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Rodríguez-Nieto G, Alvarez-Anacona DF, Mantini D, Edden RAE, Oeltzschner G, Sunaert S, Swinnen SP. Association between Inhibitory-Excitatory Balance and Brain Activity Response during Cognitive Flexibility in Young and Older Individuals. J Neurosci 2024; 44:e0355242024. [PMID: 39134417 PMCID: PMC11376334 DOI: 10.1523/jneurosci.0355-24.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 06/21/2024] [Accepted: 07/05/2024] [Indexed: 09/06/2024] Open
Abstract
Cognitive flexibility represents the capacity to switch among different mental schemes, providing an adaptive advantage to a changing environment. The neural underpinnings of this executive function have been deeply studied in humans through fMRI, showing that the left inferior frontal cortex (IFC) and the left inferior parietal lobule (IPL) are crucial. Here, we investigated the inhibitory-excitatory balance in these regions by means of γ-aminobutyric acid (GABA+) and glutamate + glutamine (Glx), measured with magnetic resonance spectroscopy, during a cognitive flexibility task and its relationship with the performance level and the local task-induced blood oxygenation level-dependent (BOLD) response in 40 young (18-35 years; 26 female) and 40 older (18-35 years; 21 female) human adults. As the IFC and the IPL are richly connected regions, we also examined whole-brain effects associated with their local metabolic activity. Results did not show absolute metabolic modulations associated with flexibility performance, but the performance level was related to the direction of metabolic modulation in the IPL with opposite patterns in young and older individuals. The individual inhibitory-excitatory balance modulation showed an inverse relationship with the local BOLD response in the IPL. Finally, the modulation of inhibitory-excitatory balance in IPL was related to whole-brain effects only in older individuals. These findings show disparities in the metabolic mechanisms underlying cognitive flexibility in young and older adults and their association with the performance level and BOLD response. Such metabolic differences are likely to play a role in executive functioning during aging and specifically in cognitive flexibility.
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Affiliation(s)
- Geraldine Rodríguez-Nieto
- Movement Control and Neuroplasticity Research Group, Biomedical Sciences, KU Leuven, Leuven 3001, Belgium
- Leuven Brain Institute, KU Leuven, Leuven 3000, Belgium
| | | | - Dante Mantini
- Movement Control and Neuroplasticity Research Group, Biomedical Sciences, KU Leuven, Leuven 3001, Belgium
- Leuven Brain Institute, KU Leuven, Leuven 3000, Belgium
| | - Richard A E Edden
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21287
| | - Georg Oeltzschner
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21287
| | - Stefan Sunaert
- Department of Imaging and Pathology, Biomedical Sciences, KU Leuven, Leuven 3000, Belgium
| | - Stephan P Swinnen
- Movement Control and Neuroplasticity Research Group, Biomedical Sciences, KU Leuven, Leuven 3001, Belgium
- Leuven Brain Institute, KU Leuven, Leuven 3000, Belgium
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Li H, Rodríguez-Nieto G, Chalavi S, Seer C, Mikkelsen M, Edden RAE, Swinnen SP. MRS-assessed brain GABA modulation in response to task performance and learning. BEHAVIORAL AND BRAIN FUNCTIONS : BBF 2024; 20:22. [PMID: 39217354 PMCID: PMC11366171 DOI: 10.1186/s12993-024-00248-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 08/16/2024] [Indexed: 09/04/2024]
Abstract
Gamma-aminobutyric acid (GABA), the most important inhibitory neurotransmitter in the human brain, has long been considered essential in human behavior in general and learning in particular. GABA concentration can be quantified using magnetic resonance spectroscopy (MRS). Using this technique, numerous studies have reported associations between baseline GABA levels and various human behaviors. However, regional GABA concentration is not fixed and may exhibit rapid modulation as a function of environmental factors. Hence, quantification of GABA levels at several time points during the performance of tasks can provide insights into the dynamics of GABA levels in distinct brain regions. This review reports on findings from studies using repeated measures (n = 41) examining the dynamic modulation of GABA levels in humans in response to various interventions in the perceptual, motor, and cognitive domains to explore associations between GABA modulation and human behavior. GABA levels in a specific brain area may increase or decrease during task performance or as a function of learning, depending on its precise involvement in the process under investigation. Here, we summarize the available evidence and derive two overarching hypotheses regarding the role of GABA modulation in performance and learning. Firstly, training-induced increases in GABA levels appear to be associated with an improved ability to differentiate minor perceptual differences during perceptual learning. This observation gives rise to the 'GABA increase for better neural distinctiveness hypothesis'. Secondly, converging evidence suggests that reducing GABA levels may play a beneficial role in effectively filtering perceptual noise, enhancing motor learning, and improving performance in visuomotor tasks. Additionally, some studies suggest that the reduction of GABA levels is related to better working memory and successful reinforcement learning. These observations inspire the 'GABA decrease to boost learning hypothesis', which states that decreasing neural inhibition through a reduction of GABA in dedicated brain areas facilitates human learning. Additionally, modulation of GABA levels is also observed after short-term physical exercise. Future work should elucidate which specific circumstances induce robust GABA modulation to enhance neuroplasticity and boost performance.
