Real-Time Kinematic Adaptive Deep Brain Stimulation Safely Reduces Gait Impairment and Freezing of Gait in Parkinson’s Disease

Abstract Gait impairment (GI) and freezing of gait (FOG) affect 80% of patients with advanced Parkinson’s disease. Continuous deep brain stimulation (cDBS) provides limited adaptability to address the episodic nature of FOG due to fixed parameters. Neural biomarkers for adaptive DBS are limited by signal artifacts and poor FOG classification. Wearable inertial measurement units (IMUs) offer a promising alternative by directly measuring signatures of GI symptom-free reports were 87.5% and 71.4% for arrhythmicity and P(FOG) models respectively, compared to 50.0% for cDBS. All symptoms were mild, transient, and resolved without intervention. KaDBS significantly reduced percent time freezing versus OFF during stepping-in-place (35.8%, P= 4.80 × 10⁻³) and free walking (33.4%, p = 9.00 × 10⁻⁴). Therapeutic effects concentrated in baseline freezers: two participants with 100% time freezing during OFF achieved complete resolution with KaDBS, while non-freezers maintained stable gait. These findings establish KaDBS as a safe, effective approach to personalized neuromodulation for PD.