Toward Precision Post-Stroke Rehabilitation Medicine: Integrating Molecular, Imaging, and Computational Biomarkers for Functional Outcome Prediction

Ischemic stroke remains a leading cause of mortality and long-term disability worldwide, with prognosis influenced by heterogeneous biological and neuroanatomical factors. In the past decade, numerous possible biomarkers-molecular, imaging, and electrophysiological-have been investigated to improve outcome prediction and guide rehabilitation strategies and main objectives. Among them, neurofilament light chain (NFL), a cytoskeletal protein released during neuroaxonal injury, has become an effective marker of the severity of the neurological condition and the integrity of the neurons. Additional circulating biomarkers, including thioredoxin, netrin-1, omentin-1, bilirubin, and others, have been linked to oxidative stress, angiogenesis, neuroprotection, and regenerative processes. Meanwhile, innovations in electrophysiology (EEG and TMS-based predictions) and neuroimaging (diffusion tensor imaging, corticospinal tract lesion load, and functional connectivity) add some additional perspectives on the possibility for brain recovery. This work is a narrative synthesizing evidence from PubMed, Scopus, and Web of Science between 2015 and 2025, including both clinical and experimental studies addressing stroke biomarkers and outcome prediction. The review outlines a framework for the integration of multimodal biomarkers to support precision medicine and individualized rehabilitation in stroke.