Department of Biomedical Engineering, University of Delaware, Newark, DE, USA.
Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA.
J Child Neurol. 2020 Jun;35(7):463-471. doi: 10.1177/0883073820909274. Epub 2020 Mar 23.
Cerebral palsy is a neurodevelopmental movement disorder that affects coordination and balance. Therapeutic treatments for balance deficiencies in this population primarily focus on the musculoskeletal system, whereas the neural basis of balance impairment is often overlooked. Magnetic resonance elastography (MRE) is an emerging technique that has the ability to sensitively assess microstructural brain health through measurements of neural tissue stiffness. Using magnetic resonance elastography, we have previously measured significantly softer grey matter in children with cerebral palsy as compared with typically developing children. To further allow magnetic resonance elastography to be a clinically useful tool in rehabilitation, we aim to understand how brain stiffness in children with cerebral palsy is related to dynamic balance reaction performance as measured through anterior and posterior single-stepping thresholds, defined as the standing perturbation magnitudes that elicit anterior or posterior recovery steps. We found that global brain stiffness is significantly correlated with posterior stepping thresholds ( = .024) such that higher brain stiffness was related to better balance recovery. We further identified specific regions of the brain where stiffness was correlated with stepping thresholds, including the precentral and postcentral gyri, the precuneus and cuneus, and the superior temporal gyrus. Identifying brain regions affected in cerebral palsy and related to balance impairment can help inform rehabilitation strategies targeting neuroplasticity to improve motor function.
脑瘫是一种神经发育运动障碍，会影响协调和平衡。针对该人群的平衡缺陷的治疗方法主要集中在肌肉骨骼系统上，而平衡受损的神经基础通常被忽视。磁共振弹性成像（MRE）是一种新兴技术，具有通过测量神经组织的硬度来敏感地评估微观结构脑健康的能力。使用磁共振弹性成像，我们之前已经测量到脑瘫儿童的灰质比正常发育的儿童明显更软。为了进一步使磁共振弹性成像成为康复治疗中有用的工具，我们旨在了解脑瘫儿童的大脑硬度与通过前后单步阈值（定义为引起前向或后向恢复步的站立扰动幅度）测量的动态平衡反应性能之间的关系。我们发现，大脑整体硬度与后步阈值显著相关（r =.024），即大脑硬度越高，平衡恢复越好。我们还确定了与步阈值相关的大脑特定区域，包括中央前回和中央后回、楔前叶和楔叶以及颞上回。确定脑瘫患者受影响的大脑区域以及与平衡障碍相关的区域可以帮助确定针对神经可塑性的康复策略，以改善运动功能。
