Regional cerebellar volume reflects static balance in elite female short-track speed skaters

Consensus Paper: Ataxic Gait

The aim of this consensus paper is to discuss the roles of the cerebellum in human gait, as well as its assessment and therapy. Cerebellar vermis is critical for postural control. The cerebellum ensures the mapping of sensory information into temporally relevant motor commands. Mental imagery of gait involves intrinsically connected fronto-parietal networks comprising the cerebellum. Muscular activities in cerebellar patients show impaired timing of discharges, affecting the patterning of the synergies subserving locomotion. Ataxia of stance/gait is amongst the first cerebellar deficits in cerebellar disorders such as degenerative ataxias and is a disabling symptom with a high risk of falls. Prolonged discharges and increased muscle coactivation may be related to compensatory mechanisms and enhanced body sway, respectively. Essential tremor is frequently associated with mild gait ataxia. There is growing evidence for an important role of the cerebellar cortex in the pathogenesis of essential tremor. In multiple sclerosis, balance and gait are affected due to cerebellar and spinal cord involvement, as a result of disseminated demyelination and neurodegeneration impairing proprioception. In orthostatic tremor, patients often show mild-to-moderate limb and gait ataxia. The tremor generator is likely located in the posterior fossa. Tandem gait is impaired in the early stages of cerebellar disorders and may be particularly useful in the evaluation of pre-ataxic stages of progressive ataxias. Impaired inter-joint coordination and enhanced variability of gait temporal and kinetic parameters can be grasped by wearable devices such as accelerometers. Kinect is a promising low cost technology to obtain reliable measurements and remote assessments of gait. Deep learning methods are being developed in order to help clinicians in the diagnosis and decision-making process. Locomotor adaptation is impaired in cerebellar patients. Coordinative training aims to improve the coordinative strategy and foot placements across strides, cerebellar patients benefiting from intense rehabilitation therapies. Robotic training is a promising approach to complement conventional rehabilitation and neuromodulation of the cerebellum. Wearable dynamic orthoses represent a potential aid to assist gait. The panel of experts agree that the understanding of the cerebellar contribution to gait control will lead to a better management of cerebellar ataxias in general and will likely contribute to use gait parameters as robust biomarkers of future clinical trials.

Dynamic balance deficit and the neural network in Alzheimer's disease and mild cognitive impairment

BACKGROUND

Patients with Alzheimer's disease (AD) and mild cognitive impairment (MCI) exhibit balance deficits. Although only a few studies have evaluated the relationship between the brain images and balance indices. In this study, we measured balance indices, including the index of postural stability (IPS) and assessed the relationship between the brain images and their clinical motor and cognitive functional features.

METHODS

The study included patients with MCI (N = 14) and patients with AD (N = 19). The primary outcome was IPS under a visual block condition and/or a proprioception block condition. In addition, 9 MCI and 8 AD patients underwent a 1.5-Tesla (1.5-T) Magnetic Resonance Imaging (MRI) scan, and the relationships between the MRI parameters and the balance indices were evaluated.

RESULTS

The IPS score was significantly lower in the AD group than the MCI group, but only under the closed eyes/hard surface condition. In terms of MRI, there was a significant positive correlation between the IPS and the regional betweenness centrality in the left hippocampal region.

CONCLUSIONS

The finding of a significantly lower IPS score under the closed eyes/hard surface condition in AD than in MCI cases suggests that the vestibular and/or proprioceptive systems were more severely impaired in AD than MCI cases. The results suggest that a dynamic balance disturbance due to deficits of the vestibular hippocampal pathway may be a useful marker for the diagnosis of MCI and detection of disease progression from MCI to AD.

Balance and the brain: A review of structural brain correlates of postural balance and balance training in humans

BACKGROUND

Balance challenges are associated with not only the aging process but also a wide variety of psychiatric and neurological disorders. However, relatively little is known regarding the neural basis of balance and the effects of balance interventions on the brain.

RESEARCH QUESTION

This review synthesizes the existing literature to answer the question: What are the key brain structures associated with balance?

METHODS

This review examined 37 studies that assessed brain structures in relation to balance assessment or intervention. These studies provided 234 findings implicating 71 brain structures. The frequency of implication for each structure was examined based upon specific methodological parameters, including study design (assessment/intervention), type of balance measured (static/dynamic), population (clinical/non-clinical), and imaging analysis technique (region of interest [ROI]/voxel-based morphometry [VBM]).

RESULTS

Although a number of structures were associated with balance across the brain, the most frequently implicated structures included the cerebellum, basal ganglia, thalamus, hippocampus, inferior parietal cortex, and frontal lobe regions. Findings in the cerebellum and brainstem were most common in studies with clinical populations, studies that used an ROI approach, and studies that measured dynamic balance. Findings in the frontal, occipital, and parietal regions were also more common in studies that measured dynamic compared to static balance.

SIGNIFICANCE

While balance appears to be a whole-brain phenomenon, a subset of structures appear to play a key role in balance and are likely implicated in balance disorders. Some of these structures (i.e., the cerebellum, basal ganglia and thalamus) have a well-appreciated role in balance, whereas other regions (i.e., hippocampus and inferior parietal cortex) are not commonly thought to be associated with balance and therefore may provide alternative explanations for the neural basis of balance. Key avenues for future research include understanding the roles of all regions involved in balance across the lifespan and in different clinical populations.

