Drijkoningen David, Caeyenberghs Karen, Leunissen Inge, Vander Linden Catharine, Leemans Alexander, Sunaert Stefan, Duysens Jacques, Swinnen Stephan P
KU Leuven, Movement Control and Neuroplasticity Research Group, Group Biomedical Sciences, B-3001 Leuven, Belgium.
Department of Physical Therapy and Motor Rehabilitation, Faculty of Medicine and Health Sciences, University of Ghent, Ghent B-9000, Belgium.
Neuroimage Clin. 2014 Dec 17;7:240-51. doi: 10.1016/j.nicl.2014.12.006. eCollection 2015.
We investigated whether balance control in young TBI patients can be promoted by an 8-week balance training program and whether this is associated with neuroplastic alterations in brain structure. The cerebellum and cerebellar peduncles were selected as regions of interest because of their importance in postural control as well as their vulnerability to brain injury. Young patients with moderate to severe TBI and typically developing (TD) subjects participated in balance training using PC-based portable balancers with storage of training data and real-time visual feedback. An additional control group of TD subjects did not attend balance training. Mean diffusivity and fractional anisotropy were determined with diffusion MRI scans and were acquired before, during (4 weeks) and at completion of training (8 weeks) together with balance assessments on the EquiTest® System (NeuroCom) which included the Sensory Organization Test, Rhythmic Weight Shift and Limits of Stability protocols. Following training, TBI patients showed significant improvements on all EquiTest protocols, as well as a significant increase in mean diffusivity in the inferior cerebellar peduncle. Moreover, in both training groups, diffusion metrics in the cerebellum and/or cerebellar peduncles at baseline were predictive of the amount of performance increase after training. Finally, amount of training-induced improvement on the Rhythmic Weight Shift test in TBI patients was positively correlated with amount of change in fractional anisotropy in the inferior cerebellar peduncle. This suggests that training-induced plastic changes in balance control are associated with alterations in the cerebellar white matter microstructure in TBI patients.
我们研究了为期8周的平衡训练计划是否能促进年轻创伤性脑损伤（TBI）患者的平衡控制，以及这是否与脑结构的神经可塑性改变有关。由于小脑及其脚在姿势控制中的重要性以及它们易受脑损伤影响，因此将小脑和小脑脚选为感兴趣区域。中度至重度TBI的年轻患者和典型发育（TD）受试者使用基于PC的便携式平衡仪参与平衡训练，该平衡仪可存储训练数据并提供实时视觉反馈。另外一组TD受试者作为对照组未参加平衡训练。通过扩散磁共振成像扫描测定平均扩散率和分数各向异性，并在训练前、训练期间（4周）和训练结束时（8周）进行采集，同时在EquiTest®系统（NeuroCom）上进行平衡评估，包括感觉组织测试、节律性体重转移和稳定性极限协议。训练后，TBI患者在所有EquiTest协议上均有显著改善，并且小脑下脚的平均扩散率显著增加。此外，在两个训练组中，基线时小脑和/或小脑脚的扩散指标可预测训练后性能提高的程度。最后，TBI患者在节律性体重转移测试中训练诱导的改善程度与小脑下脚分数各向异性的变化量呈正相关。这表明训练诱导的平衡控制可塑性变化与TBI患者小脑白质微观结构的改变有关。
