Table 1 Studies investigating physical therapy programs in patients with Parkinson’s disease and deep brain stimulation

Cohen et al. [37]

Retrospective study

73 patients (23 F; age, mean [range]: 60.6 [43–80] yo; disease duration mean [range]: 13.6 [3–27] yy; UPDRS—Part III: N.

Bilateral STN (n = 71) and GPi-DBS (n = 2)

N.R. duration

N.R. parameters

Multi-disciplinary personalized rehabilitation treatment (physical, occupational, and speech therapy + nutritional and psychological support)

UPDRS; FIM

Assessments pre- and post- hospitalisation

Significant improvements in motor performances and disability

Nampiaparampil et al. [47]

Case series

Case 1: Male patient (age: 70 yo; disease duration: 7 yy; FIM: 39)

Case 2: Male patient with previous pallidotomy (age: 65 yo; disease duration: 15 yy; FIM: 25)

Case 1: bilateral DBS

Case 2: bilateral STN-DBS

N.R. duration

N.R. parameters

Case 1: physical, occupational and speech therapy (once a day, for 6 weeks)

Case 2: physical, occupational, and speech therapy (once a day, for 4 weeks)

FIM

Assessments pre- and post- hospitalization

Case 1:

recovery of walking function with walker, and independency in ADL with assistance

Case 2:

gait, tremor, and dyskinesia improved

Tassorelli et al. [44]

Pilot, pre-post, clinical study

34 patients (15 F; age, mean ± SD: 57.6 ± 9.4 yo; disease duration, mean ± SD: 11.3 ± 4.4 yy; UPDRS—Part III, mean ± SD: 26.8 ± 12.8)

bilateral STN-DBS

n = 13: < 1 month after surgery;

n = 8: 1–12 months after surgery;

n = 13, > 12 months after surgery

N.R. parameters

Personalized protocol:

• Cardiovascular warm-up (5–10 min);

• Stretching—trunk and limbs (15 min);

• Strengthening muscles in a functional context—active-assisted or active isometric and isotonic exercises for trunk and limbs (10–15 min);

• Relaxing muscles—especially for the flexor muscles (10 min);

• Motor skills, coordination, and dual task performance (10 min);

• Balance (10 min);

• Gait training—with sensory cues (30 min)

Once a day, 5 days a week for 4-to-8 consecutive weeks

UPDRS—Part III; FIM; mBI; MGHFAC; standing balance index

Assessments pre- and post-rehabilitative intervention

Significant improvement of motor performance, functional independence, standing balance and independent walking ability

Nardo et al. [40]

Pilot, pre-post, clinical study

9 patients (2 F; age, mean ± SD: 66.44 ± 5.7 yo; disease duration, mean ± SD: 12.2 ± 6 yy; UPDRS—Part III, mean ± SD: 36.7 ± 6.4)

DBS (months after surgery, mean ± SD: 3.11 ± 1.19)

N.R. parameters

Protocol comprising:

• Body weight supported and robotic-assisted treadmill training: speed at 1.5 km/h, increased up to 3 km/h as tolerated (45 min)

Once a day, for 5 weeks

UPDRS—Part III; Gait kinematics, kinetic, and spatiotemporal parameters

Assessments pre- and post-rehabilitative intervention

Significant improvements in gait performance, in all the spatiotemporal gait parameters, and in maximal ankle plantar flexion angle in the toe-off phase

Luna et al. [42]

Cross-over clinical trial

12 patients (5 F; age, mean ± SD: 61.5 ± 10.4 yo; disease duration, mean ± SD: 18.6 ± 5.2 yy; mH&Y, mean ± SD: 2.3 ± 0.3)

bilateral STN-DBS (months after surgery, mean ± SD: 1.7 ± 0.6)

N.R. parameters

EG: treadmill training with body weight support (30 min) + physical therapy (60 min)

CG: treadmill training without body weight support (30 min) + physical therapy (60 min)

• Treadmill training: speed at 0.5 km/h, increased by increments of 0.5 km/h as tolerated

