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Si B, Zhu H, Wei X, Li S, Wu X. The mechanism of static postural control in the impact of lower limb muscle strength asymmetry on gait performance in the elderly. PeerJ 2024; 12:e17626. [PMID: 38948226 PMCID: PMC11214735 DOI: 10.7717/peerj.17626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 06/02/2024] [Indexed: 07/02/2024] Open
Abstract
Background Abnormal gait is prevalent among the elderly population, leading to reduced physical activity, increased risk of falls, and the potential development of dementia and disabilities, thus degrading the quality of life in later years. Numerous studies have highlighted the crucial roles of lower limb muscle strength asymmetry and static postural control in gait, and the reciprocal influence of lower limb muscle strength asymmetry on static postural control. However, research exploring the interrelationship between lower limb muscle strength asymmetry, static postural control, and gait performance has been limited. Methods A total of 55 elderly participants aged 60 to 75 years were recruited. Isokinetic muscle strength testing was used to assess bilateral knee extension strength, and asymmetry values were calculated. Participants with asymmetry greater than 15% were categorized as the Asymmetry Group (AG), while those with asymmetry less than 15% were classified in the Symmetry Group (SG). Gait parameters were measured using a plantar pressure gait analysis system to evaluate gait performance, and static postural control was assessed through comfortable and narrow stance tests. Results First, participants in the AG demonstrated inferior gait performance, characterized by slower gait speed, longer stance time and percentage of stance time in gait, and smaller swing time and percentage of swing time in gait. Spatial-temporal gait parameters of the weaker limb tended to be abnormal. Second, static postural control indices were higher in AG compared to SG in all aspects except for the area of ellipse during the comfortable stance with eyes open test. Third, abnormal gait parameters were associated with static postural control. Conclusion Firstly, elderly individuals with lower limb muscle strength asymmetry are prone to abnormal gait, with the weaker limb exhibiting poorer gait performance. Secondly, lower limb muscle strength asymmetry contributes to diminished static postural control in the elderly. Thirdly, the mechanism underlying abnormal gait in the elderly due to lower limb muscle strength asymmetry may be linked to a decline in static postural control.
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Affiliation(s)
- Beili Si
- School of Physical Education, Shanghai University of Sport, Shanghai, China
| | - Hao Zhu
- School of Psychology, Shanghai University of Sport, Shanghai, China
| | - Xinmei Wei
- School of Economics and Management, Shanghai University of Sport, Shanghai, China
| | - Shun Li
- School of Physical Education, Shanghai University of Sport, Shanghai, China
| | - Xueping Wu
- School of Physical Education, Shanghai University of Sport, Shanghai, China
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2
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Wang J, Zou Q, Li S, Tang R, Yang X, Zeng J, Shen B, Li K, Nie Y. Gait asymmetry of lower extremities reduced immediately after minimally invasive surgery among patients with lumbar disc herniation. Clin Biomech (Bristol, Avon) 2022; 98:105720. [PMID: 35863143 DOI: 10.1016/j.clinbiomech.2022.105720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 07/06/2022] [Accepted: 07/12/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Lumbar disc herniation patients with increased pain exhibit greater gait asymmetry in stance time, swing time and single support time. Percutaneous endoscopic lumbar discectomy, as a minimally invasive surgical procedure has been used to treat patients with lumbar disc herniation. The objective of this study was to evaluate the immediate impact of the percutaneous endoscopic lumbar discectomy on gait asymmetry in spatiotemporal and kinetic parameters among lumbar disc herniation patients. METHODS Marker trajectories and ground reaction forces were measured during walking among 67 lumbar disc herniation patients and 15 healthy controls. Spatiotemporal gait parameters were analyzed via Visual3D. Muscle force and joint contact force were calculated with OpenSim. Gait asymmetry of those parameters were assessed with asymmetry index. FINDINGS After surgery, gait asymmetry in gait cycle time, step length, peak biceps femoris long head, tensor fasciae latae and rectus femoris muscle forces, and peak hip and knee joint contact forces reduced immediately. Postoperatively, increased gait cycle time and decreased step length were found in the affected side. Moreover, decreased peak biceps femoris long head, tensor fasciae latae and rectus femoris muscle forces, and peak hip joint contact force were observed in the contralateral side. INTERPRETATION These results suggested compensation strategy that biceps femoris long head, tensor fasciae latae and rectus femoris in the contralateral side were mainly used to compensate the affected side preoperatively in lumbar disc herniation patients, with less compensation between lower limbs after surgery, which may provide an insight into postoperative rehabilitation.
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Affiliation(s)
- Junqing Wang
- West China Biomedical Big Data Center, Sichuan University West China Hospital, Chengdu, Sichuan Province, China; Med-X Center for Informatics, Sichuan University, Chengdu, Sichuan Province, China
| | - Qiang Zou
- Department of Orthopedics, Orthopedic Research Institute and National Clinical Research Center for Geriatrics, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan Province, China
| | - Shiqi Li
- College of Electrical Engineering, Sichuan University, Chengdu, Sichuan Province, China
| | - Ruoliang Tang
- Sichuan University-Pittsburgh Institute (SCUPI), Sichuan University, Chengdu, Sichuan Province, China
| | - Xi Yang
- Department of Orthopedics, Orthopedic Research Institute and National Clinical Research Center for Geriatrics, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan Province, China
| | - Jiancheng Zeng
- Department of Orthopedics, Orthopedic Research Institute and National Clinical Research Center for Geriatrics, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan Province, China
| | - Bin Shen
- Department of Orthopedics, Orthopedic Research Institute and National Clinical Research Center for Geriatrics, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan Province, China
| | - Kang Li
- West China Biomedical Big Data Center, Sichuan University West China Hospital, Chengdu, Sichuan Province, China.
| | - Yong Nie
- Department of Orthopedics, Orthopedic Research Institute and National Clinical Research Center for Geriatrics, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan Province, China.
