Title:The resilient brain

Revolutionizing stroke and recovery

It happens in an instant. One moment, you’re reaching for a coffee mug, preparing breakfast—and the next, everything changes. Your right side feels impossibly heavy, and fingers refuse to respond. Words form in your mind but won’t come out of your mouth. Each passing moment could mean the difference between recovery and life-altering disability.

This is the devastating reality of stroke, a neurological thunderbolt that can erase or severely impair basic human functions in moments.

Every year, stroke hits nearly 800,000 Americans. The aftermath varies dramatically among survivors, with variables such as the type of stroke, the location in the brain, and how long it takes them to receive critical care playing a major role.

The vast majority—about 80%—of strokes are known as ischemic, where blood clots choke off vital circulation to brain tissue. The remaining 20% are hemorrhagic, where a blood vessel ruptures inside the brain and results in bleeding.

Some stroke survivors face one-sided paralysis, aphasia (lost language abilities), partial blindness, or perception issues. Beyond physical disabilities, many survivors struggle with emotional dysregulation and depression.

As America’s leading cause of long-term disability, stroke doesn’t just affect individuals—it overwhelms families and strains the health care system. Its economic aftershocks can include medical bills, rehabilitation costs, lost wages, and the unmeasurable expense of family members becoming caregivers.

Behind the statistics are people and families suddenly thrust into navigating a complex medical system, often with little preparation for the challenging journey ahead.

This can be overwhelming and isolating for patients and families, according to Norman J. Beauchamp Jr., a professor of neurology and radiology who serves as executive vice president for health sciences at Georgetown University Medical Center (GUMC) and executive dean of the School of Medicine.

“You’re going through something and you don’t even know if you’ll survive, let alone get your functions back,” says Beauchamp. “There are just so many unknowns.”

Beauchamp believes the team of elite researchers and clinicians at GUMC and MedStar Health that focus on stroke and related issues has the capacity to shift the narrative for patients and their families.

“We’re bringing together remarkable experts from every field—from skilled clinicians to innovative researchers—all serving a large and diverse patient community,” Beauchamp says. “There is a powerful synergy that enables us to make a real difference for patients who might otherwise feel like they’re walking the road to recovery alone.”

Regaining what stroke has taken

Stroke offers a unique model for studying brain plasticity—the brain’s ability to recover and adapt following injury.

“Because we know when and where stroke occurs, and it is not a progressive disorder, we can see exactly where it damages the brain and can better understand how to promote recovery,” says Peter Turkeltaub (M’05, G’05), professor of neurology and rehabilitation medicine at Georgetown’s School of Medicine, who also directs the Cognitive Recovery Lab at Georgetown and the Aphasia Clinic at MedStar National Rehabilitation Network.

By studying patients who exceed recovery expectations, researchers can understand how healthy brain regions compensate for injured areas.

“While your hair, fingernails, and skin can regenerate, your brain doesn’t grow neurons back,” explains Elissa Newport, professor of neurology at Georgetown School of Medicine, and director of the Center for Brain Plasticity and Recovery, a joint enterprise between Georgetown University and MedStar National Rehabilitation Network.

Yet a team of researchers from the center discovered that adults have a critical window of heightened plasticity—approximately 60 to 90 days post-stroke—when the brain demonstrates remarkable rewiring potential.

“The brain essentially returns to early developmental stages like you see in babies, with new synapses and connections sprouting as it attempts to recover,” says Newport.

Newport and colleagues have also found that children who suffer strokes at birth show extraordinary neural adaptation, with language and spatial abilities often developing normally despite significant damage.

Unlike adults who experience brain damage, children effectively recruit the opposite hemisphere to “take over” lost functions. This discovery has prompted Newport and Turkeltaub to try to pinpoint precisely when this neurological flexibility diminishes between infancy and adulthood—potentially unlocking new approaches that could help adult patients tap into similar recovery mechanisms.

“The exciting question is, do these residual abilities exist for adults too but maybe are just underpowered? And how can we tap into them to get better recovery?” Newport says.

Understanding how the brain is wired

By studying patients who recover well from stroke, researchers hope to unlock insights applicable to a variety of different neurological conditions such as traumatic brain injury, multiple sclerosis, and neurodegenerative diseases including Parkinson’s and Alzheimer’s.

“Studies of different neurological pathologies cannot be done in silos,” explains Carlo Tornatore (G’82, M’86, R’90), professor and chair of neurology at Georgetown School of Medicine, and regional chief of neurology for MedStar Health.

“People like to put these conditions in their own little containers, but that’s not how nature works— it’s actually a continuum,” he explains.

Discoveries about neural pathway reorganization after stroke have informed new treatments for traumatic brain injury. Similarly, markers identified in stroke patients have provided insights into inflammatory processes in multiple sclerosis. Even research into migraines has yielded insights about the brain’s capacity to heal.

