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Review

Focused Ultrasounds in the Rehabilitation Setting: A Narrative Review

by
Carmelo Pirri
1,*,
Nicola Manocchio
2,*,
Daniele Polisano
2,
Andrea Sorbino
2 and
Calogero Foti
2
1
Department of Neurosciences, Institute of Human Anatomy, University of Padova, 35121 Padova, Italy
2
Physical and Rehabilitation Medicine, Department of Clinical Sciences and Translational Medicine, Tor Vergata University, 00133 Rome, Italy
*
Authors to whom correspondence should be addressed.
Appl. Sci. 2025, 15(9), 4743; https://doi.org/10.3390/app15094743
Submission received: 27 March 2025 / Revised: 18 April 2025 / Accepted: 24 April 2025 / Published: 24 April 2025
(This article belongs to the Special Issue Innovative Approaches and Tools for Healthcare and Medical Applications)
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Versions Notes

Abstract

:
Focused ultrasound (FUS) is an emerging noninvasive technology with significant therapeutic potential across various clinical domains. FUS enables precise targeting of tissues using mechanisms like thermoablation, mechanical disruption, and neuromodulation, minimizing damage to surrounding areas. In movement disorders such as essential tremor and Parkinson’s disease, MR-guided FUS thalamotomy has demonstrated substantial tremor reduction and improved quality of life. Psychiatric applications include anterior capsulotomy for treatment-resistant obsessive-compulsive disorder and major depressive disorder, with promising symptom relief and minimal cognitive side effects. FUS also facilitates blood-brain barrier opening for drug delivery in neurological conditions like Alzheimer’s disease. Musculoskeletal applications highlight its efficacy in managing chronic pain from knee osteoarthritis and lumbar facet joint syndrome through precise thermal ablation. Additionally, FUS has shown potential in neuropathic pain management and peripheral nerve stimulation, offering innovative approaches for amputees and cancer survivors. Cognitive and neuromodulatory research underscores its ability to enhance motor function and interhemispheric cortical balance, benefiting stroke and traumatic brain injury rehabilitation. Despite these conditions frequently leading to various kinds of disabilities, no direct exploration of the possible FUS application in rehabilitation is yet available in the literature. All this considered, this review aims to discuss how FUS could be applied in rehabilitation, exploring the current status of knowledge and highlighting future directions.

1. Introduction

Focused ultrasound (FUS) is a non-incisional ablative medical technology that uses US waves concentrated via a curved transducer, lens, or phased array to achieve precise therapeutic effects [1,2]. This differs from conventional diffuse US, used for diagnosis or general rehabilitation. This technique enables targeted interventions with minimal impact on surrounding tissues, offering a safer alternative to invasive procedures [3]. Initially applied in oncology for conditions like uterine fibroids and liver lesions, FUS has expanded its applications to neurological and musculoskeletal disorders due to advancements in imaging and acoustic technologies [4,5,6]. Its ability to penetrate the skull and interact with brain structures has made it particularly promising for treating brain-related conditions, addressing challenges such as the blood-brain barrier (BBB) and surgical risks associated with traditional approaches [7]. FUS operates through various mechanisms, including thermoablation, mechanical disruption, and neuromodulation [8]. These modalities have been applied across diverse clinical domains. For instance, MR-guided focused ultrasound (MRgFUS) has shown efficacy in treating movement disorders like essential tremor (ET) and Parkinson’s disease (PD) through precise thalamotomy [9]. In psychiatric disabilities, FUS has been explored for treatment-resistant obsessive-compulsive disorder (OCD) and major depressive disorder (MDD) via anterior capsulotomy [10]. Additionally, FUS has demonstrated potential in opening the BBB for drug delivery in Alzheimer’s disease and enabling pain relief in musculoskeletal (MSK) conditions [11,12].
The therapeutic implications of FUS extend beyond disease management to rehabilitation. Its ability to modulate neural circuits noninvasively offers opportunities for motor and cognitive rehabilitation following stroke or traumatic brain injury. Furthermore, its application in pain management could enhance functional recovery in patients with chronic pain or neuropathic conditions. Despite these promising prospects, the integration of FUS into rehabilitation remains underexplored, necessitating further research to optimize protocols and broaden its clinical utility. This review aims to evaluate the current applications of FUS across various clinical domains, emphasizing its potential role in rehabilitation. This paper seeks to highlight the translational opportunities of FUS while addressing gaps in knowledge that could guide future research and clinical practice.

