title: Training-induced improvements in postural control are accompanied by alterations in cerebellar white matter in brain injured patients.
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.
authors.affiliation: KU Leuven, Movement Control and Neuroplasticity Research Group, Group Biomedical Sciences, B-3001 Leuven, Belgium.
authors.forename: David
authors.initials: D
authors.lastname: Drijkoningen
authors.affiliation: Department of Physical Therapy and Motor Rehabilitation, Faculty of Medicine and Health Sciences, University of Ghent, Ghent B-9000, Belgium.
authors.forename: Karen
authors.initials: K
authors.lastname: Caeyenberghs
authors.affiliation: KU Leuven, Movement Control and Neuroplasticity Research Group, Group Biomedical Sciences, B-3001 Leuven, Belgium.
authors.forename: Inge
authors.initials: I
authors.lastname: Leunissen
authors.affiliation: Child Rehabilitation Centre, Department of Physical Medicine and Rehabilitation, Ghent University Hospital, B-9000 Ghent, Belgium.
authors.forename: Catharine
authors.initials: C
authors.lastname: Vander Linden
authors.forename: Alexander
authors.initials: A
authors.lastname: Leemans
authors.affiliation: KU Leuven, Department of Radiology, University Hospital, B-3000 Leuven, Belgium.
authors.forename: Stefan
authors.initials: S
authors.lastname: Sunaert
authors.affiliation: KU Leuven, Movement Control and Neuroplasticity Research Group, Group Biomedical Sciences, B-3001 Leuven, Belgium.
authors.forename: Jacques
authors.initials: J
authors.lastname: Duysens
authors.affiliation: KU Leuven, Movement Control and Neuroplasticity Research Group, Group Biomedical Sciences, B-3001 Leuven, Belgium ; KU Leuven, Leuven Research Institute for Neuroscience & Disease (LIND), Belgium.
authors.forename: Stephan P
authors.initials: SP
authors.lastname: Swinnen
mesh_terms: D000293:Adolescent; D001930:Brain Injuries / Q000473:pathology / Q000534:rehabilitation*; D002531:Cerebellum / Q000473:pathology*; D002648:Child; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D026741:Physical Therapy Modalities; D004856:Postural Balance / Q000502:physiology*; D066127:White Matter / Q000473:pathology*; D055815:Young Adult
keywords: Balance control training; Brain injury; Cerebellum; Diffusion tensor imaging; ICP, inferior cerebellar peduncle; LOS, Limits of Stability; MCP, middle cerebellar peduncle; Plasticity; 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