Deep Brain Stimulation as a Rehabilitation Amplifier A Precision, Network-Guided Framework for Functional Restoration in Movement Disorders

Deep brain stimulation (DBS) is increasingly understood as a precision neuromodulation therapy capable of influencing distributed basal ganglia–thalamo–cortical and cerebellothalamic net-works. Although its symptomatic benefits in Parkinson’s disease, essential tremor, and dystonia are well established, the extent to which DBS supports motor learning, adaptive plasticity, and participation in rehabilitation remains insufficiently defined. Traditional interpretations of DBS as a focal or lesion-like intervention are being challenged by electrophysiological and imaging evidence demonstrating multiscale modulation of circuit dynamics. DBS may enhance rehabilitation outcomes by stabilizing pathological oscillations and reducing moment-to-moment variability in motor performance—conditions that enable consistent task ex-ecution and more effective physiotherapy, occupational therapy, and speech–language interven-tions. Yet this potential is not fully realized in clinical practice due to interindividual variability, incomplete mechanistic understanding, and the limited specificity of current connectomic bi-omarkers for predicting functional gains. Technological advances such as tractography-guided targeting, directional leads, sensing-enabled devices, and adaptive stimulation are expanding opportunities to align neuromodulation with individualized circuit dysfunction. Despite these developments, major conceptual and empirical gaps persist. Few studies directly examine how stimulation-induced changes in neural stability interact with structured rehabilita-tion to promote long-term functional recovery. Heterogeneity in therapeutic response and rehabil-itation access further complicates interpretation of outcomes. Clarifying these relationships is es-sential for developing precision frameworks that integrate DBS with rehabilitative strategies. This review synthesizes mechanistic, imaging, and technological evidence to outline a net-work-informed perspective of DBS as a potential facilitator of rehabilitation-driven functional improvement and identifies priorities for future research aimed at optimizing durable functional restoration.