The current project will pave the way to the development of biomarkers, which allow to predict the individual degree and course of recovery as the basis for personalized precision medicine treatments. First approaches of precision rehabilitation based on neurotechnology (non-invasive brain stimulation, virtual reality and robotics) will be tested.
The current project addresses (1) the better, individual understanding of recovery and its underlying mechanisms by a multimodal, multi-domain, longitudinal evaluation of a large number of stroke patients, (2) the development of biomarkers usable in daily clinical life for stratification of patients towards precision medicine and (3) to apply first approaches of personalized neurotechnology-based neurorehabilitation. Such a project requires strong scientific and clinical expertise, up-to-date research equipment in close vicinity to large numbers of patients in the acute as well as in the subacute and chronic stage, requirements uniquely achieved in Sion. In summary, TiMeS will add to the better understanding of stroke and pave the way to novel, neurotechnology-based personalized treatment strategies.
TiMeS aims to acquire detailed multi-domain and multimodal information to understand mechanisms of recovery and to predict the course of recovery from the acute to the chronic phase after a stroke. This knowledge will translate into ‘biomarkers’, which can hopefully be used in daily clinical life and will impact on the selection of specific personalized treatments. The second main goal is to use the acquired understanding to develop and evaluate innovative, personalized interventional approaches based on neurotechnology, such as brain stimulation, virtual reality or robotics to maximize the interventional effects for each individual patient. If successful, this will significantly improve stroke neurorehabilitation with better outcomes for patients with respective impact on patients’ and relatives’ life, health care and socio-economics.
In the global burden report, stroke has been described as the epidemic of the 21st century. This statement is based on the high incidence (e.g., 16.000 new patients/year in CH, 1.5 Million/year in Europe, 15 Millions/year in the world) with up to 20% of patients below 55 years. Despite current developments in stroke treatment, full recovery is still limited to 15-20%. This impacts daily life of the individual patients and their relatives and leads to significant cost for them and the society (29 Billion € in Europe). Remaining deficits of upper extremity function, especially hand function, is the main factor determining the re-integration into professional and social life, affecting independence and quality of life. Efforts in improving neuro-rehabilitative therapy remain unsatisfactory leaving still too many patients significantly impaired with a lack of independence and a need of continuous assistance from health care providers. What are the reasons for the still unsatisfactory recovery? Stroke is a heterogeneous disorder, there is insufficient understanding of the processes relevant for recovery, a lack of understanding of courses and degrees of recovery of the individual patients and an insufficient usage of the available rehabilitative treatment strategies (e.g., based on neuro-technologies), especially in the view of personalized, precision medicine. These facts lead to unsatisfactory treatment effects.
Pers. Medicine / Health Research
Prof. Dr. med. Friedhelm Hummel
Defitech Chair of Clinical Neuroengineering, Centre for Neuroprosthetics (CNP) and Brain Mind Institute, School of Life Sciences (SV), EPFL