2. Methods

A literature search was conducted using the search strategy (“focused ultrasound” AND “rehabilitation”) on the PubMed and Scopus databases. No other specifier was applied, and no time limit was used to keep the search as broad as possible. Papers were considered if they (1) were in vivo, (2) evaluated FUS, and (3) were published in the English language. The search was extended through the reference lists of the selected papers. Papers were not considered if they were (1) papers on in vitro or base research, (2) papers on animals (e.g., murine models), (3) consensus, editorials, letters to editors, study protocols, reviews, and commentaries, (4) papers off-topic, and (5) papers not published in the English language. Three reviewers (N.M., A.S., and D.P.) independently screened the papers by reading titles and abstracts. Two reviewers finalized the screening in case of disagreement (C.P. and C.F.). Following the initial abstract evaluation, the corresponding full-text manuscript was retrieved. After the selection, each paper was independently assessed by each of the authors.
Figure 1 shows the study selection process.

Data Extraction

Data concerning the topic were collected and analyzed as follows:
  • General characteristics of the paper: first author, year of publication, and study design.
  • Study population characteristics: age, gender, and type of disease.
  • Methods: type of FUS, parameters applied, setting, and rehabilitation protocol applied.
  • Outcome measures, results, and adverse events.

3. Focused Ultrasound Applications in Disabling Conditions

In recent years, FUS methods have grown in their breadth of clinical applications with expanding clinical versatility because of their safety, efficacy, and translational potential.
FUSs have been gaining attention in several disabling conditions, encompassing movement disorders (such as ET and PD), psychiatric and neurological conditions, neuropathic pain, MSK disorders, and cognitive and neuromodulatory research. In this section, the most promising FUS applications are analyzed, divided per condition. Table 1 summarizes key features of FUS rehabilitative applications. Deeper specifications of the assessed studies are reported in Supplementary Materials.

3.1. Movement Disorders

In patients experiencing essential tremor, Abe et al. [13] reported a 56.4% reduction in postural tremor severity at 12 months in 35 patients, accompanied by sustained quality of life (QoL) improvements. Hashida et al. [14] observed a 59.4% tremor improvement rate at two-year follow-up in 38 ET patients, although transient gait disturbances (23.7%) and numbness (28.9%) were noted. Gopinath et al. [15] found reduced caregiver burden in 18 ET patients following thalamotomy, which correlated with tremor severity reduction. For PD, Sinai et al. [16] reported long-term tremor relief in 23 patients, with mild gait unsteadiness resolving within three months. Tani et al. [17] used functional MRI to identify increased thalamic-premotor connectivity after thalamotomy in seven ET patients. Petersen et al. [18] and Scantlebury et al. [19] both confirmed the safety and efficacy of staged bilateral thalamotomy in patients with refractory ET. Finally, Kato et al. [20] used resting-state functional MRI to demonstrate restored resting-state network (RSN) in 15 ET patients post-thalamotomy, suggesting that these changes may serve as potential biomarkers for treatment success.

3.2. Psychiatric/Neurological Disorders

FUS has been applied in psychiatric and neurological disorders. Davidson et al. [21] reported symptom improvement in ten patients with OCD/MDD without cognitive impairment following MRgFUS anterior capsulotomy. Krishna et al. [22] demonstrated a reduction in seizure frequency in two epilepsy patients after anterior thalamic ablation, although one patient experienced transient verbal fluency deficits. Huang et al. conducted a phase I trial demonstrating the safety and feasibility of low-intensity focused ultrasound (LIFUS) applied to the ipsilesional motor cortex in 18 chronic stroke patients during motor rehabilitation. In their dose-escalation study (0–8 W/cm2 spatial-peak pulse-average intensity), 67% of the high-intensity group participants (4–8 W/cm2) showed ≥20% motor sequence learning improvements compared to controls, alongside modulated corticospinal excitability patterns [23]. In a separate study, Meng et al. [24] investigated MRgFUS-mediated BBB opening in nine patients with Alzheimer’s disease. While no cognitive improvements were observed, they noted an increase in cerebrospinal fluid neurofilament light chain levels.