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Affiliation(s)
- Hong Li
- Movement Control and Neuroplasticity Research Group, Group Biomedical Sciences, KU Leuven, Leuven, Belgium
- Leuven Brain Institute (LBI), KU Leuven, Leuven, Belgium
| | - Geraldine Rodríguez-Nieto
- Movement Control and Neuroplasticity Research Group, Group Biomedical Sciences, KU Leuven, Leuven, Belgium
- Leuven Brain Institute (LBI), KU Leuven, Leuven, Belgium
| | - Sima Chalavi
- Movement Control and Neuroplasticity Research Group, Group Biomedical Sciences, KU Leuven, Leuven, Belgium
- Leuven Brain Institute (LBI), KU Leuven, Leuven, Belgium
| | - Caroline Seer
- Movement Control and Neuroplasticity Research Group, Group Biomedical Sciences, KU Leuven, Leuven, Belgium
- Leuven Brain Institute (LBI), KU Leuven, Leuven, Belgium
| | - Mark Mikkelsen
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - Richard A E Edden
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Stephan P Swinnen
- Movement Control and Neuroplasticity Research Group, Group Biomedical Sciences, KU Leuven, Leuven, Belgium.
- Leuven Brain Institute (LBI), KU Leuven, Leuven, Belgium.
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McGregor KM, Novak T, Nocera JR, Mammino K, Wolf SL, Krishnamurthy LC. Examination of acute spin exercise on GABA levels in aging and stroke: The EASE study protocol. PLoS One 2024; 19:e0297841. [PMID: 39008457 PMCID: PMC11249249 DOI: 10.1371/journal.pone.0297841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 01/08/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND Changes in regional levels of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) may indicate the potential for favorable responses to the treatment of stroke affecting the upper extremity. By selectively altering GABA levels during training, we may induce long-term potentiation and adjust excitatory/inhibitory balance (E/I balance). However, the impact of this alteration may be limited by neural damage or aging. Aerobic exercise has been shown to increase GABA levels in the sensorimotor cortex and improve motor learning by widening the dynamic range of E/I balance. The cross-sectional project, Effects of Acute Exercise on Functional Magnetic Resonance Spectroscopy Measures of GABA in Aging and Chronic Stroke (EASE), is designed to assess the functional relevance of changes in GABA concentration within the sensorimotor cortex before and after an acute aerobic exercise session. METHODS/DESIGN EASE will enroll 30 participants comprised of healthy younger adults (18-35 years; n = 10), older adults (60+ years; n = 10), and persons with chronic stroke (n = 10) affecting distal upper extremity function. We will use resting magnetic resonance spectroscopy to measure all participants' GABA levels at rest before and after aerobic exercise. In addition, we will employ functional magnetic resonance spectroscopy using motor skill acquisition and recall tasks in healthy adults. We hypothesize that acute aerobic exercise will increase resting sensorimotor GABA concentration and that higher GABA resting levels will predict better motor learning performance on measures taken both inside and outside the magnet. We also hypothesize that a higher dynamic range of GABA during task-based spectroscopy in healthy adults will predict better motor skill acquisition and recall. DISCUSSION The EASE project will evaluate the effect of acute exercise on GABA levels as a biomarker of upper extremity motor skill learning with two populations (aging adults and those with chronic stroke). We predict that acute exercise, higher sensorimotor GABA levels, and broader dynamic range will be related to better motor skill acquisition.