Roles of the Declive, Folium, and Tuber Cerebellar Vermian Lobules in Sportspeople

The cerebellum plays vital roles in balance control and motor learning, including in saccadic adaptation and coordination. It consists of the vermis and two hemispheres and is anatomically separated into ten lobules that are designated as I–X. Although neuroimaging and clinical studies suggest that functions are compartmentalized within the cerebellum, the function of each cerebellar lobule is not fully understood. Electrophysiological and lesion studies in animals as well as neuroimaging and lesion studies in humans have revealed that vermian lobules VI and VII (declive, folium, and tuber) are critical for controlling postural balance, saccadic eye movements, and coordination. In addition, recent structural magnetic resonance imaging studies have revealed that these lobules are larger in elite basketball and short-track speed skaters. Furthermore, in female short-track speed skaters, the volume of this region is significantly correlated with static balance. This article reviews the function of vermian lobules VI and VII, focusing on the control of balance, eye movements, and coordination including coordination between the eyes and hands and bimanual coordination.

The Effects of Taekwondo Training on Brain Connectivity and Body Intelligence

OBJECTIVE

Many studies have reported that Taekwondo training could improve body perception, control and brain activity, as assessed with an electroencephalogram. This study aimed to assess body intelligence and brain connectivity in children with Taekwondo training as compared to children without Taekwondo training.

METHODS

Fifteen children with Taekwondo training (TKD) and 13 age- and sex-matched children who had no previous experience of Taekwondo training (controls) were recruited. Body intelligence, clinical characteristics and brain connectivity in all children were assessed with the Body Intelligence Scale (BIS), self-report, and resting state functional magnetic resonance imaging.

RESULTS

The mean BIS score in the TKD group was higher than that in the control group. The TKD group showed increased low-frequency fluctuations in the right frontal precentral gyrus and the right parietal precuneus, compared to the control group. The TKD group showed positive cerebellum vermis (lobe VII) seed to the right frontal, left frontal, and left parietal lobe. The control group showed positive cerebellum seed to the left frontal, parietal, and occipital cortex. Relative to the control group, the TKD group showed increased functional connectivity from cerebellum seed to the right inferior frontal gyrus.

CONCLUSION

To the best of our knowledge, this is the first study to assess the effect of Taekwondo training on brain connectivity in children. Taekwondo training improved body intelligence and brain connectivity from the cerebellum to the parietal and frontal cortex.

A single-unit design structure and gender differences in the swimming world championships

Four 50 meter male/female finals - the freestyle, butterfly, breaststroke, and backstroke - swum during individual events at the Swimming World Championships (SWCs) can be defined in four clusters. The aim of the present study was to use a single-unit design structure, in which the swimmer was defined at only one scale, to evaluate gender differences in start reaction times among elite swimmers in 50 m events. The top six male and female swimmers in the finals of four swimming stroke final events in six SWCs were analyzed. An unpaired t-test was used. The p-values were evaluated using Neo-Fisherian significance assessments (Hurlbert and Lombardi, 2012). For the freestyle, gender differences in the start reaction times were positively identified for five of the six SWCs. For the backstroke, gender differences in the start reaction times could be dismissed for five of the six SWCs. For both the butterfly and breaststroke, gender differences in the start reaction times yielded inconsistent statistical differences. Pooling all swimmers together (df = 286) showed that an overall gender difference in the start reaction times could be positively identified: p = 0.00004. The contrast between the gender differences in start reaction times between the freestyle and backstroke may be associated with different types of gender adaptations to swimming performances. When the natural groupings of swimming stroke final events were ignored, sacrificial pseudoreplication occurred, which may lead to erroneous statistical differences.

Postural stability in cigarette smokers and during abstinence from alcohol

BACKGROUND

Static postural instability is common in alcohol-dependent individuals (ALC). Chronic alcohol consumption has deleterious effects on the neural and perceptual systems subserving postural stability. However, little is known about the effects of chronic cigarette smoking on postural stability and its changes during abstinence from alcohol.

METHODS

A modified Fregly ataxia battery was administered to a total of 115 smoking (sALC) and nonsmoking ALC (nsALC) and to 71 smoking (sCON) and nonsmoking light/nondrinking controls (nsCON). Subgroups of abstinent ALC were assessed at 3 time points (TPs; approximately 1, 5, 34 weeks of abstinence from alcohol); a subset of nsCON was retested at 40 weeks. We tested whether cigarette smoking affects postural stability in CON and in ALC during extended abstinence from alcohol, and we used linear mixed effects modeling to measure change across TPs within ALC.

RESULTS

Chronic smoking was associated with reduced performance on the Sharpened Romberg eyes-closed task in abstinent ALC at all 3 TPs and in CON. The test performance of nsALC increased significantly between 1 and 32 weeks of abstinence, whereas the corresponding increases for sALC between 1 and 35 weeks were nonsignificant. With long-term abstinence from alcohol, nsALC recovered into the range of nsCON and sALC recovered into the range of sCON. Static postural stability decreased with age and correlated with smoking variables but not with drinking measures.

CONCLUSIONS

Chronic smoking was associated with reduced static postural stability with eyes closed and with lower increases of postural stability during abstinence from alcohol. Smoking cessation in alcohol dependence treatment may facilitate recovery from static postural instability during abstinence.