3.3. Musculoskeletal Applications

FUS has shown promising results in various MSK applications. Kawasaki et al. [25] evaluated the efficacy and safety of MRgFUS for refractory chronic pain in medial knee osteoarthritis. MRgFUS was applied to areas of severe tenderness around the medial femorotibial joint, targeting a bone surface temperature of 55 °C. The procedure was conducted under real-time MRI guidance to ensure precision. After identifying the most sensitive site using a handheld algometer, a detectable marker was attached to the area, and MR imaging was used to plan the treatment within a 2 cm radius centered on the bone surface. A sonication transducer, secured to the medial side of the knee, delivered MRgFUS. The US beam was carefully angled to avoid critical structures like the joint cavity and neurovascular bundle. Authors reported significant pain relief (73.7% of patients: ≥50% reduction in pain scores at 12 months). Tiegs-Heiden et al. [26] reported sustained pain relief (VAS: 0–2/10) and improved functional capacity at 12 months in a patient with lumbar facet joint pain treated with MRgFUS. Authors applied MRgFUS to ablate the posterior facet joint capsules of the patient’s lumbar spine, targeting the joint capsule with a software-generated ultrasound beam manually adjusted to avoid non-target structures, such as nerve roots or spinous processes. MRgFUS was delivered in four sonications lasting 20–25 s each, with energy levels between 1000 and 1400 J per sonication, monitoring real-time temperature maps via MRI thermometry to ensure precise ablation and sparing of surrounding tissues. The treatment was performed under moderate sedation, and post-procedural imaging confirmed successful ablation requiring no incisions or needles.

3.4. Neuropathic Pain/Amputation Applications

FUS has also been applied for pain management and peripheral nerve stimulation. Ezeokeke et al. [27] reported restoration of sensation and muscle function in an amputee using high-intensity FUS (71.5 W/cm2), suggesting a mechanism of peripheral nerve reactivation. Mourad et al. [28] investigated the effects of FUS on phantom limb sensations in 11 amputees, showing the feasibility of using FUS to selectively stimulate severed nerves in limb stumps and suggesting that FUS could represent an innovative method to identify deep, painful tissues noninvasively, improving the diagnosis of peripheral pain, guiding targeted therapeutic interventions, and monitoring the effectiveness of pain treatments over time. For neuropathic pain, Patel et al. [29] achieved an 85.7% response rate in cancer-related cases using low-intensity FUS.

3.5. Cognitive Functions

Lastly, several studies have investigated the effects of FUS on brain function. Legon et al. [30] demonstrated the ability of transcranial FUS to inhibit thalamic sensory-evoked potentials in 40 participants. In a separate study, the same group [31] showed that FUS modulation of the motor cortex could reduce reaction times in 50 subjects. Legon et al. [32] also reported transient side effects, such as headache, in 64 participants following low-intensity FUS. Regarding electroencephalographic (EEG) activity, Jerel Mueller et al. [33] found that FUS preferentially modulates beta and gamma oscillations. For cognitive effects, Park et al. [34] reported improved performance on an anti-saccade task after prefrontal cortex stimulation in two individuals. Finally, Xia et al. [35] observed changes in interhemispheric excitability following motor cortex FUS in 20 participants.

3.6. Adverse Events

The most commonly reported adverse events (AEs) associated with FUS thalamotomy included transient gait disturbances [14,16], numbness [14], and headache [16,19]. Cognitive deficits were infrequent, with one report of transient verbal fluency decline following anterior thalamic ablation [22]. In peripheral applications, transient leg or shoulder pain was observed [19]. Similarly, mild and transient pain was reported after FUS application for lower limb amputation [28]. While Meng et al. [24] noted increased cerebrospinal fluid neurofilament light chain levels after FUS-mediated blood-brain barrier opening, this finding was not associated with any clinical sequelae. Transient pain exacerbation was observed in a subset of patients undergoing FUS for knee osteoarthritis [25]. Huang et al. reported a single transient first-degree scalp burn resolved spontaneously at LIFUS maximal intensity [23]. Importantly, no severe or irreversible complications were reported in any of the studies.
While it would be of interest to evaluate whether unilateral or bilateral FUS results in different rates of AEs, the available studies report that adverse events were infrequent and never severe. Based on current evidence, no definitive conclusions can be drawn regarding differences in the incidence or nature of adverse events between unilateral and bilateral FUS procedures.