What these crossover insights reveal is that full recovery from stroke is not an impossible dream. In fact, it may be an achievable reality for many patients when we discover the most effective interventions and provide the right support.

“When we talk about return of function, we’ve already done it for some disorders. This is something we currently know how to do—it’s not something in the distant future,” Tornatore says.

Even with diseases such as Parkinson’s and Alzheimer’s, which have no cure, patients experience fluctuations in symptoms. These ups and downs are cause for hope for stroke patients.

“The point is that we can see the brain is trying to recover, and the mechanisms exist for it to recover,” Tornatore says. “Our challenge is to keep working to figure out ways to encourage and sustain that recovery.”

In the realm of laboratory science, Georgetown researchers are exploring mechanisms that could transform how stroke is understood and treated— from the circuits neurons use to communicate with each other to the cellular and subcellular levels.

“If we don’t understand the brain’s circuitry— how it functions—then we can’t understand how the brain recovers from an injury such as stroke, or imagine new therapies to help these patients,” explains Kathleen Maguire-Zeiss, professor and chair of the department of neuroscience. “It’s about taking what we learn in the laboratory with the hope of one day applying it to the bedside.”

Georgetown researchers are studying inflammatory responses in the brain, with findings that could help explain why stroke recovery differs with age. Other research focuses on how we can protect neuron function. For example, studies from traumatic brain injury, Alzheimer’s, multiple sclerosis, and Parkinson’s laboratories will add to our understanding of brain plasticity, function, and health.

Neuroscience research is fundamentally interdisciplinary—principals from fields such as neurology, neuroscience, biology, pharmacology, physiology, psychology, and physics are all important to address complex brain recovery challenges, underscoring the notion that discoveries about one condition can affect how we approach and treat others.

“There are overarching themes that are broader than any one disorder, so the data we are generating about inflammation and brain plasticity, for example, helps us understand how the brain recovers in general,” Maguire-Zeiss says.

A research powerhouse

The Georgetown University and MedStar Health partnership is making great strides in this work.

The collaboration combines Georgetown’s academic research with MedStar Health’s clnical expertise and specialized care—all in close proximity and under the same network umbrella. Researchers, clinicians, and rehabilitation specialists across Georgetown University, MedStar National Rehabilitation Network, MedStar Georgetown University Hospital, and MedStar Washington Hospital Center are able to connect and advance their work.

Strategically positioned at what experts describe as the “buckle of the stroke belt”—a region with high stroke incidence and mortality—the partnership gives researchers access to diverse patients from urban and rural areas. MedStar Health’s broad reach extends from MedStar Washington Hospital Center in the District to hospitals in Maryland including Baltimore, and to urgent care and specialty care facilities throughout DC, Maryland, and Northern Virginia.

The Center for Brain Plasticity and Recovery exemplifies this collaborative approach, with interdisciplinary teams of experts—including linguists, psychologists, computer scientists, neurobiologists, clinical neurologists, and rehabilitation therapists—working together to understand how the brain recovers after injury. The Center for Neuroengineering and the Center for Neural Injury and Recovery also bring together researchers that study recovery of function, ranging from cells to the human experience.

This commitment to advancing stroke research and treatment has earned recognition, with Georgetown’s Department of Rehabilitation Medicine ranking among the top 10 such programs nationwide.

“We’re not just treating symptoms,” Newport explains. “We’re investigating the fundamental mechanisms of brain plasticity. This kind of work demands a wide range of expertise, and there are hardly any other places where you can find what we have here.”

Regional stroke network

At the heart of this collaborative ecosystem between Georgetown and MedStar Health lies the Stroke Central Atlantic Network for Research (SCANR), the leading consortium for stroke clinical trials in the Mid-Atlantic region.

Co-led by Turkeltaub and Amie Hsia, medical director of the MedStar Washington Hospital Center Comprehensive Stroke Center, SCANR covers every stage of stroke care, from emergency treatments like advanced clot removal to better prevention strategies and innovative rehabilitation methods.

“Our population is basically a microcosm of the country’s population of stroke survivors, which greatly benefits our research,” Turkeltaub says.

One of SCANR’s promising initiatives addresses a critical gap—access to specialized rehabilitation services. For many survivors, particularly those in rural areas or with mobility limitations, regularly traveling to rehabilitation facilities can be a significant barrier to recovery.

A new telehealth study looks at occupational therapy for arm recovery that’s delivered remotely. By bringing expert occupational therapy into people’s homes virtually, the research program aims to eliminate geographical and physical barriers that have traditionally limited access to specialized stroke rehabilitation.

“We are not just focused on stroke recovery, but are rethinking how rehabilitation is delivered, particularly to underserved patient populations who might not otherwise have access to critical services,” Turkeltaub says.

Where technology meets brain recovery

New tools and digital platforms are transforming how stroke care is conceptualized, delivered, and personalized.

