After immobilization, patients show impaired postural control and increased risk of falling. Therefore, loss of balance control should already be counteracted during immobilization. Previously, studies have demonstrated that both motor imagery (MI) and action observation (AO) can improve motor performance. The current study elaborated how the brain is activated during imagination and observation of different postural tasks to provide recommendations about the conception of non-physical balance training. For this purpose, participants were tested in a within-subject design in an fMRI-scanner in three different conditions: (a) AO + MI, (b) AO, and (c) MI. In (a) participants were instructed to imagine themselves as the person pictured in the video whereas in (b) they were instructed simply to watch the video. In (c) subjects closed their eyes and kinesthetically imagined the task displayed in the video. Two tasks were evaluated in each condition: (i) static standing balance and (ii) dynamic standing balance (medio-lateral perturbation). In all conditions the start of a new trial was indicated every 2 sec by a sound. During AO + MI of the dynamic task, participants activated motor centers including the putamen, cerebellum, supplementary motor area, premotor cortices (PMv/d) and primary motor cortex (M1). MI showed a similar pattern but no activity in M1 and PMv/d. In the SMA and cerebellum, activity was generally higher in the dynamic than in the static condition. AO did not significantly activate any of these brain areas. Our results showed that (I) mainly AO + MI, but also MI, activate brain regions important for balance control; (II) participants display higher levels of brain activation in the more demanding balance task; (III) there is a significant difference between AO + MI and AO. Consequently, best training effects should be expected when participants apply MI during AO (AO + MI) of challenging postural tasks.

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Case series, Level IV.

The authors assessed regional cerebral blood flow dynamics with magnetic resonance (MR) imaging enhanced with gadolinium diethylenetriaminepentaacetic acid (DTPA). After bolus administration of Gd-DTPA, rapid T2*-weighted gradient-echo images were acquired. Image acquisition time ranged from 2 to 3 seconds. The signal intensity (SI) of brain tissue and blood vessels markedly decreased during the first pass of contrast agent through the brain due to the local field inhomogeneity caused by the concentrated paramagnetic contrast agent. The method was used in 18 subjects with no cerebrovascular disease and 32 patients with stroke, vascular stenosis, arteriovenous malformation, and cerebral neoplasm. Comparison with intracranial angiography was performed in three patients and with single-photon emission computed tomography of blood flow in four. The change in T2* relaxation rate was approximately linearly related to the dose of contrast agent. The SI change increased as the echo time was lengthened. Regions in cerebral infarcts, metastases, and arteriovenous malformations showed different enhancement patterns than those of edema around a lesion and of normal brain tissue. Abnormal circulation times in patients with vascular stenoses were demonstrated. The method provides information about cerebral blood flow dynamics not available from conventional MR imaging and MR angiography.

No abstract