4. Discussion and Future Directions

This review addressed both lower-intensity and higher-intensity FUS applications. Higher-intensity FUS (HIFU) has been used primarily for thermoablation and mechanical disruption, such as in movement disorders (e.g., ET and PD), musculoskeletal (MSK) conditions, and neuropathic pain management (e.g., peripheral nerve reactivation in amputees, refractory pain in knee osteoarthritis through thermal denaturation of nociceptors). On the other hand, LIFUS has been employed for neuromodulation, including cognitive and motor rehabilitation, as well as psychiatric and neurological conditions. Examples include transcranial FUS for modulating cortical circuits to improve reaction times or reduce errors in cognitive tasks. LIFUS has also been explored for cancer-related neuropathic pain management with minimal side effects.
Many studies about FUS reported preliminary results, emphasizing the need for further research to comprehensively analyze the potential of focused ultrasound (FUS). Notably, the absence of direct implications for rehabilitation in the reviewed literature should encourage researchers to explore this emerging field, particularly its applications for patients with various disabilities. Given the broad range of FUS applications, including chronic pain management, neuromodulation, and tumor ablation, numerous conditions could potentially benefit from this technology. However, expanding the body of literature is essential to better understand its efficacy, safety, and clinical utility across diverse patient populations.

4.1. Neurological and Psychiatric Disabilities

MRgFUS thalamotomy has emerged as a promising therapeutic option for several possible rehabilitation applications (Figure 2). Among the most promising conditions, movement disorders such as ET and PD have raised interest. Studies by Abe et al. [13] and Hashida et al. [14] reported substantial tremor reduction rates (56.4–59.4%) in ET patients, with concomitant improvements in QoL. Furthermore, functional imaging by Tani et al. [17] demonstrated increased thalamic-premotor connectivity following thalamotomy, suggesting enhanced motor-sensory integration as a potential mechanism underlying tremor reduction. Functional neurosurgical procedures, including stereotactic lesion surgery, have long demonstrated efficacy in ameliorating the involuntary movements characteristic of PD and ET. MRgFUS offers a less invasive alternative to deep brain stimulation (DBS) by precisely creating localized lesions within deep brain structures without the need for invasive surgical procedures, such as burr holes or electrode implantation [36,37]. Given the significant impact of movement disorders on QoL [38], effective therapeutic options are crucial, and FUS could represent a crucial alternative for future rehabilitation approaches. Moreover, FUS demonstrated excellent safety profiles with minimal treatment-related side effects.
Another area of application for FUS that emerged from our review lies in the treatment of psychiatric conditions such as MDD and OCD, which rank among the most prevalent mental health disorders globally. Notably, approximately one-third of patients with MDD or OCD exhibit treatment resistance, highlighting the critical need for novel therapeutic approaches [39]. Psychiatric surgery, encompassing neurosurgical procedures such as DBS or lesional surgery targeting critical nodes within the limbic circuitry, represents a viable treatment option for these refractory cases [40]. Unlike DBS, which necessitates permanent implantation of a neurostimulator device, lesional procedures such as FUS eliminate the need for continuous device monitoring, programming, and battery replacements, with the potential to revolutionize lesional procedures [41]. Clinical evidence supports the efficacy of lesional procedures in treatment-resistant OCD and MDD. Case series consistently report significant clinical improvement in approximately 50% of patients [42]. Davidson et al.’s [21] findings support this concept, demonstrating significant symptom improvement without cognitive decline in patients with OCD/MDD following MRgFUS anterior capsulotomy. Advancements in the field of neurological conditions following FUS therapy are also supported by Krishna et al. [22], who reported a reduction in seizure frequency following anterior thalamic ablation, although transient verbal fluency deficits were observed. In contrast, Meng et al. [24] found no cognitive improvements in patients with Alzheimer’s disease despite successful BBB opening using FUS. This discrepancy suggests that achieving therapeutic efficacy in human neurological conditions may require a more nuanced approach, potentially involving adjunctive pharmacotherapies or further refinement of FUS parameters.
Moreover, FUS represents an innovative tool for noninvasive neuromodulation with promising applications in motor and cognitive rehabilitation. While rehabilitation of neurological conditions is already a vastly developed field, the ability of FUS to selectively target cortical circuits with minimal side effects positions it as a valuable technique for advancing therapeutic approaches in neurological disorders [43,44,45]. Previous studies have demonstrated that transcranial FUS (tFUS) can modulate neuronal activity in animal models with high spatial resolution, targeting specific cortical areas [46,47,48]. Compared to other noninvasive neuromodulation techniques, such as repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS), low-intensity focused ultrasound (LIFUS) has shown a similar or lower incidence of side effects like headaches and drowsiness. Importantly, no seizures have been reported with LIFUS, unlike rTMS (0.3%) and deep transcranial magnetic stimulation (dTMS, 2.4%) [32]. FUS appears to exert an inhibitory effect on the motor cortex, improving reaction times in visual stimulus-response tasks compared to control conditions. This suggests a behavioral advantage through neuronal inhibition, potentially enhancing motor speed and accuracy. Such effects could benefit the rehabilitation of patients with motor deficits caused by stroke or traumatic brain injuries. Selective inhibition of specific cortical circuits may also help restore the balance between excitation and inhibition in movement disorders such as dystonia or PD. This inhibition might be mediated by mechanical effects on astrocytes or mechanosensitive ion channels rather than direct action on pyramidal neurons [31]. Positive results have also been observed in tasks requiring inhibitory control, such as reducing errors in anti-saccade tasks, where participants must look in the opposite direction of a visual stimulus. These findings suggest potential applications for FUS in rehabilitating patients with motor or cognitive control deficits caused by stroke, traumatic brain injuries, or neuropsychiatric conditions like PD [34]. Furthermore, theta-burst transcranial ultrasound stimulation (tbTUS) applied to the left primary motor cortex (M1) has been shown to enhance excitability in the stimulated M1 while reducing excitability in the contralateral M1, thereby modulating interhemispheric inhibition (IHI). This is particularly relevant for stroke patients, where an imbalance between the two M1 regions—characterized by hyperactivation of the unaffected M1—can hinder motor recovery. tbTUS may help restore functional hemispheric balance, offering potential benefits for conditions such as Parkinson’s disease, dystonia, and other motor pathologies involving disrupted cortical connections [35]. Lastly, Huang et al.’s phase I trial provided preliminary evidence that LIFUS is safe and feasible for stroke patients at intensities up to 8 W/cm2. High-intensity stimulation seems to enhance motor learning and may improve corticospinal excitability. Phase II trials are needed to further investigate efficacy and optimize stimulation parameters for clinical applications [23].