For example, in January GUMC researchers in collaboration with MedStar Health colleagues launched the Acute Stroke Imaging Database (AStrID), an AI-driven brain imaging platform that helps doctors match patients to clinical trials based on their specific brain damage patterns. By enabling scientists to quickly and effectively group patients with similar stroke characteristics for more targeted clinical trials, the tool will improve treatment options for patients who are most likely to benefit.

“I don’t know of another center that is systematically gathering MRI data, and then using AI to precisely map stroke location and characteristics in this way,” says Turkeltaub, one of the developers of the database.

Turkeltaub and colleagues can set up an alert when a patient is admitted with a stroke affecting a specific brain area, or has a motor deficit in a range that makes them a strong candidate for a particular trial.

“We can even determine if they still have connections between their brain and spinal cord, which helps us sort them into the right clinical trial where the therapy is likely to be successful,” he says.

In another innovative study, Georgetown researchers are exploring advanced neuroimaging techniques to enhance stroke assessment. A new MRI method, developed through collaboration between GUMC, MedStar Health, and the National Institutes of Health, helps doctors better predict how well stroke patients might recover movement in their arms and legs.

This breakthrough, published this past March in the journal Neurology, allows clinicians to better visualize the white matter “wiring” that runs from the brain to the spinal cord, indicating a person’s potential to recover limb function following a stroke.

Complementing these diagnostic advances, Georgetown and MedStar Health are implementing therapeutic innovations such as Vivistim—a device that uses vagus nerve stimulation to help patients recover hand and arm function.

“It’s like a pacemaker, implanted through a very simple operation that stimulates this nerve,” explains Tornatore. “What’s amazing is that people who have had a stroke, even if it was years ago, can still experience a return of some function in their paralyzed arm when stimulation is paired with rehabilitation.”

The treatment protocol is inherently collaborative, requiring neurologists to program the stimulation parameters, physical therapists to guide patients through rehabilitation exercises, and researchers to document and analyze outcomes.

While these cutting-edge treatments offer hope for recovery after stroke, Tornatore emphasizes that prevention remains the ultimate goal— and that technology is the key.

“We have the technology to predict stroke in our hands right now,” he says. “We want to get to the point where we can prevent the disability and have a better understanding of who is at risk years before there is a catastrophic event.”

With its capacity to track measures such as blood pressure, heart rate, and temperature, wearable technology will revolutionize preventative care, Tornatore predicts.

“I am 100% convinced that wearable technologies like your smartwatch will transform stroke prevention,” he says.

Taking it to the community

GUMC and MedStar Health’s approach to stroke care extends beyond the lab and stroke clinic and into the community.

Every Monday evening, a unique gathering takes place via Zoom. What began as a research initiative has evolved into a lifeline for many stroke survivors, especially those experiencing aphasia, a language disorder affecting roughly one-third of stroke patients.

What’s particularly striking about these meetings is the age group. Turkeltaub says there are a surprising number of people in their 30s and 40s who have had a stroke.

“It’s turned into a predominantly young stroke survivor group,” Turkeltaub says.

For these younger survivors, the conversation group offers not just communication practice but also vital community support. It also enables researchers to solicit feedback about planned and ongoing research.

This approach exemplifies Georgetown’s commitment to community-engaged research—where those being studied have a voice in shaping the research itself.

Building on this patient-centered approach, Georgetown’s team is also tackling one of the most overlooked challenges facing stroke survivors: access to mental health care. Depression affects as many as half of all stroke patients, yet finding appropriate care can be particularly difficult for those with communication disorders.

“It can be really difficult to find mental health care when you have aphasia, so we have created a resource guide for people in the region because we want to remove these barriers,” Turkeltaub says.

Teaching the next generation

Sustaining these advances in stroke care depends on preparing future leaders in the field. Recognizing this critical need, GUMC’s interdisciplinary PhD program in neuroscience trains outstanding researchers, and SCANR’s fellowship program cultivates emerging talent across institutions, creating a robust mentorship ecosystem. Each year, SCANR chooses a new fellow from among the participating sites.

“One of SCANR’s concrete goals is to train the next generation of stroke investigators. We also provide an opportunity for newer investigators to take on roles as principal investigators of clinical trials or to participate in working groups at the national level,” Turkeltaub says.

Students and early career faculty also are exposed to the cross-disciplinary experts and resources at Georgetown and MedStar Health, as stroke research and care cuts across so many fields.

This interdisciplinary approach reflects Georgetown’s commitment to cura personalis— care for the whole person—where tackling medical challenges addresses not just the condition but the patient’s entire human experience.

At the heart of this philosophy is the recognition that effective health care extends beyond technical interventions to encompass emotional and psychological support.

“Health care done correctly is about all people feeling cared about and not feeling alone,” Beauchamp says.