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Affiliation(s)
- Keith M. McGregor
- Birmingham VA Geriatric Research Education and Clinical Center, Birmingham VA Health Care System, Birmingham, Alabama, United States of America
- Department of Clinical and Diagnostic Sciences, University of Alabama at Birmingham School of Health Professions, Birmingham, Alabama, United States of America
| | - Thomas Novak
- Rehabilitation R&D Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Health Care System, Atlanta, Georgia, United States of America
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, United States of America
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Joe R. Nocera
- Rehabilitation R&D Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Health Care System, Atlanta, Georgia, United States of America
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, United States of America
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Kevin Mammino
- Rehabilitation R&D Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Health Care System, Atlanta, Georgia, United States of America
| | - Steven L. Wolf
- Rehabilitation R&D Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Health Care System, Atlanta, Georgia, United States of America
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, Georgia, United States of America
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, United States of America
- Department of Cell Biology, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Lisa C. Krishnamurthy
- Atlanta VA Health Care System, Decatur, Georgia, United States of America
- Tri-Institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia State, Georgia Tech and Emory, Atlanta, Georgia, United States of America
- Department of Physics & Astronomy, Georgia State University, Atlanta, Georgia, United States of America
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia, United States of America
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Zhou XC, Chen LH, Wu S, Wang KZ, Wei ZC, Li T, Huang YS, Hua ZH, Xia Q, Lv ZZ, Lv LJ. Brain effect mechanism of lever positioning manipulation on LDH analgesia based on multimodal MRI: a study protocol. BMC Complement Med Ther 2024; 24:246. [PMID: 38915038 PMCID: PMC11194935 DOI: 10.1186/s12906-024-04549-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 06/11/2024] [Indexed: 06/26/2024] Open
Abstract
INTRODUCTION The clinical symptoms of Lumbar Disc Herniation (LDH) can be effectively ameliorated through Lever Positioning Manipulation (LPM), which is closely linked to the brain's pain-regulating mechanisms. Magnetic Resonance Imaging (MRI) offers an objective and visual means to study how the brain orchestrates the characteristics of analgesic effects. From the perspective of multimodal MRI, we applied functional MRI (fMRI) and Magnetic Resonance Spectrum (MRS) techniques to comprehensively evaluate the characteristics of the effects of LPM on the brain region of LDH from the aspects of brain structure, brain function and brain metabolism. This multimodal MRI technique provides a biological basis for the clinical application of LPM in LDH. METHODS AND ANALYSIS A total of 60 LDH patients and 30 healthy controls, matched by gender, age, and years of education, will be enrolled in this study. The LDH patients will be divided into two groups (Group 1, n = 30; Group 2, n = 30) using a random number table method. Group 1 will receive LPM treatment once every two days, for a total of 12 times over 4 weeks. Group 2 will receive sham LPM treatment during the same period as Group 1. All 30 healthy controls will be divided into Group 3. Multimodal MRI will be performed on Group 1 and Group 2 at three time points (TPs): before LPM (TP1), after one LPM session (TP2), and after a full course of LPM treatment. The healthy controls (Group 3) will not undergo LPM and will be subject to only a single multimodal MRI scan. Participants in both Group 1 and Group 2 will be required to complete clinical questionnaires. These assessments will focus on pain intensity and functional disorders, using the Visual Analog Scale (VAS) and the Japanese Orthopaedic Association (JOA) scoring systems, respectively. DISCUSSION The purpose of this study is to investigate the multimodal brain response characteristics of LDH patients after treatment with LPM, with the goal of providing a biological basis for clinical applications. TRIAL REGISTRATION NUMBER https://clinicaltrials.gov/ct2/show/NCT05613179 , identifier: NCT05613179.