4.2. Musculoskeletal Disabilities

FUS has also been applied in the treatment of MSK conditions, such as refractory knee pain and facet joint pain, conditions that often lead to functional disability and impair QOL. While several treatment options exist for knee osteoarthritis [49,50,51] and facet joint pain [52,53], surgery remains the only option in certain cases. However, surgery is often not feasible due to patient unwillingness or poor health conditions. Furthermore, surgical interventions carry a higher risk of severe complications compared to conservative treatments, with chronic postsurgical pain reported in 10–34% of cases [54]. This underscores the need for advanced, minimally invasive, nonsurgical interventions to manage MSK conditions effectively. MRgFUS has garnered attention for its precision, noninvasive real-time monitoring capabilities, and potential to reduce pain sensitization. Kawasaki et al. demonstrated that MRgFUS not only effectively managed refractory pain but also improved physical function without adverse events in elderly patients with medial knee osteoarthritis. Similarly, Tieg-Heiden et al. reported positive outcomes using MRgFUS for lumbar facet joint ablation, highlighting its promise as a therapy for facet joint-mediated low back pain. The mechanism of MRgFUS in MSK conditions appears to involve localized degeneration of nociceptors and nerve fibers through thermal denaturation of peri-articular tissues in the medial femorotibial joint. Heating these tissues beyond the protein denaturation threshold (55 °C) results in localized denervation [55]. MRgFUS offers several advantages for treating MSK conditions, including noninvasive thermal ablation without the need for ionizing radiation or needles, the ability to treat multiple joints in a single session, and the option to repeat treatments if symptoms recur. MRI guidance provides direct visualization of treatment targets and real-time monitoring with MRI thermometry, ensuring precise targeting. However, challenges include the complex etiology of MSK conditions, which requires careful patient selection, and contraindications to MRI. Clinicians must accurately identify treatment targets and ensure the safety of the beam path to avoid unintended tissue damage.
Considering their ability to reduce pain, FUS has shown potential in addressing pain associated with limb amputation and neuropathic conditions. Despite advancements like targeted muscle reinnervation, which connects transected nerves to neuromuscular junctions to reduce neuroma-related pain, many patients still suffer from pain due to peripheral and central mechanisms [56,57]. FUS could be applied to stimulate peripheral nerves at or near the distal tips of transected nerves, potentially activating dormant thalamus-cortex circuits to restore motor and sensory functions, as hypothesized by Ezeokeke et al. Preclinical studies, such as those by Mesik et al., support this concept by demonstrating FUS’s ability to activate dormant neural pathways, including transcranial ultrasound stimulation of the thalamus [58]. If validated, this approach could revolutionize rehabilitation by reducing pain and improving functionality in individuals with nerve injuries or amputations. FUS also offers promise for cancer-related neuropathic pain, which affects up to 40% of cancer survivors [59]. This pain arises from direct neural damage caused by tumors or treatments like chemotherapy. Current options often involve significant side effects, emphasizing the need for safer alternatives [60]. FUS provides a noninvasive technique that avoids surgery and invasive procedures, reducing infection risks and recovery times. It precisely targets specific nerves or tissues without harming surrounding areas, directly stimulating peripheral and central nervous systems to promote functional activity in damaged tissues. Compared to prolonged pharmacotherapy or electrical implants, FUS offers a superior safety profile with minimal side effects, making it a promising option for managing neuropathic pain in cancer survivors [29].

4.3. FUS Controversial Aspects

FUS is a promising non-invasive therapeutic technology, but its clinical application is hindered by several controversial aspects. The heterogeneity in the parameters used across studies complicates standardization and reproducibility, limiting the comparability of results. Furthermore, the scarcity of randomized controlled trials (RCTs) reduces the strength of evidence supporting its efficacy and safety. Anatomical variability, such as differences in skull and scalp structure, can affect targeting precision and therapeutic outcomes. Additionally, adverse events, although generally mild and transient (e.g., gait disturbances, numbness, or headaches), raise concerns about consistency in safety profiles. These issues underscore the need for further research to refine protocols, improve standardization, and expand the evidence base for FUS applications.

5. Conclusions

In conclusion, FUS represents a transformative noninvasive technology with broad therapeutic potential across multiple clinical domains. This review highlights its versatility in achieving precise therapeutic effects, such as reducing tremors in ET and PD, alleviating chronic pain in musculoskeletal conditions, and modulating neural circuits for psychiatric and cognitive applications. Importantly, FUS has demonstrated a favorable safety profile with minimal adverse events, further supporting its clinical utility.
Despite these advancements, the integration of FUS into rehabilitation settings remains underexplored. Its ability to modulate neural pathways noninvasively offers significant promise for motor recovery following stroke or traumatic brain injury and cognitive rehabilitation in neurodegenerative disorders. Furthermore, its role in chronic pain management could enhance functional outcomes by reducing pain-related disability. However, the lack of direct evidence linking FUS to specific rehabilitation protocols underscores the need for further research to optimize treatment parameters, identify suitable patient populations, and evaluate its efficacy across diverse conditions.
By addressing these gaps, FUS could pave the way for innovative approaches to managing complex medical conditions and improving quality of life for diverse patient populations. As a noninvasive alternative to traditional therapies like deep brain stimulation, FUS holds the potential to revolutionize movement disorder treatment, chronic pain management, motor recovery after stroke, and cognitive restoration following traumatic brain injuries. Future research should focus on refining its parameters and applications to fully realize this promise.

