# Bilateral Closed Loop Deep Brain Stimulation for Freezing of Gait using Neural and Kinematic Feedback

> **NIH NIH UH3** · STANFORD UNIVERSITY · 2022 · $1,210,585

## Abstract

Gait impairment and Freezing of gait (FOG), lead to falls, injury (even death), loss of independent living, and are
common in neurodegenerative diseases such as Parkinson’s Disease (PD), affecting over 7 million people
worldwide. The incidence of neurodegenerative diseases increases with age and as the population lives longer,
the societal consequences of FOG, will be very significant. Gait impairment and FOG have a partial response to
medication and subthalamic nucleus (STN) open loop deep brain stimulation (olDBS), which cannot adjust
therapy in response to underlying brain signals or motor symptoms such as FOG. One reason is that FOG may
respond to different parameters of DBS, such as lower frequency, than that needed for tremor and most patients
do not tolerate 60 Hz DBS for long periods of time. Emerging technology using sensing neurostimulators and
Bluetooth enabled wearable sensors has allowed research into closed loop or adaptive (a)DBS using neural or
behavioral control variables. FOG is episodic and usually occurs in predictable environments, so it is well suited
for ‘on demand’ aDBS. ADBS, responding to markers of gait impairment and intermittent FOG, with changes in
DBS intensity or frequency, could then prevent FOG, falls and injury, while still treating other motor signs of PD.
From over four years of research and regulatory experience in an academic-industry collaboration with
Medtronic, we have provided design inputs for the next generation aDBS devices, and have determined that
aDBS for tremor and bradykinesia is safe and tolerable in the largest freely-moving PD cohort implanted with a
Medtronic investigative neurostimulation/sensing system (Activa® PC+S-Nexus D/D3/E). We have discovered
neural and behavioral markers of gait impairment and FOG using synchronized neural and kinematic recordings
during gait tasks that elicit FOG. Our research findings and the technological advances embedded in the
Medtronic Summit® RC+S-system now enable the next step: the first clinical studies of lateralized, independent,
bilateral STN aDBS control algorithms for FOG in PD, driven by subject-specific neural (Aim 1) or behavioral
(Aim 2) control variables, and in response to medication (Aim 3). The project will translate stepwise in a ‘bench
to bedside’ manner, testing aDBS during the stepping in place (SIP) task, where the subject is in a harness and
steps in place on dual force-plates. Then aDBS will be tested during the forward walking Turning and Barrier
Course, which mimics environments known to trigger FOG in the real world, and then how aDBS responds to
subject-specific doses of medication, while freely moving. The outcome of these experiments will provide critical
next-steps for safety and feasibility of testing aDBS for gait impairment and FOG in the subject’s home
environment, and on their normal medication. Patient safety, tolerability, adverse effects, gait parameters, and
the number and duration of freezing episodes (FEs), during no ...

## Key facts

- **NIH application ID:** 10455532
- **Project number:** 5UH3NS107709-04
- **Recipient organization:** STANFORD UNIVERSITY
- **Principal Investigator:** Helen Bronte-Stewart
- **Activity code:** UH3 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $1,210,585
- **Award type:** 5
- **Project period:** 2019-08-01 → 2024-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10455532

## Citation

> US National Institutes of Health, RePORTER application 10455532, Bilateral Closed Loop Deep Brain Stimulation for Freezing of Gait using Neural and Kinematic Feedback (5UH3NS107709-04). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10455532. Licensed CC0.

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