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3
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Jardak M, Chaari F, Bouchaala F, Fendri T, Harrabi MA, Rebai H, Sahli S. Does piriformis muscle syndrome impair postural balance? A case control study. Somatosens Mot Res 2021; 38:315-321. [PMID: 34519264 DOI: 10.1080/08990220.2021.1973404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND PURPOSE While patients with musculoskeletal disorders reported postural balance impairments, it is unknown whether patients with piriformis muscle syndrome (PMS) may exhibit postural balance disorders compared to controls. The aim was to compare postural balance in patients with PMS to controls in static and dynamic conditions. MATERIAL AND METHODS Twelve patients with PMS and twelve controls were enrolled. Static postural balance was assessed by calculating the symmetry index (SI) in the unipedal posture. To measure vision contribution, the Romberg index (RI) was computed. Dynamic postural balance was evaluated with the Timed up and go test (TUGT). Besides, inter-limb strength asymmetry (SA), pain and the short form-36 (SF-36) were assessed. RESULTS The PMS group (PMSG) exhibited significant (p < 0.001) higher SI in eyes opened (EO) and eyes closed (EC) conditions compared to the control group (CG). Besides, PMSG had significant higher RI (p < 0.05), TUGT scores (p < 0.001), SA values (p < 0.05), pain intensity (p < 0.001), and worse SF-36 scores on all physical health (p < 0.05) and psychological health (only in vitality and mental health [p < 0.05]), compared to CG. CONCLUSION Our data revealed impaired static and dynamic postural balance, and reduced quality of life in PMSG compared to CG. Postural balance impairments could explain the poor quality of life, which are likely due to the higher SA and higher pain intensity. Clinicians and physiotherapists should consider postural balance disorders while designing rehabilitation programs in these patients.
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Affiliation(s)
- Mariem Jardak
- Research Laboratory Education, Motricité, Sport et Santé, EM2S, LR19JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia
| | - Fatma Chaari
- Research Laboratory Education, Motricité, Sport et Santé, EM2S, LR19JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia
| | - Fatma Bouchaala
- Research Laboratory Education, Motricité, Sport et Santé, EM2S, LR19JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia
| | - Thouraya Fendri
- Research Laboratory Education, Motricité, Sport et Santé, EM2S, LR19JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia
| | - Mohammed Achraf Harrabi
- Research Laboratory Education, Motricité, Sport et Santé, EM2S, LR19JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia
| | - Haithem Rebai
- Research Laboratory Education, Motricité, Sport et Santé, EM2S, LR19JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia
| | - Sonia Sahli
- Research Laboratory Education, Motricité, Sport et Santé, EM2S, LR19JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia
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4
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Liang X, Yeh CH, Domínguez D JF, Poudel G, Swinnen SP, Caeyenberghs K. Longitudinal fixel-based analysis reveals restoration of white matter alterations following balance training in young brain-injured patients. Neuroimage Clin 2021; 30:102621. [PMID: 33780865 PMCID: PMC8022866 DOI: 10.1016/j.nicl.2021.102621] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 02/24/2021] [Accepted: 03/03/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND OBJECTIVES Traumatic brain injury (TBI) is one of the leading causes of death and disability in children and adolescents. Young TBI patients suffer from gross motor deficits, such as postural control deficits, which can severely compromise their daily life activities. However, little attention has been devoted to uncovering the underlying white matter changes in response to training in TBI. In this study, we used longitudinal fixel-based analysis (FBA), an advanced diffusion imaging analysis technique, to investigate the effect of a balance training program on white matter fibre density and morphology in a group of young TBI patients. METHODS Young patients with moderate-to-severe TBI (N = 17, 10 females, mean age = 13 ± 3 years) and age-matched controls (N = 17) underwent a home-based balance training program. Diffusion MRI scans together with gross motor assessments, including the gross motor items of the Bruininks-Oseretsky Test of Motor Proficiency, the Activities-Specific Balance Confidence (ABC) Scale, and the Sensory Organization Test (SOT) were administered before and at completion of 8-weeks of training. We used FBA to compare microstructural differences in fibre density (FD), macrostructural (morphological) changes in fibre cross-section (FC), and the combined FD and FC (FDC) metric across the whole brain. We then performed a longitudinal analysis to test whether training restores the white matter in the regions found to be damaged before treatment. RESULTS Whole-brain fixel-based analysis revealed lower FD and FC in TBI patients compared to the control group across several commissural tracts, association fibres and projection fibres, with FD reductions of up to 50%. Following training, TBI patients showed a significant interaction effect between Group and Time for the SOT test, as well as significant increases in macrostructural white matter (i.e., FC & FDC) in left sensorimotor tracts. The amount of change in FC and FDC over time was, however, not associated with behavioural changes. DISCUSSION Our fixel-based findings identified both microstructural and macrostructural abnormalities in young TBI patients. The longitudinal results provide a deeper understanding of the neurobiological mechanisms underlying balance training, which will allow clinicians to make more effective treatment decisions in everyday clinical practice with brain-injured patients.
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Affiliation(s)
- Xiaoyun Liang
- Mary Mackillop Institute for Health Research, Australian Catholic University, Melbourne, Australia; Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
| | - Chun-Hung Yeh
- Institute for Radiological Research, Chang Gung University and Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Child and Adolescent Psychiatry, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Juan F Domínguez D
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, Australia
| | - Govinda Poudel
- Mary Mackillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - Stephan P Swinnen
- Motor Control Laboratory, Movement Control and Neuroplasticity Research Group, KU Leuven, Belgium
| | - Karen Caeyenberghs
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, Australia.
