KU neurology professor persistent in push for more understanding of stroke rehabilitation

When Sandra Billinger, Ph.D., isn’t in a research lab, uncovering the latest breakthroughs in stroke recovery and exercise science, one might find her at work on another project: tending to her home garden. 

“It’s something I really enjoy,” Billinger said of her gardening hobby. “I like to build things, and I see gardening as a project you’re building on and see through to a finished product. That kind of thing is very exciting to me.” 

Billinger, a professor in the Department of Neurology at the University of Kansas School of Medicine, has seen many significant scientific discoveries to the finish line during her career as a researcher. Her most widely recognized contribution is the development of the recumbent stepper submaximal exercise test, which predicts a person’s peak oxygen consumption or aerobic fitness. Nearly 15 years after its publication, it remains a widely adopted protocol for research and practical, clinic-based fitness assessment.

“I’ve always had this curiosity that makes me ask questions, and finding ways to do things better,” Billinger said. “If you leave things the way they are, how do you grow?” 

In the last year alone, she has co-authored a paper on high-intensity gait training, been named the principal investigator for a multi-site clinical trial investigating home-based stroke telerehabilitation and, alongside colleagues at KU Medical Center, received a patent related to a novel system for monitoring a patient’s response to exercise. 

“She is a visionary,” Michael Abraham, M.D., a professor in the Department of Neurology, said of his colleague and frequent collaborator.  “She thinks years into the future and has a good eye for the big picture.” 

A generous collaborator 

Billinger’s forward-thinking mindset doesn’t happen in a vacuum. For an innovative idea to reach its potential, Billinger believes that multiple perspectives are essential. 

“Collaboration has always been critical to me,” Billinger said. “It pushes me to think about things differently, explore new avenues of research or to see data from a different viewpoint.” 

Billinger’s collaborative approach has proved inspiring to colleagues such as Sarah Eickmeyer, M.D., professor and chair of the Department of Physical Medicine and Rehabilitation.  

“She’s very generous with her time and open to multiple new team members at a given time,” Eickmeyer said.  

As a physician also interested in stroke recovery, Eickmeyer appreciates the dynamic Billinger brings to the field. 

“As a researcher, she really tries to understand where a busy clinician is coming from and seeks to integrate her research team into the clinical work,” Eickmeyer said. “That approach makes it seamless and easy to collaborate.” 

That integration of perspectives has also shaped the scientific direction of Billinger’s laboratory. In her work with transcranial Doppler ultrasound, a noninvasive test that uses sound waves to measure blood flow in the brain’s major arteries, she sought to move beyond simple associations and examine how multiple physiologic systems interact during exercise. In an integrative study published in the Journal of Applied Physiology, Billinger and her team investigated how heart rate, blood pressure, carbon dioxide and cerebral blood flow influence one another during exercise. To answer those questions, she partnered with statisticians at the University of Washington. The collaboration generated first-of-its-kind data clarifying the relationships underlying cerebrovascular responses to exercise.

An attentive mentor 

The qualities that make Billinger a respected colleague are also the ones that make her a sought-after mentor for younger medical professionals. 

“Dr. Billinger is highly invested in the success of her trainees,” said Bria Bartsch, a student in KU’s rehabilitation science doctoral program who works in the Research in Exercise and Cardiovascular Health laboratory where Billinger serves as director. “She always makes time for updates and research questions despite being a very busy and accomplished researcher in the field of stroke recovery.” 

Billinger’s dedication to her trainees is something that many have carried into their own careers. 

“What stands out most to me is her combination of practical efficiency with genuine generosity in mentorship,” said Jacqueline Palmer, DPT, Ph.D., who worked alongside Billinger during her postdoctoral fellowship and is now an assistant professor at the University of Minnesota. “Sandy created an environment where I felt genuinely valued as a colleague and instilled in me a foundational principle I now carry in my own lab: that research participants and their experience come first.”  

For Billinger, mentorship always begins with a conversation. 

“To be a good mentor, I have to understand [my mentee’s] goals,” Billinger said. “When a mentee can articulate what exactly they want to do, then I try to position them with projects and connect them with others who can help them reach that goal.” 

A future of innovation 

In early February, Billinger traveled to New Orleans for this year’s International Stroke Conference, delivering a talk on high-intensity interval training, part of her ongoing effort to refine how intensity is defined and implemented in stroke recovery. This year will also mark the release of Billinger’s stepper submaximal exercise test as a smartphone app, translating years of research into a tool designed to increase access to precision-guided exercise. There’s also her home garden, which she’ll continue to cultivate. 

Whether advancing stroke recovery or tending to new growth at home, Billinger remains focused on building systems that endure.

“Persistence, I think, is part of innovation,” Billinger said. “You’ve got to keep pushing for it.”