Regional volumes in brain stem and cerebellum are associated with postural impairments in young brain‐injured patients

Abstract

Many patients with traumatic brain injury (TBI) suffer from postural control impairments that can profoundly affect daily life. The cerebellum and brain stem are crucial for the neural control of posture and have been shown to be vulnerable to primary and secondary structural consequences of TBI. The aim of this study was to investigate whether morphometric differences in the brain stem and cerebellum can account for impairments in static and dynamic postural control in TBI. TBI patients (n = 18) and healthy controls (n = 30) completed three challenging postural control tasks on the EquiTest® system (Neurocom). Infratentorial grey matter (GM) and white matter (WM) volumes were analyzed with cerebellum-optimized voxel-based morphometry using the spatially unbiased infratentorial toolbox. Volume loss in TBI patients was revealed in global cerebellar GM, global infratentorial WM, middle cerebellar peduncles, pons and midbrain. In the TBI group and across both groups, lower postural control performance was associated with reduced GM volume in the vermal/paravermal regions of lobules I-IV, V and VI. Moreover, across all participants, worse postural control performance was associated with lower WM volume in the pons, medulla, midbrain, superior and middle cerebellar peduncles and cerebellum. This is the first study in TBI patients to demonstrate an association between postural impairments and reduced volume in specific infratentorial brain areas. Volumetric measures of the brain stem and cerebellum may be valuable prognostic markers of the chronic neural pathology, which complicates rehabilitation of postural control in TBI.

Low variability of dynamical functional connectivity in cerebellar networks

“…When scrutinizing the brain areas to which modules 1 and 14 connect both structurally and functionally (figure 5), we found strong mutual connectivity between the anterior and posterior parts of the cerebellum (table 2), which is in agreement with previous work [40,43]. Moreover, the anterior part projects also to the motor cortex among other areas as is also well established [41,44,45].…”

Enhanced prefrontal functional–structural networks to support postural control deficits after traumatic brain injury in a pediatric population

“…More precisely, we found a strong decrease in connectivity degree in motor areas, brainstem, cingulate gyrus, cerebellum, and the temporal poles, areas that are typically associated with the performance of motor skills and balance control. Indeed, decreased subcortical connectivity, in particular in the brainstem and cerebellum, was recently associated with postural impairments in TBI patients ( Drijkoningen, Leunissen, et al, 2015 ), suggesting a possible diffuse pathology across subcortical structures.…”

“…On a neural level, TBI generally disrupts functional and structural large-scale brain networks (i.e., the networks of white matter tracts connecting different brain regions), while on a behavioral level, TBI often triggers various deficits, including cognitive impairments, motor problems, emotional sequelae, and so forth, that can persist for years postinjury ( Caeyenberghs, Leemans, De Decker, et al, 2012 ; Ham & Sharp, 2012 ; D. H. Smith & Meaney, 2000 ). We focus here on deficits in balance control after TBI, which can last from months to several years after the traumatic impact in both adults ( Guskiewicz, Riemann, Perrin, & Nashner, 1997 ; McCulloch, Buxton, Hackney, & Lowers, 2010 ) and children ( Drijkoningen, Caeyenberghs, Vander Linden, et al, 2015 ; Drijkoningen, Leunissen, et al, 2015 ; Katz-Leurer, Rotem, Lewitus, Keren, & Meyer, 2008 ), which is psychosocially important because it increases the risk of falling, and thus affects the patient’s independence ( McCulloch, Buxton, Hackney, & Lowers, 2010 ; Wade, Canning, Fowler, Felmingham, & Baguley, 1997 ).…”

Discriminant validity of spatial and temporal postural index in children with neurodevelopmental disorders

“…Burciu et al (2013) observed that in 20 patients with cerebellar degeneration, two weeks of sensorimotor training lead to both an improvement in postural performances and an increase of gray matter volume in the cerebellum; in a group of patients with Parkinson's disease, Sehm et al (2014) reported a change of grey matter in the right cerebellum, together with an improvement in postural stability after postural training on movable support. Recently, Drijkoningen et al (2015) examined the effect of eight weeks of balance training program in a group of 29 children with traumatic brain injury and they found that the changes in balance control were associated with alterations in the cerebellar white matter microstructure. Finally, our group (Goulème et al, 2015a,b) reported in a small group of dyslexic children an improvement in postural stability after 3 min of postural training in deprived sensory conditions only (eyes closed on an unstable platform), suggesting an improvement in sensory input processing, most likely due to a better cerebellar integration.…”