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Penedo T, Polastri PF, Rodrigues ST, Santinelli FB, Costa EDC, Imaizumi LFI, Barbieri RA, Barbieri FA. Motor strategy during postural control is not muscle fatigue joint-dependent, but muscle fatigue increases postural asymmetry. PLoS One 2021; 16:e0247395. [PMID: 33630950 PMCID: PMC7906473 DOI: 10.1371/journal.pone.0247395] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 02/06/2021] [Indexed: 11/29/2022] Open
Abstract
The aim of this study was to investigate the effects of ankle and hip muscle fatigue on motor adjustments (experiment 1) and symmetry (experiment 2) of postural control during a quiet standing task. Twenty-three young adults performed a bipedal postural task on separate force platforms, before and after a bilateral ankle and hip muscle fatigue protocol (randomized). Ankle and hip muscles were fatigued separately using a standing calf raise protocol (ankle fatigue) on a step and flexion and extension of the hip (hip fatigue) sitting on a chair, at a controlled movement frequency (0.5Hz), respectively. In both experiments, force, center of pressure, and electromyography parameters were measured. The symmetry index was used in experiment 2 to analyze the postural asymmetry in the parameters. Our main findings showed that muscle fatigue impaired postural stability, regardless of the fatigued muscle region (i.e., ankle or hip). In addition, young adults used an ankle motor strategy (experiment 1) before and after both the ankle and hip muscle fatigue protocols. Moreover, we found increased asymmetry between the lower limbs (experiment 2) during the quiet standing task after muscle fatigue. Thus, we can conclude that the postural motor strategy is not muscle fatigue joint-dependent and a fatigue task increases postural asymmetry, regardless of the fatigued region (hip or ankle). These findings could be applied in sports training and rehabilitation programs with the objective of reducing the fatigue effects on asymmetry and improving balance.
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Affiliation(s)
- Tiago Penedo
- Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), Graduate Program in Human Movement, School of Sciences, São Paulo State University (UNESP), Bauru, São Paulo, Brazil
| | - Paula Favaro Polastri
- Department of Physical Education, Laboratory of Information, Vision and Action (LIVIA), Graduate Program in Human Movement, School of Sciences, São Paulo State University (UNESP), Bauru, São Paulo, Brazil
| | - Sérgio Tosi Rodrigues
- Department of Physical Education, Laboratory of Information, Vision and Action (LIVIA), Graduate Program in Human Movement, School of Sciences, São Paulo State University (UNESP), Bauru, São Paulo, Brazil
| | - Felipe Balistieri Santinelli
- Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), Graduate Program in Human Movement, School of Sciences, São Paulo State University (UNESP), Bauru, São Paulo, Brazil
| | - Elisa de Carvalho Costa
- Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), Graduate Program in Human Movement, School of Sciences, São Paulo State University (UNESP), Bauru, São Paulo, Brazil
| | - Luis Felipe Itikawa Imaizumi
- Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), Graduate Program in Human Movement, School of Sciences, São Paulo State University (UNESP), Bauru, São Paulo, Brazil
| | - Ricardo Augusto Barbieri
- Centro Universitário Estácio de Ribeirão Preto, Ribeirão Preto, São Paulo, Brazil
- Graduate Program in Physical Education and Sport at School of Physical Education and Sport of Ribeirao Preto (EEFERP), University of São Paulo (USP), Ribeirão Preto, São Paulo, Brazil
| | - Fabio Augusto Barbieri
- Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), Graduate Program in Human Movement, School of Sciences, São Paulo State University (UNESP), Bauru, São Paulo, Brazil
- * E-mail:
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6
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Sensitivity and Specificity of a Multimodal Approach for Concussion Assessment in Youth Athletes. J Sport Rehabil 2021; 30:850-859. [PMID: 33547256 DOI: 10.1123/jsr.2020-0279] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 10/21/2020] [Accepted: 11/06/2020] [Indexed: 12/16/2022]
Abstract
CONTEXT Current international consensus endorses a multimodal approach to concussion assessment. However, the psychometric evaluation of clinical measures used to identify postconcussion performance deficits once an athlete is asymptomatic remains limited, particularly in the pediatric population. OBJECTIVE To describe and compare the sensitivity and specificity of a multimodal assessment battery (balance, cognition, and upper and lower body strength) versus individual clinical measures at discriminating between concussed youth athletes and noninjured controls when asymptomatic. DESIGN Prospective cohort study. SETTING Hospital laboratory setting. PARTICIPANTS A total of 32 youth athletes with a concussion and 32 matched (age and sex) noninjured control participants aged 10-18 years. INTERVENTION(S) Participants were administered preinjury (baseline) assessments of cognition (Immediate Post-Concussion Assessment and Cognitive Testing [ImPACT]), balance (BioSway), and upper and lower body strength (grip strength and standing long jump). Assessments were readministered when concussed participants reported symptom resolution (asymptomatic time point). Noninjured control participants were reassessed using the same time interval as their concussion matched pair. Sensitivity and specificity were calculated using standardized regression-based methods and receiver operating characteristic curves. MAIN OUTCOME MEASURES Outcome measures included baseline and postinjury ImPACT, BioSway, grip strength, and standing long jump scores. RESULTS When asymptomatic, declines in performance on each individual clinical measure were seen in 3% to 22% of the concussion group (sensitivity = 3%-22%) compared with 3% to 13% of the noninjured control group (specificity = 87%-97%) (90% confidence interval). The multimodal battery of all combined clinical measures yielded a sensitivity of 41% and a specificity of 77% (90% confidence interval). Based on discriminative analyses, the multimodal approach was statistically superior compared with an individual measures approach for balance and upper and lower body strength, but not for cognition. CONCLUSIONS Results provide a foundation for understanding which domains of assessment (cognition, balance, and strength) may be sensitive and specific to deficits once symptoms resolve in youth athletes. More work is needed prior to clinical implementation of a preinjury (baseline) to postinjury multimodal approach to assessment following concussion in youth athletes.
