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Further, to map the neural correlates of dynamic balance impairments in ABI, we examine the correlation between dynamic balance impairments and the volume of pre-defined regions of interest in the cortex and sub-cortical regions 17, 18, 19, 34. In this study, we investigate the neural correlates of dynamic balance impairments and recovery by longitudinally examining resting-state functional Magnetic Resonance Imaging connectivity (Rs-fMRI) in a group of ABI participants whose dynamic balance improved following a rehabilitation intervention 30. Imaging studies from recent years indicate that cognitive and motor training effects can be predicted by functional brain connectivity reorganization and are associated with changes in functional connectivity 31, 32, 33. Furthermore, facing unpredictable perturbations, generated by mechatronic shoes, has been recently shown to be associated with improvement in dynamic balance 30. Lesions in the previously mentioned areas and in their inter-hemispheric connections are associated with gait and balance impairments 20, 21, 22, 23 and are being targeted for rehabilitation interventions in stroke and parkinson’s 24, 25, 26.ĭynamic balance and mobility at the chronic phase of ABI have been demonstrated to respond to rehabilitation treatments such as virtual reality training, multi-disciplinary rehabilitation, and conventional balance training 27, 28, 29, 30. Imaging studies indicate the involvement of the cerebellum, basal ganglia and the motor cortex in gait and postural control in healthy subjects 16, 17, 18, 19. Dynamic balance control is a complex function that is achieved by both feedback and feedforward control mechanisms and mediated by both central pattern generators at the spinal level and subcortical and cortical brain areas 13, 14, 15. Subjects post-ABI at the chronic phase frequently suffer from dynamic balance control impairments that restrict their mobility and limit their community integration and locomotor abilities 10, 11, 12. Longitudinal studies indicate an association between brain atrophy post-stroke and gait-control decline 7, 8, as well as increased risk of motor-related neurodegenerative disorders (such as parkinson’s disease post-TBI) 9. Furthermore, both etiologies trigger brain atrophy and neurodegenerative conditions 4, 5 that have been shown to be associated with motor, cognitive, and psychiatric decline 4, 6. Both etiologies are characterized by neuronal loss, and local and remote neurophysiological changes in structural and functional networks that are associated with the sensorimotor impairments and with the recovery process 2, 3. Two common ABI conditions are Traumatic Brain Injury (TBI) and stroke 1. The lack of global structural correlates of dynamic balance may point to the involvement of specific networks in balance control.Īcquired Brain Injury (ABI) is defined as damage to the brain that occurs after birth. Our results show that dynamic balance recovery is associated with FC reduction within and between the cerebellar and sensorimotor networks.
Brain volume analysis did not reveal structural correlates of dynamic balance, but dynamic balance was correlated with time since injury. Improvement in 10MWT was associated with baseline FC within the cerebellar-putamen and cerebellar-cortical networks. Improvement in CB&M scale was associated with a reduction in FC within the cerebellar network and with baseline FC within the cerebellar-putamen and cerebellar-thalamic networks. ICA revealed a reduction in component-related activation within the sensorimotor and cerebellar networks post-intervention. Brain morphology was also assessed using structural MRI. Brain function was estimated using resting-state fMRI imaging that was analysed using independent component analysis (ICA), and regions-of-interest analyses.
Dynamic balance was assessed using the Community Balance and Mobility scale (CB&M) and the 10-Meter Walking Test (10MWT). Thirty-one chronic participants with ABI participated in a novel rehabilitation treatment composed of 22 sessions of a perturbation-based rehabilitation training. This study aims to characterize the functional and structural correlates of ABI-induced dynamic balance impairments and recovery following a rehabilitation treatment. Dynamic balance control is associated with the function of multiple brain networks and is impaired following Acquired Brain Injury (ABI).
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