Supplementary Materials

The following supporting information can be downloaded at: https://www.mdpi.com/article/10.3390/app15094743/s1, Table S1: Relevant studies about FUS application in the Rehabilitation setting. FUS were unilateral applied unless differently specified.

Author Contributions

Conceptualization, C.P.; writing—original draft preparation, C.P., N.M., D.P. and A.S.; writing—review and editing, C.P., N.M., D.P. and A.S.; supervision, C.F. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Data Availability Statement

All data used for this review are available in the manuscript.

Conflicts of Interest

The authors declare no conflicts of interest.

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Applsci 15 04743 g001
Figure 1. Studies’ selection process (PRISMA flow-chart).
Figure 1. Studies’ selection process (PRISMA flow-chart).
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Figure 2. Schematic representation of potential FUS uses in rehabilitation settings.
Figure 2. Schematic representation of potential FUS uses in rehabilitation settings.
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Table 1. Key features of FUS applications in the rehabilitation setting.
Table 1. Key features of FUS applications in the rehabilitation setting.
Application AreaCondition/TargetFUS TechniqueMechanismKey OutcomesAdverse Effects
Movement DisordersEssential tremor, Parkinson’sMRgFUS thalamotomyAblation of ventral intermediate thalamic nucleus56.4–59.4% tremor reduction; sustained QoL improvementsTransient gait disturbances (23.7%), numbness (28.9%)
Psychiatric DisordersOCD, MDDMRgFUS anterior capsulotomyModulation of cortico-striato-thalamo-cortical circuitsSymptom improvement without cognitive deficitsNone significant reported
EpilepsyRefractory seizuresAnterior thalamic ablationDisruption of seizure propagation pathwaysReduced seizure frequencyTransient verbal fluency deficits
Stroke RehabilitationChronic motor deficitsLIFUS to ipsilesional motor cortexEnhanced neuroplasticity via corticospinal excitability modulation≥20% motor learning improvement (high-intensity group)None significant reported
Neuropathic PainCancer-related painLow-intensity FUSNon-thermal neuromodulation85.7% response rateNot specified
Phantom Limb PainAmputation-related sensationsHigh-intensity FUS (71.5 W/cm2)Peripheral nerve reactivationRestored sensation; pain modulationNot specified
Musculoskeletal PainKnee osteoarthritis, facet jointMRgFUS thermal ablationTargeted denervation of nociceptive fibers73.7% with ≥50% pain reduction; functional improvementMild post-procedural discomfort
Cognitive ModulationExecutive functionTranscranial FUS to prefrontal cortexCortical network modulationImproved anti-saccade task performanceTransient headaches (64 participants)
Neurodegenerative ResearchAlzheimer’s diseaseMRgFUS-mediated BBB openingEnhanced drug delivery via blood-brain barrier disruptionIncreased CSF neurofilament light chainNo cognitive improvements observed
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Pirri, C.; Manocchio, N.; Polisano, D.; Sorbino, A.; Foti, C. Focused Ultrasounds in the Rehabilitation Setting: A Narrative Review. Appl. Sci. 2025, 15, 4743. https://doi.org/10.3390/app15094743

AMA Style

Pirri C, Manocchio N, Polisano D, Sorbino A, Foti C. Focused Ultrasounds in the Rehabilitation Setting: A Narrative Review. Applied Sciences. 2025; 15(9):4743. https://doi.org/10.3390/app15094743

Chicago/Turabian Style

Pirri, Carmelo, Nicola Manocchio, Daniele Polisano, Andrea Sorbino, and Calogero Foti. 2025. "Focused Ultrasounds in the Rehabilitation Setting: A Narrative Review" Applied Sciences 15, no. 9: 4743. https://doi.org/10.3390/app15094743

APA Style

Pirri, C., Manocchio, N., Polisano, D., Sorbino, A., & Foti, C. (2025). Focused Ultrasounds in the Rehabilitation Setting: A Narrative Review. Applied Sciences, 15(9), 4743. https://doi.org/10.3390/app15094743

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