Elsevier

NeuroImage: Clinical

Volume 7, 2015, Pages 240-251
NeuroImage: Clinical

Training-induced improvements in postural control are accompanied by alterations in cerebellar white matter in brain injured patients

https://doi.org/10.1016/j.nicl.2014.12.006Get rights and content
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Highlights

  • Brain injury patients and healthy subjects attended 8-weeks of balance training.

  • Diffusion MRI and postural tests were acquired before, during and after training.

  • Cerebellum and cerebellar peduncles were selected as regions of interest.

  • Training-induced changes shown in postural control and inferior cerebellar peduncle

  • Correlations between change in balance and change in white matter microstructure

Abstract

We investigated whether balance control in young TBI patients can be promoted by an 8-week balance training program and whether this is associated with neuroplastic alterations in brain structure. The cerebellum and cerebellar peduncles were selected as regions of interest because of their importance in postural control as well as their vulnerability to brain injury. Young patients with moderate to severe TBI and typically developing (TD) subjects participated in balance training using PC-based portable balancers with storage of training data and real-time visual feedback. An additional control group of TD subjects did not attend balance training. Mean diffusivity and fractional anisotropy were determined with diffusion MRI scans and were acquired before, during (4 weeks) and at completion of training (8 weeks) together with balance assessments on the EquiTest® System (NeuroCom) which included the Sensory Organization Test, Rhythmic Weight Shift and Limits of Stability protocols. Following training, TBI patients showed significant improvements on all EquiTest protocols, as well as a significant increase in mean diffusivity in the inferior cerebellar peduncle. Moreover, in both training groups, diffusion metrics in the cerebellum and/or cerebellar peduncles at baseline were predictive of the amount of performance increase after training. Finally, amount of training-induced improvement on the Rhythmic Weight Shift test in TBI patients was positively correlated with amount of change in fractional anisotropy in the inferior cerebellar peduncle. This suggests that training-induced plastic changes in balance control are associated with alterations in the cerebellar white matter microstructure in TBI patients.

Abbreviations

ICP
inferior cerebellar peduncle
LOS
Limits of Stability
MCP
middle cerebellar peduncle
RWS
Rhythmic Weight Shift
SCP
superior cerebellar peduncle
SOT
Sensory Organization Test
TBI
traumatic brain injury
TBI-t
TBI group with training
TD
typically developing
TD-c
TD group without training
TD-t
TD group with training
UF
uncinate fasciculus

Keywords

Brain injury
Cerebellum
Diffusion tensor imaging
Plasticity
Balance control training

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