• Physical therapy: stretching exercise for trunk, upper and lower limbs muscles (2 min); strengthening exercises for upper, lower limbs, trunk, and scapular muscles (for each, 3 sets of 15 repetitions); exercise for balance (bipodal, tandem and unipodal stance—2 sets of each)

twice a week for 8 weeks

Gait kinematics, spatiotemporal and angular parameters

Assessments pre- and post-rehabilitative intervention

Significant improvements in pelvis’ range of motion; hip’s range of amplitude; knee flexion on swing phase; and foot progression range of motion (EG group)

Bestaven et al. [43]

Pilot, pre-post, clinical study

10 patients (3 F; age, mean ± SD: 67.6 ± 6.3 yo; disease duration, mean ± SD: 18.8 ± 4 yy; UPDRS—Part III: N.R.)

bilateral STN-DBS (months after surgery, mean ± SD: 94.8 ± 37.2, 60–175 Hz; 60–90 μs; 2.1–4.6 V)

Protocol comprising:

• Stretching exercise for trunk muscles (75 min);

• Strengthening exercises for trunk muscles, in extension, flexion and rotation (75 min);

• Cardiovascular training (30 min)

twice a day, 5 days a week for 4 weeks

UPDRS—Part III; UPDRS—Part III axial score (items 18, 19, 20, 22, 27–30); UPDRS—Part III gait score (item 30); UPDRS—Part III postural instability score (item 29); ABD; BBS; 3D kinematic gait analyses

Assessments pre- and post-rehabilitative intervention

Significant improvements in gait performances and posture; significant decrease in daily number of falls

Sato et al. [38]

Retrospective study

16 patients (5 F; age, median ± IQR: 61.5 ± 9.5 yo; disease duration, median ± IQR: 13 ± 8 yy; UPDRS—Part III, median ± IQR: 17.5 ± 7.75)

STN-DBS (median: 130 Hz; 60 μs; 1.68 V)

N.R. duration

Protocol aiming to improve muscle strength, flexibility, balance, and gait

• Flexibility: active assistive range of motion exercise for ankle, hip, and trunk joints

• Strength and balance: dynamic balance exercise in the quadrupedal (cat and dog, diagonal balancing exercise) and standing positions (toe-heel weight bearing, one-leg standing, step position)

• Gait: active assistive gait training

40 min a day, for 14 days

Mini-BESTest; TUG; UPDRS-III; BI

Assessments before, three days after and 2 weeks after surgery

Significant improvements in balance and gait ability

Naro et al. [41]

Case-controlled pilot study

EG: 10 patients with STN-DBS (4 F; age, mean ± SD: 62 ± 5 yo; disease duration, mean ± SD: 15 ± 2 yy; UPDRS—Part III, mean ± SD: 19.1 ± 9.03)

CG: 10 patients without DBS (5 F; age, mean ± SD: 62 ± 4 yo; disease duration, mean ± SD: 14 ± 2 yy; UPDRS—Part III, mean ± SD: 27.54 ± 1.12)

bilateral STN-DBS (months after surgery: > 12; 130–240 Hz; 60–120 μs; 2.2–3.6 V)

EG, CG: RAS-assisted treadmill training (30 min) + physical therapy (60 min)

• RAS-assisted treadmill training: bpm at 85 ± 5 (0.43 m/s), increased by 5 bpm every 3 min up to 120 bpm (0.61 m/s)

• Physical therapy: exercises to improve flexibility, balance, gait, and muscular tone and resistance

once a day, 6 days a week, for 4 weeks

UPDRS—part III; TUG; 10MWT; BBS; FES; ACE-R; EEG

Assessments pre- and post-rehabilitative intervention

EG: Significant improvements in motor performance (self-confidence in balance, sit-to-stand, velocity), walking (velocity), and remodulation of gait cycle–related beta oscillations

Both groups: significant improvements in dynamic and static balance, cognitive performance, and the fear of falling

Li et al. [45]