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7
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Evans EA, Cook NE, Iverson GL, Townsend EL, Duhaime AC. Assessing Physical Function and Mobility following Pediatric Traumatic Brain Injury with the NIH Toolbox Motor Battery: A Feasibility Study. Phys Occup Ther Pediatr 2021; 41:56-73. [PMID: 32396483 PMCID: PMC7657981 DOI: 10.1080/01942638.2020.1758985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
AIMS Traumatic brain injury (TBI) can impair physical function in children. The NIH Toolbox Motor Battery (NIHTB-M) was designed to be a brief assessment of physical function, but no studies have examined its use in children with TBI. This study aims to describe the feasibility of using the NIHTB-M to assess children with TBI. METHODS The NIHTB-M was administered to children with TBI 2 weeks (n = 22) and/or 6 months (n = 23) following injury. This descriptive study summarizes participant performance, administration challenges, and the association between NIHTB-M scores, participant characteristics, and subjective report of physical function. RESULTS Of the NIHTB-M domains, deficits in endurance and balance were most prevalent. Children aged 5 to 16 years could complete the assessment per administration guidelines, except for a few cases (n = 3) where orthopedic injuries limited participation. Younger children (aged 3 to 4) had difficulty following the NIHTB-M directions. Technological issues impacted balance assessment in several cases (n = 6). CONCLUSION The NIHTB-M is brief to administer, generally well tolerated by school-aged children and, despite occasional technological challenges, is a feasible performance-based battery for assessment of children with TBI for clinical and research purposes. Additional investigation of psychometric properties and ceiling and floor effects is needed.
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Affiliation(s)
- Emily A Evans
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA.,Center for Gerontology and Healthcare Research, Brown University, Rhode Island, USA
| | - Nathan E Cook
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA.,MassGeneral Hospital for Children™ Sports Concussion Program, Massachusetts General Hospital, Boston, Massachusetts, USA.,Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA.,MassGeneral Hospital for Children™ Sports Concussion Program, Massachusetts General Hospital, Boston, Massachusetts, USA.,Spaulding Rehabilitation Hospital and Spaulding Research Institute, Boston, Massachusetts, USA.,Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Boston, Massachusetts, USA
| | - Elise L Townsend
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Boston, Massachusetts, USA
| | - Ann-Christine Duhaime
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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- San Francisco General Hospital and Trauma Center, University of California, San Francisco, California, USA
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8
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Walter J, Kovalenko O, Younsi A, Grutza M, Unterberg A, Zweckberger K. The CatWalk XT® is a valid tool for objective assessment of motor function in the acute phase after controlled cortical impact in mice. Behav Brain Res 2020; 392:112680. [DOI: 10.1016/j.bbr.2020.112680] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 04/15/2020] [Accepted: 04/27/2020] [Indexed: 01/01/2023]
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9
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Pediatric Traumatic Brain Injury and Exercise Medicine: A Narrative Review. Pediatr Exerc Sci 2019; 31:393-400. [PMID: 30955443 DOI: 10.1123/pes.2017-0286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 01/10/2019] [Accepted: 01/28/2019] [Indexed: 11/18/2022]
Abstract
The multidisciplinary field of pediatric traumatic brain injury (TBI) and exercise medicine is of growing importance. There is active study into the diagnostic and therapeutic potential of exercise in pediatric TBI as well as the effects of TBI on postinjury fitness. With the evidence-based growing, a literature review can help establish the state of the science and inform future research. Therefore, the authors performed a narrative review (based on a search of 6 health sciences databases) to summarize evidence on pediatric TBI and cardiorespiratory fitness, muscular fitness and neuromotor control, and obesity. To date, studies related to cardiorespiratory fitness have centered on exercise tolerance and readiness to return to play, and indicate that protracted rest may not facilitate symptom recovery; this suggests a role for exercise in concussion management. Furthermore, strength and gait may be impaired following pediatric brain injury, and interventions designed to train these impairments may lead to their improvement. Pediatric brain injury can also lead to changes in body composition (which may be related to poorer cognitive recovery), but additional research is required to better understand such associations. This narrative review of pediatric TBI and exercise medicine can serve as a reference for researchers and clinicians alike.
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10
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Kinder HA, Baker EW, Wang S, Fleischer CC, Howerth EW, Duberstein KJ, Mao H, Platt SR, West FD. Traumatic Brain Injury Results in Dynamic Brain Structure Changes Leading to Acute and Chronic Motor Function Deficits in a Pediatric Piglet Model. J Neurotrauma 2019; 36:2930-2942. [PMID: 31084386 DOI: 10.1089/neu.2018.6303] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Traumatic brain injury (TBI) is a leading cause of death and disability in children. Pediatric TBI patients often suffer from crippling cognitive, emotional, and motor function deficits that have negative lifelong effects. The objective of this study was to longitudinally assess TBI pathophysiology using multi-parametric magnetic resonance imaging (MRI), gait analysis, and histological approaches in a pediatric piglet model. TBI was produced by controlled cortical impact in Landrace piglets. MRI data, including from proton magnetic resonance spectroscopy (MRS), were collected 24 hours and 12 weeks post-TBI, and gait analysis was performed at multiple time-points over 12 weeks post-TBI. A subset of animals was sacrificed 24 hours, 1 week, 4 weeks, and 12 weeks post-TBI for histological analysis. MRI results demonstrated that TBI led to a significant brain lesion and midline shift as well as microscopic tissue damage with altered brain diffusivity, decreased white matter integrity, and reduced cerebral blood flow. MRS showed a range of neurochemical changes after TBI. Histological analysis revealed neuronal loss, astrogliosis/astrocytosis, and microglia activation. Further, gait analysis showed transient impairments in cadence, cycle time, % stance, step length, and stride length, as well as long-term impairments in weight distribution after TBI. Taken together, this study illustrates the distinct time course of TBI pathoanatomic and functional responses up to 12 weeks post-TBI in a piglet TBI model. The study of TBI injury and recovery mechanisms, as well as the testing of therapeutics in this translational model, are likely to be more predictive of human responses and clinical outcomes compared to traditional small animal models.
