Including individuals with Parkinson's disease and deep brain stimulation in rehabilitation trials: feasibility, challenges, and preliminary gait and postural stability results.

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BackgroundPeople with Parkinson's disease (PwPD) who have undergone deep brain stimulation (DBS) surgery have been historically excluded from rehabilitation clinical trials.ObjectiveThis project investigated the safety, feasibility, and preliminary efficacy of a dual-task training intervention aimed at improving postural instability and gait dysfunction (PIGD) in PwPD with DBS.MethodsSymptoms of PIGD were measured with the 2-Minute Walk Test (2MWT) and Timed Up and Go (TUG) test under single- and dual-task conditions.ResultsFive participants completed 97.5 % of the 16 intervention sessions without serious adverse events. One participant was excluded from the motor analysis due to frequent changes in DBS settings. Of the four participants included in the analysis, all demonstrated improvement in the TUG under single- and dual-task conditions. During the 2MWT, two participants experienced an improvement in gait speed under single-task conditions, and three experienced an improvement under dual-task conditions.ConclusionInitial data suggest dual-task training is safe and feasible for PwPD with DBS. Having DBS presents unique challenges including advanced motor symptoms, autonomic dysfunction, and potential changes in DBS parameters, that impact intervention delivery, adherence, and outcomes. Despite unique challenges, appropriately selected PwPD with DBS have the capacity to improve PIGD symptoms with dual-task training. To facilitate generalizability across the PD continuum, future rehabilitation trials including PwPD with DBS are justified and recommended.

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