title: Regional volumes in brain stem and cerebellum are associated with postural impairments in young brain-injured patients.
abstract: Many patients with traumatic brain injury (TBI) suffer from postural control impairments that can profoundly affect daily life. The cerebellum and brain stem are crucial for the neural control of posture and have been shown to be vulnerable to primary and secondary structural consequences of TBI. The aim of this study was to investigate whether morphometric differences in the brain stem and cerebellum can account for impairments in static and dynamic postural control in TBI. TBI patients (n = 18) and healthy controls (n = 30) completed three challenging postural control tasks on the EquiTest® system (Neurocom). Infratentorial grey matter (GM) and white matter (WM) volumes were analyzed with cerebellum-optimized voxel-based morphometry using the spatially unbiased infratentorial toolbox. Volume loss in TBI patients was revealed in global cerebellar GM, global infratentorial WM, middle cerebellar peduncles, pons and midbrain. In the TBI group and across both groups, lower postural control performance was associated with reduced GM volume in the vermal/paravermal regions of lobules I-IV, V and VI. Moreover, across all participants, worse postural control performance was associated with lower WM volume in the pons, medulla, midbrain, superior and middle cerebellar peduncles and cerebellum. This is the first study in TBI patients to demonstrate an association between postural impairments and reduced volume in specific infratentorial brain areas. Volumetric measures of the brain stem and cerebellum may be valuable prognostic markers of the chronic neural pathology, which complicates rehabilitation of postural control in TBI.
authors.affiliation: KU Leuven, Movement Control and Neuroplasticity Research Group, Group Biomedical Sciences, Leuven, Belgium.
authors.forename: David
authors.initials: D
authors.lastname: Drijkoningen
authors.affiliation: KU Leuven, Movement Control and Neuroplasticity Research Group, Group Biomedical Sciences, Leuven, Belgium.
authors.forename: Inge
authors.initials: I
authors.lastname: Leunissen
authors.affiliation: School of Psychology, Faculty of Health Sciences, Australian Catholic University, Melbourne, Victoria, Australia.
authors.forename: Karen
authors.initials: K
authors.lastname: Caeyenberghs
authors.affiliation: KU Leuven, Movement Control and Neuroplasticity Research Group, Group Biomedical Sciences, Leuven, Belgium.
authors.forename: Wouter
authors.initials: W
authors.lastname: Hoogkamer
authors.affiliation: KU Leuven, Department of Radiology, University Hospital, Leuven, Belgium.
authors.forename: Stefan
authors.initials: S
authors.lastname: Sunaert
authors.affiliation: KU Leuven, Movement Control and Neuroplasticity Research Group, Group Biomedical Sciences, Leuven, Belgium.
authors.forename: Jacques
authors.initials: J
authors.lastname: Duysens
authors.affiliation: KU Leuven, Movement Control and Neuroplasticity Research Group, Group Biomedical Sciences, 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; D000818:Animals; D001930:Brain Injuries / Q000150:complications*; D001933:Brain Stem / Q000473:pathology*; D002531:Cerebellum / Q000473:pathology*; D002648:Child; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging; D008297:Male; D004856:Postural Balance / Q000502:physiology*; D012678:Sensation Disorders / Q000209:etiology* / Q000473:pathology*; D012720:Severity of Illness Index; D014907:Whales
keywords: brain stem; cerebellum; grey matter; postural control; spatially unbiased infratentorial template; traumatic brain injury; volumetric analysis; voxel-based morphometry; white matter