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Affiliation(s)
- Holly A Kinder
- Regenerative Bioscience Center, University of Georgia, Athens, Georgia.,Department of Animal and Dairy Science, University of Georgia, Athens, Georgia
| | - Emily W Baker
- Regenerative Bioscience Center, University of Georgia, Athens, Georgia.,Department of Animal and Dairy Science, University of Georgia, Athens, Georgia
| | - Silun Wang
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia
| | - Candace C Fleischer
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia
| | - Elizabeth W Howerth
- Regenerative Bioscience Center, University of Georgia, Athens, Georgia.,Department of Pathology, University of Georgia, Athens, Georgia
| | - Kylee J Duberstein
- Regenerative Bioscience Center, University of Georgia, Athens, Georgia.,Department of Animal and Dairy Science, University of Georgia, Athens, Georgia
| | - Hui Mao
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia
| | - Simon R Platt
- Regenerative Bioscience Center, University of Georgia, Athens, Georgia.,Department of Small Animal Medicine and Surgery, University of Georgia, Athens, Georgia
| | - Franklin D West
- Regenerative Bioscience Center, University of Georgia, Athens, Georgia.,Department of Animal and Dairy Science, University of Georgia, Athens, Georgia
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11
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Klima D, Morgan L, Baylor M, Reilly C, Gladmon D, Davey A. Physical Performance and Fall Risk in Persons With Traumatic Brain Injury. Percept Mot Skills 2018; 126:50-69. [PMID: 30458668 DOI: 10.1177/0031512518809203] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Injuries sustained from traumatic brain injury (TBI) culminate in both cognitive and neuromuscular deficits. Patients often progress to higher functioning on the Rancho continuum even while mobility deficits persist. Although prior studies have examined physical performance among persons with chronic symptoms of TBI, less is known about the relatively acute phase of TBI as patients prepare for rehabilitation discharge. The aims of this cross-sectional study were to (a) compare balance and gait performance in 20 ambulant persons with moderate to severe TBI who were nearing rehabilitation discharge with their age-matched controls and (b) describe performance with thresholds for fall risk and community navigation. During a designed task circuit, 40 participants (20 persons with TBI and 20 controls) performed the Timed Up and Go (TUG), gait velocity, and Walking and Remembering tests. Balance testing included the Fullerton Advanced Balance Scale (FABS) and instrumented Modified Clinical Test for Sensory Interaction in Balance (MCTSIB). Statistical analyses included analysis of covariance for group comparisons and a multivariate analysis of covariance for MCTSIB sway velocities with anthropometric controls. The TBI group (mean [ M] age = 42, standard deviation [ SD] =19.5 years; 70% males) performed significantly more poorly on all mobility tests ( p < .05) and their scores reflected a potential fall risk. Gait velocity was significantly slower for the TBI versus control group ( M = .96, SD = 2.6 vs. M = 1.5, SD = 2.2 m/s; p < .001), including TUG times ( M = 13.5, SD = 4.9 vs. M = 7.7, SD = 1.4; p < .001). TBI participants also demonstrated significantly greater sway velocity on all MCTSIB conditions ( p < .01) and lower performance on the FABS ( p < .001). Performance indices indicate potential fall risk and community navigation compromise for individuals with moderate to severe TBI. Physical performance scores support the need for continued interventions to optimize functional mobility upon discharge.
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Affiliation(s)
- Dennis Klima
- 1 Department of Physical Therapy, University of Maryland Eastern Shore, Princess Anne, MD, USA
| | - Lindsay Morgan
- 2 Department of Rehabilitation, Anne Arundel Medical Center, Annapolis, MD, USA
| | - Michelle Baylor
- 3 Rehabilitation Services, University of Maryland Rehabilitation and Orthopedic Institute, Baltimore, MD, USA
| | - Cordia Reilly
- 4 Rehabilitation Services, University of Maryland Shore Regional Health, Easton, MD, USA
| | - Daniel Gladmon
- 3 Rehabilitation Services, University of Maryland Rehabilitation and Orthopedic Institute, Baltimore, MD, USA
| | - Adam Davey
- 5 Department of Behavioral Health and Nutrition, University of Delaware, Newark, DE, USA
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12
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Perez OH, Green RE, Mochizuki G. Characterization of Balance Control After Moderate to Severe Traumatic Brain Injury: A Longitudinal Recovery Study. Phys Ther 2018; 98:786-795. [PMID: 29878265 DOI: 10.1093/ptj/pzy065] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 06/05/2018] [Indexed: 02/09/2023]
Abstract
BACKGROUND Balance impairments after traumatic brain injury (TBI) are common and persist after injury. Postural asymmetries in balance have been reported, but not quantified, across recovery. OBJECTIVE The objective of this study was to characterize balance recovery after moderate to severe TBI, with a focus on postural asymmetry. DESIGN A secondary analysis of prospectively collected data was used in this study. METHODS Data were from 45 participants with moderate to severe TBI. Participants' balance in 2 bipedal stances and 2 unipedal stances was assessed with force plates at approximately 2, 5, and 12 months after injury. Single-visit data from participants who were matched for age and served as healthy controls were collected for visual comparison using 95% confidence intervals. Spatial and temporal center-of-pressure (COP) measures were calculated from force plates in the anteroposterior (AP) and mediolateral (ML) directions. RESULTS Despite improvements in net ML COP postural sway from 2 to 5 months after injury, there were no changes in AP postural sway across recovery. Postural sway in individuals with TBI was higher than normative values at all time points in both directions. Interlimb synchrony did not change across recovery in either direction. TBI weight-bearing asymmetry was lower than normative values at all time points and did not change across recovery. The characteristics of unipedal stance differed between limbs. LIMITATIONS Sample size was reduced as a result of the inclusion and exclusion criteria; future studies will benefit from a larger sample size. CONCLUSIONS The absence of recovery in ML COP postural sway, interlimb synchrony, and weight-bearing symmetry indicated that reduced ML control may contribute to balance impairments after TBI. These impairments may extend to dynamic balance tasks and may also place individuals with TBI at a higher risk for falls.
