Examining Neural Plasticity for Slip-Perturbation Training: An fMRI Study.

Perturbation-based balance training has shown to induce adaptation of reactive balance responses that can significantly reduce longer-term fall risk in older adults. While specific cortical and subcortical areas in control of posture and locomotion have been identified, little is known about the training-induced plasticity occurring in neural substrates for challenging tasks involving reactive balance control. The purpose of this study was to use functional neuroimaging to examine and determine the neural substrates, if any, involved in inducing adaptation to slip-like perturbations experienced during walking over 3 consecutive training days. We used a mental imagery task to examine the neural changes accompanied by treadmill-slip perturbation training. Ten healthy young adults were exposed to increasing magnitude of displacements during slip-like perturbations while walking, with an acceleration of 6 m/s on a motorized treadmill for 3 consecutive days. Brain activity was recorded through MRI while performing imagined slipping and imagined walking tasks before and after the perturbation training. The number of compensatory steps and center of mass state stability at compensatory step touchdown were recorded. As compared with day 1 (first trial), on day 3 (last trial) there was a significant reduction in number of compensatory steps and increase in stability at compensatory step touchdown on the mid and highest perturbation intensities. Before perturbation training, imagined slipping showed increased activity in the SMA, parietal regions, parahippocampal gyrus, and cingulate gyrus compared with rest. After perturbation training, imagined slipping showed increased activation in DLPFC, superior parietal lobule, inferior occipital gyrus, and lingual gyrus. Perturbation training was not associated with decline in activity in any of the brain regions. This study provides evidence for learning-related changes in cortical structures while adapting to slip-like perturbations while walking. The findings reflect that higher-level processing is required for timing and sequencing of movements to execute an effective balance response to perturbations. Specifically, the CNS relies on DLPFC along with motor, parietal, and occipital cortices for adapting to postural tasks posing a significant threat to balance.