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Affiliation(s)
- Xing-Chen Zhou
- The Third Affiliated Hospital of Zhejiang, University of Traditional Chinese Medicine, Hangzhou, Zhejiang, China
- The Third School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
- Research Institute of Tuina (Spinal Disease), Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Long-Hao Chen
- The Third Affiliated Hospital of Zhejiang, University of Traditional Chinese Medicine, Hangzhou, Zhejiang, China
- The Third School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
- Research Institute of Tuina (Spinal Disease), Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Shuang Wu
- The Third Affiliated Hospital of Zhejiang, University of Traditional Chinese Medicine, Hangzhou, Zhejiang, China
- The Third School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Kai-Zheng Wang
- The Third Affiliated Hospital of Zhejiang, University of Traditional Chinese Medicine, Hangzhou, Zhejiang, China
- The Third School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
- Research Institute of Tuina (Spinal Disease), Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Zi-Cheng Wei
- The Third Affiliated Hospital of Zhejiang, University of Traditional Chinese Medicine, Hangzhou, Zhejiang, China
- The Third School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Tao Li
- The Third Affiliated Hospital of Zhejiang, University of Traditional Chinese Medicine, Hangzhou, Zhejiang, China
- The Third School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Yuan-Shen Huang
- The Third Affiliated Hospital of Zhejiang, University of Traditional Chinese Medicine, Hangzhou, Zhejiang, China
- The Third School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
- Research Institute of Tuina (Spinal Disease), Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Zi-Han Hua
- The Third Affiliated Hospital of Zhejiang, University of Traditional Chinese Medicine, Hangzhou, Zhejiang, China
- The Third School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Qiong Xia
- The Third Affiliated Hospital of Zhejiang, University of Traditional Chinese Medicine, Hangzhou, Zhejiang, China
- The Third School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Zhi-Zhen Lv
- The Third Affiliated Hospital of Zhejiang, University of Traditional Chinese Medicine, Hangzhou, Zhejiang, China.
- The Third School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China.
| | - Li-Jiang Lv
- The Third Affiliated Hospital of Zhejiang, University of Traditional Chinese Medicine, Hangzhou, Zhejiang, China.
- The Third School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China.
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Rasooli A, Chalavi S, Li H, Seer C, Adab HZ, Mantini D, Sunaert S, Mikkelsen M, Edden RAE, Swinnen SP. Neural correlates of transfer of learning in motor coordination tasks: role of inhibitory and excitatory neurometabolites. Sci Rep 2024; 14:3251. [PMID: 38331950 PMCID: PMC10853253 DOI: 10.1038/s41598-024-53901-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 02/06/2024] [Indexed: 02/10/2024] Open
Abstract
We aimed to investigate transfer of learning, whereby previously acquired skills impact new task learning. While it has been debated whether such transfer may yield positive, negative, or no effects on performance, very little is known about the underlying neural mechanisms, especially concerning the role of inhibitory (GABA) and excitatory (Glu) (measured as Glu + glutamine (Glx)) neurometabolites, as measured by magnetic resonance spectroscopy (MRS). Participants practiced a bimanual coordination task across four days. The Experimental group trained a task variant with the right hand moving faster than the left (Task A) for three days and then switched to the opposite variant (Task B) on Day4. The control group trained Task B across four days. MRS data were collected before, during, and after task performance on Day4 in the somatosensory (S1) and visual (MT/V5) cortex. Results showed that both groups improved performance consistently across three days. On Day4, the Experimental group experienced performance decline due to negative task transfer while the control group continuously improved. GABA and Glx concentrations obtained during task performance showed no significant group-level changes. However, individual Glx levels during task performance correlated with better (less negative) transfer performance. These findings provide a first window into the neurochemical mechanisms underlying task transfer.
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Affiliation(s)
- Amirhossein Rasooli
- Movement Control and Neuroplasticity Research Group, Department of Movement Sciences, Group Biomedical Sciences, KU Leuven, Leuven, Belgium
- Leuven Brain Institute (LBI), KU Leuven, Leuven, Belgium
| | - Sima Chalavi
- Movement Control and Neuroplasticity Research Group, Department of Movement Sciences, Group Biomedical Sciences, KU Leuven, Leuven, Belgium
- Leuven Brain Institute (LBI), KU Leuven, Leuven, Belgium
| | - Hong Li
- Movement Control and Neuroplasticity Research Group, Department of Movement Sciences, Group Biomedical Sciences, KU Leuven, Leuven, Belgium
- Leuven Brain Institute (LBI), KU Leuven, Leuven, Belgium
| | - Caroline Seer
- Movement Control and Neuroplasticity Research Group, Department of Movement Sciences, Group Biomedical Sciences, KU Leuven, Leuven, Belgium
- Leuven Brain Institute (LBI), KU Leuven, Leuven, Belgium
| | - Hamed Zivari Adab
- Movement Control and Neuroplasticity Research Group, Department of Movement Sciences, Group Biomedical Sciences, KU Leuven, Leuven, Belgium
- Leuven Brain Institute (LBI), KU Leuven, Leuven, Belgium
| | - Dante Mantini
- Movement Control and Neuroplasticity Research Group, Department of Movement Sciences, Group Biomedical Sciences, KU Leuven, Leuven, Belgium
- Leuven Brain Institute (LBI), KU Leuven, Leuven, Belgium
| | - Stefan Sunaert
- Department of Imaging and Pathology, Group Biomedical Sciences, KU Leuven, Leuven, Belgium
| | - Mark Mikkelsen
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - Richard A E Edden
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Stephan P Swinnen
- Movement Control and Neuroplasticity Research Group, Department of Movement Sciences, Group Biomedical Sciences, KU Leuven, Leuven, Belgium.