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Affiliation(s)
- Olinda Habib Perez
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada; Sunnybrook Research Institute, Toronto, Ontario, Canada; and Toronto Rehabilitation Institute, Toronto, Ontario, Canada
| | - Robin E Green
- Rehabilitation Sciences Institute, University of Toronto; Department of Psychiatry, University of Toronto; and Toronto Rehabilitation Institute
| | - George Mochizuki
- Rehabilitation Sciences Institute, University of Toronto; Department of Physical Therapy, University of Toronto; Toronto Rehabilitation Institute; and Sunnybrook Research Institute, 2075 Bayview Ave, Room M6-178, Toronto, Ontario, Canada M4N 3M5
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13
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Effects of Stochastic Resonance Whole-Body Vibration in Individuals with Unilateral Brain Lesion: A Single-Blind Randomized Controlled Trial: Whole-Body Vibration and Neuromuscular Function. Rehabil Res Pract 2018; 2018:9319258. [PMID: 30155308 PMCID: PMC6093017 DOI: 10.1155/2018/9319258] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Accepted: 07/18/2018] [Indexed: 11/18/2022] Open
Abstract
Introduction Stochastic resonance whole-body vibration (SR-WBV) devices are promising sensorimotor interventions to address muscle weakness and to improve balance and mobility particularly in the elderly. However, it remains inconclusive whether individuals with stroke or traumatic brain injury (TBI) can profit from this method. The aim of this prospective single-blind randomized controlled trial was to investigate the effects of SR-WBV on muscle strength as well as gait and balance performance in this population. Methods Forty-eight individuals with stroke or TBI were randomly allocated to an experimental and a sham group. Participants were exposed daily to 5 consecutives 1-minute SR-WBV sessions, whereas the experimental group trained in a standing position with 5 Hz and the sham group in a seated position with 1 Hz. Isometric muscle strength properties of the paretic knee extensor muscles as well as balance and gait performance were measured at baseline, after the first session and after two weeks of SR-WBV. Results Both groups showed short- and long-term effects in gait performance. However, no between-group effects could be found at the three measurement points. Discussion Complementary SR-WBV showed no beneficial effects immediately after the intervention and after two weeks of conventional rehabilitation therapy. Future research is needed to identify the potential efficacy of SR-WBV in individuals with stroke and TBI using shorter and less exhausting test procedures and a generally prolonged intervention time.
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14
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Abstract
The purpose of this study was to investigate the relationship between muscle strength asymmetry and body sway while walking. We studied 63 older adult women. Strong side and weak side of knee extension strength, toe grip strength, hand grip strength, and body sway while walking were measured. The relationship between muscle strength asymmetry for each muscle and body sway while walking was evaluated using Pearson’s correlation coefficient. Regarding the muscles recognized to have significant correlation with body sway, the asymmetry cutoff value causing an increased sway was calculated. Toe grip strength asymmetry was significantly correlated with body sway. Toe grip strength asymmetry causing an increased body sway had a cutoff value of 23.5%. Our findings suggest toe grip strength asymmetry may be a target for improving gait stability.
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15
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Caeyenberghs K, Clemente A, Imms P, Egan G, Hocking DR, Leemans A, Metzler-Baddeley C, Jones DK, Wilson PH. Evidence for Training-Dependent Structural Neuroplasticity in Brain-Injured Patients: A Critical Review. Neurorehabil Neural Repair 2018; 32:99-114. [PMID: 29357743 DOI: 10.1177/1545968317753076] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Acquired brain injury (ABI) is associated with a range of cognitive and motor deficits, and poses a significant personal, societal, and economic burden. Rehabilitation programs are available that target motor skills or cognitive functioning. In this review, we summarize the existing evidence that training may enhance structural neuroplasticity in patients with ABI, as assessed using structural magnetic resonance imaging (MRI)-based techniques that probe microstructure or morphology. Twenty-five research articles met key inclusion criteria. Most trials measured relevant outcomes and had treatment benefits that would justify the risk of potential harm. The rehabilitation program included a variety of task-oriented movement exercises (such as facilitation therapy, postural control training), neurorehabilitation techniques (such as constraint-induced movement therapy) or computer-assisted training programs (eg, Cogmed program). The reviewed studies describe regional alterations in white matter architecture and/or gray matter volume with training. Only weak-to-moderate correlations were observed between improved behavioral function and structural changes. While structural MRI is a powerful tool for detection of longitudinal structural changes, specific measures about the underlying biological mechanisms are lacking. Continued work in this field may potentially see structural MRI metrics used as biomarkers to help guide treatment at the individual patient level.