Pilot, clinical study

16 patients (8 F; age, mean ± SD: 60.25 ± 5.6 yo; disease duration, mean ± SD: 10.38 ± 4.33 yy; MDS-UPDRS—Part III, mean ± SD: 59.38 ± 17.07)

bilateral STN-DBS

N.R. duration

N.R. parameters

Multi-disciplinary treatment (DBS, rehabilitation, medication, psychotherapy), comprising:

• Core strength training;

• Postural stability training;

• Training of sensory function

PDQ-39; MDS-UPDRS—Part III; MDS-UPDRS 3.12; BBS; LoS

Assessments pre- and post-surgery, 6 months post-surgery, 12 months post-surgery

Significant improvements in QoL, motor and balance performance at 6 and 12 months

Liang et al. [46]

Pilot, clinical study

15 patients (8 F; age, mean ± SD: 62.5 ± 8 yo; disease duration, mean ± SD: 10.5 ± 4.47 yy; MDS-UPDRS—Part III, mean ± SD: 55.06 ± 16.77)

bilateral STN-DBS (130–170 Hz; 60–90 μs; 1.5–3.5 V)

N.R. duration

Protocol comprising:

• Stretching exercises for neck, shoulders, chest, and waist muscles (10 min);

• Strengthening of back, posterior shoulder, gluteal muscles (at least 1 set of 10 to 15 repetitions for each);

• Back extension and bridge exercise (5 s each);

• Education to the patient

once per day for 8 weeks

PDQ-39, MDS-UPDRS III, degree of camptocormia

Assessments pre-, at 1 month and 6 months after surgery

Significant improvements in camptocormia

Sato et al. [39]

Pre-post, clinical study

60 patients (28 F; age, mean ± SD: 60.7 ± 8.9 yo; disease duration, mean ± SD: 12.2 ± 4.6 yy; MDS-UPDRS—Part III, mean ± SD: 18.1 ± 8.6)

STN-DBS (131.2 ± 6.5 Hz; 58.8 ± 4.9 μs; 1.8 ± 0.5 mA)

N.R. duration

General program combining muscle-strengthening exercises, stretching, and balance exercises

40–60 min a day, for 14 days

Mini-BESTest; TUG; TIS; Lower Extremity Extension Torque; 10 Toe-Tapping Seconds; Postural Sway Test

Assessments before and three days after after surgery, and just before discharge)

Significant improvements in physical function, balance, and gait ability

Canesi et al. [48]

Case-controlled pilot study

EG: 22 patients with DBS (9 F; age, median ± IQR: 63.5 ± 13.5 yo; disease duration, median ± IQR: 17 ± 9 yy; MDS-UPDRS, median ± IQR: 105.5 ± 45.55)

CG: 25 patients without DBS (9 F; age, median ± IQR: 69 ± 11 yo; disease duration, median ± IQR: 15 ± 6 yy; MDS-UPDRS, median ± IQR: 86 ± 30)

DBS (months after surgery, median ± IQR: 72 ± 69.6)

N.R. parameters

Multi-disciplinary treatment (occupational therapy, speech therapy), comprising physical therapy:

• Morning session: warming-up (passive and active mobilization exercises for both upper and lower limbs—10 min), aerobic exercises (walking and cycling, with intensity between 50 and 80% of the maximal heart rate—15 min), active mobilization exercises and strengthening exercises (60–75% of the estimated 1RM—15 min), postural/proprioceptive exercises (10 min), and cooling down (passive and active mobilization exercises—10 min)

• Afternoon session: warming-up (10 min), treadmill (15 min), aerobic exercise (intensity between 50 and 80% of the maximal heart rate—15 min), proprioceptive exercises (15 min) and cooling down (passive and active mobilization exercises—10 min)

60 min, twice a day, 5 days a week for 4 consecutive weeks

MDS-UPDRS; BBS; SPDDS; TUG; 6MWT; MoCA

Assessments pre- and 24 h after rehabilitative intervention

EG and CG improved physical functioning and performance, balance function and independence in ADL, but without difference between groups