- Leuven Brain Institute (LBI), KU Leuven, Leuven, Belgium.
- Motor Control Laboratory, Movement Control and Neuroplasticity Research Group, KU Leuven, Tervuurse Vest 101, Building De Nayer, Room 02.11, 3001, Leuven, Belgium.
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Rasooli A, Adab HZ, Van Ruitenbeek P, Weerasekera A, Chalavi S, Cuypers K, Levin O, Dhollander T, Peeters R, Sunaert S, Mantini D, Swinnen SP. White matter and neurochemical mechanisms underlying age-related differences in motor processing speed. iScience 2023; 26:106794. [PMID: 37255665 PMCID: PMC10225899 DOI: 10.1016/j.isci.2023.106794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 01/11/2023] [Accepted: 04/27/2023] [Indexed: 06/01/2023] Open
Abstract
Aging is associated with changes in the central nervous system and leads to reduced life quality. Here, we investigated the age-related differences in the CNS underlying motor performance deficits using magnetic resonance spectroscopy and diffusion MRI. MRS measured N-acetyl aspartate (NAA), choline (Cho), and creatine (Cr) concentrations in the sensorimotor and occipital cortex, whereas dMRI quantified apparent fiber density (FD) in the same voxels to evaluate white matter microstructural organization. We found that aging was associated with increased reaction time and reduced FD and NAA concentration in the sensorimotor voxel. Both FD and NAA mediated the association between age and reaction time. The NAA concentration was found to mediate the association between age and FD in the sensorimotor voxel. We propose that the age-related decrease in NAA concentration may result in reduced axonal fiber density in the sensorimotor cortex which may ultimately account for the response slowness of older participants.
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Affiliation(s)
- Amirhossein Rasooli
- Movement Control & Neuroplasticity Research Group, Group Biomedical Sciences, KU Leuven, Leuven, Belgium
- KU Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Hamed Zivari Adab
- Movement Control & Neuroplasticity Research Group, Group Biomedical Sciences, KU Leuven, Leuven, Belgium
- KU Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Peter Van Ruitenbeek
- Movement Control & Neuroplasticity Research Group, Group Biomedical Sciences, KU Leuven, Leuven, Belgium
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, 6200 MD Maastricht, the Netherlands
| | - Akila Weerasekera
- Movement Control & Neuroplasticity Research Group, Group Biomedical Sciences, KU Leuven, Leuven, Belgium
- KU Leuven Brain Institute, KU Leuven, Leuven, Belgium
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Sima Chalavi
- Movement Control & Neuroplasticity Research Group, Group Biomedical Sciences, KU Leuven, Leuven, Belgium
- KU Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Koen Cuypers
- Movement Control & Neuroplasticity Research Group, Group Biomedical Sciences, KU Leuven, Leuven, Belgium
- KU Leuven Brain Institute, KU Leuven, Leuven, Belgium
- REVAL Rehabilitation Research Center, Hasselt University, Diepenbeek, Belgium
| | - Oron Levin
- Movement Control & Neuroplasticity Research Group, Group Biomedical Sciences, KU Leuven, Leuven, Belgium
- KU Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Thijs Dhollander
- Murdoch Children’s Research Institute, Melbourne, VIC, Australia
| | - Ronald Peeters
- KU Leuven, Department of Imaging and Pathology, Group Biomedical Sciences, KU Leuven, Leuven, Belgium
| | - Stefan Sunaert
- KU Leuven, Department of Imaging and Pathology, Group Biomedical Sciences, KU Leuven, Leuven, Belgium
| | - Dante Mantini
- Movement Control & Neuroplasticity Research Group, Group Biomedical Sciences, KU Leuven, Leuven, Belgium
- KU Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Stephan P. Swinnen
- Movement Control & Neuroplasticity Research Group, Group Biomedical Sciences, KU Leuven, Leuven, Belgium
- KU Leuven Brain Institute, KU Leuven, Leuven, Belgium
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