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Affiliation(s)
| | - Adam Clemente
- 1 Australian Catholic University, Melbourne, Victoria, Australia
| | - Phoebe Imms
- 1 Australian Catholic University, Melbourne, Victoria, Australia
| | - Gary Egan
- 2 Monash University, Clayton, Victoria, Australia
| | | | | | | | | | - Peter H Wilson
- 1 Australian Catholic University, Melbourne, Victoria, Australia
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16
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Giza C, Greco T, Prins ML. Concussion: pathophysiology and clinical translation. HANDBOOK OF CLINICAL NEUROLOGY 2018; 158:51-61. [PMID: 30482375 DOI: 10.1016/b978-0-444-63954-7.00006-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The majority of the 3.8 million estimated annual traumatic brain injuries (TBI) in the United States are mild TBIs, or concussions, and they occur primarily in adolescents and young adults. A concussion is a brain injury associated with rapid brain movement and characteristic clinical symptoms, with no associated objective biomarkers or overt pathologic brain changes, thereby making it difficult to diagnose by neuroimaging or other objective diagnostic tests. Most concussion symptoms are transient and resolve within 1-2 weeks. Concussions share similar acute pathophysiologic perturbations to more severe TBI: there is a rapid release of neurotransmitters, which causes ionic disequilibrium across neuronal membranes. Re-establishing ionic homeostasis consumes energy and leads to dynamic changes in cerebral glucose uptake. The magnitude and duration of these changes are related to injury severity, with milder injuries showing faster normalization. Cerebral sex differences add further variation to concussion manifestation. Relative to the male brain, the female brain has higher overall cerebral blood flow, and demonstrates regional differences in glucose metabolism, inflammatory responses, and connectivity. Understanding the pathophysiology and clinical translation of concussion can move research towards management paradigms that will minimize the risk for prolonged recovery and repeat injury.
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Affiliation(s)
- Christopher Giza
- Department of Neurosurgery, University of California, Los Angeles, CA, United States
| | - Tiffany Greco
- Department of Neurosurgery, University of California, Los Angeles, CA, United States
| | - Mayumi Lynn Prins
- Department of Neurosurgery, University of California, Los Angeles, CA, United States.
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17
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Oliveira VHF, Wiechmann SL, Narciso AMS, Deminice R. Knee extension and flexion strength asymmetry in Human Immunodeficiency Virus positive subjects: a cross-sectional study. Braz J Phys Ther 2017; 21:434-439. [PMID: 28720481 PMCID: PMC5693428 DOI: 10.1016/j.bjpt.2017.06.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Revised: 11/02/2016] [Accepted: 02/06/2017] [Indexed: 11/26/2022] Open
Abstract
HIV-positive subjects present higher strength indices for the dominant versus the non-dominant leg. Strength asymmetry between limbs was observed in up to 58% of subjects. Lower-limb strength asymmetry is associated with impaired balance and gait.
Background Human Immunodeficiency Virus positive subjects present impairment in muscle function, neural activation, balance, and gait. In other populations, all of these factors have been associated with muscle strength asymmetry. Objective To investigate the existence of muscle strength asymmetry between dominant and non-dominant lower limbs and to determine the hamstrings-to-quadriceps strength ratio in Human Immunodeficiency Virus positive subjects. Methods In this cross-sectional study, 48 subjects were included (22 men and 26 women; mean age 44.6 years), all of them under highly active antiretroviral therapy. They performed isokinetic strength efforts at speeds of 60°/s and 180°/s for knee extension and flexion in concentric-concentric mode. Results Peak torque was higher (p < 0.01) at 60°/s for quadriceps (193, SD = 57 vs. 173, SD = 55% body mass) and hamstrings (97, SD = 36 vs. 90, SD = 37% body mass) in dominant compared to non-dominant. Similarly, peak torque was higher at 180°/s (quadriceps 128, SD = 44 vs. 112, SD = 42; hamstrings 64, SD = 24 vs. 57, SD = 26% body mass) in dominant. Average power was also higher for all muscle groups and speeds, comparing dominant with non-dominant. The hamstrings-to-quadriceps ratio at 60°/s was 0.50 for dominant and 0.52 for non-dominant, and at 180°/s, it was 0.51 for both limbs, with no significant difference between them. The percentage of subjects with strength asymmetry ranged from 46 to 58%, depending upon muscle group and speed analyzed. Conclusion Human Immunodeficiency Virus positive subjects present muscle strength asymmetry between lower limbs, assessed through isokinetic dynamometry.
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Affiliation(s)
- Vitor H F Oliveira
- Universidade Estadual de Londrina (UEL), Departamento de Educação Física, Londrina, PR, Brazil
| | - Susana L Wiechmann
- Universidade Estadual de Londrina (UEL), Centro de Ciências da Saúde, Hospital das Clínicas, Londrina, PR, Brazil
| | - Argéria M S Narciso
- Universidade Estadual de Londrina (UEL), Centro de Ciências da Saúde, Hospital das Clínicas, Londrina, PR, Brazil
| | - Rafael Deminice
- Universidade Estadual de Londrina (UEL), Departamento de Educação Física, Londrina, PR, Brazil.
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18
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Diez I, Drijkoningen D, Stramaglia S, Bonifazi P, Marinazzo D, Gooijers J, Swinnen SP, Cortes JM. Enhanced prefrontal functional-structural networks to support postural control deficits after traumatic brain injury in a pediatric population. Netw Neurosci 2017; 1:116-142. [PMID: 29911675 PMCID: PMC5988395 DOI: 10.1162/netn_a_00007] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 01/28/2017] [Indexed: 11/04/2022] Open
Abstract
Traumatic brain injury (TBI) affects structural connectivity, triggering the reorganization of structural-functional circuits in a manner that remains poorly understood. We focus here on brain network reorganization in relation to postural control deficits after TBI. We enrolled young participants who had suffered moderate to severe TBI, comparing them to young, typically developing control participants. TBI patients (but not controls) recruited prefrontal regions to interact with two separated networks: (1) a subcortical network, including parts of the motor network, basal ganglia, cerebellum, hippocampus, amygdala, posterior cingulate gyrus, and precuneus; and (2) a task-positive network, involving regions of the dorsal attention system, together with dorsolateral and ventrolateral prefrontal regions. We also found that the increased prefrontal connectivity in TBI patients was correlated with some postural control indices, such as the amount of body sway, whereby patients with worse balance increased their connectivity in frontal regions more strongly. The increased prefrontal connectivity found in TBI patients may provide the structural scaffolding for stronger cognitive control of certain behavioral functions, consistent with the observations that various motor tasks are performed less automatically following TBI and that more cognitive control is associated with such actions.
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Affiliation(s)
- Ibai Diez
- Biocruces Health Research Institute, Cruces University Hospital, Barakaldo, Spain
| | - David Drijkoningen
- KU Leuven, Movement Control and Neuroplasticity Research Group, Group Biomedical Sciences, Leuve, Belgium
| | - Sebastiano Stramaglia
- Dipartimento di Fisica, Universita degli Studi di Bari and INFN, Bari, Italy.,Basque Center for Applied Mathematics (BCAM), Bilbao, Spain
| | - Paolo Bonifazi
- Biocruces Health Research Institute, Cruces University Hospital, Barakaldo, Spain.,Ikerbasque: The Basque Foundation for Science, Bilbao, Spain
| | - Daniele Marinazzo
- Department of Data Analysis, Faculty of Psychological and Pedagogical Sciences, University of Ghent, Ghent, Belgium
| | - Jolien Gooijers
- KU Leuven, Movement Control and Neuroplasticity Research Group, Group Biomedical Sciences, Leuve, Belgium
| | - Stephan P Swinnen
- KU Leuven, Movement Control and Neuroplasticity Research Group, Group Biomedical Sciences, Leuve, Belgium.,KU Leuven, Leuven Research Institute for Neuroscience & Disease (LIND), Leuven, Belgium
| | - Jesus M Cortes
- Biocruces Health Research Institute, Cruces University Hospital, Barakaldo, Spain.,Ikerbasque: The Basque Foundation for Science, Bilbao, Spain.,Department of Cell Biology and Histology, University of the Basque Country, Leioa, Spain
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19
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Drijkoningen D, Chalavi S, Sunaert S, Duysens J, Swinnen SP, Caeyenberghs K. Regional Gray Matter Volume Loss Is Associated with Gait Impairments in Young Brain-Injured Individuals. J Neurotrauma 2017; 34:1022-1034. [DOI: 10.1089/neu.2016.4500] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- David Drijkoningen
- University Medical Center Utrecht, Utrecht, the Netherlands
- Movement Control and Neuroplasticity Research Group, Group Biomedical Sciences, Leuven, Belgium
| | - Sima Chalavi
- Movement Control and Neuroplasticity Research Group, Group Biomedical Sciences, Leuven, Belgium
| | - Stefan Sunaert
- Department of Radiology, University Hospital, Leuven, Belgium
| | - Jacques Duysens
- Movement Control and Neuroplasticity Research Group, Group Biomedical Sciences, Leuven, Belgium
| | - Stephan P. Swinnen
- Movement Control and Neuroplasticity Research Group, Group Biomedical Sciences, Leuven, Belgium
- Leuven Research Institute for Neuroscience and Disease, Leuven, Belgium
| | - Karen Caeyenberghs
- Movement Control and Neuroplasticity Research Group, Group Biomedical Sciences, Leuven, Belgium
- Australian Catholic University, Melbourne, Australia
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20
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Drijkoningen D, Leunissen I, Caeyenberghs K, Hoogkamer W, Sunaert S, Duysens J, Swinnen SP. Regional volumes in brain stem and cerebellum are associated with postural impairments in young brain-injured patients. Hum Brain Mapp 2015; 36:4897-909. [PMID: 26441014 DOI: 10.1002/hbm.22958] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 08/19/2015] [Accepted: 08/20/2015] [Indexed: 01/08/2023] Open
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.
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Affiliation(s)
- David Drijkoningen
- KU Leuven, Movement Control and Neuroplasticity Research Group, Group Biomedical Sciences, Leuven, Belgium
| | - Inge Leunissen
- KU Leuven, Movement Control and Neuroplasticity Research Group, Group Biomedical Sciences, Leuven, Belgium
| | - Karen Caeyenberghs
- School of Psychology, Faculty of Health Sciences, Australian Catholic University, Melbourne, Victoria, Australia
| | - Wouter Hoogkamer
- KU Leuven, Movement Control and Neuroplasticity Research Group, Group Biomedical Sciences, Leuven, Belgium
| | - Stefan Sunaert
- KU Leuven, Department of Radiology, University Hospital, Leuven, Belgium
| | - Jacques Duysens
- KU Leuven, Movement Control and Neuroplasticity Research Group, Group Biomedical Sciences, Leuven, Belgium
| | - Stephan P Swinnen
- KU Leuven, Movement Control and Neuroplasticity Research Group, Group Biomedical Sciences, Leuven, Belgium.,KU Leuven, Leuven Research Institute for Neuroscience & Disease (LIND), Belgium
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