Structural brain correlates of balance control in children with cerebral palsy: baseline correlations and effects of training

Structural brain abnormalities likely underlie impaired balance control in cerebral palsy (CP). This study investigated whether balance measures were associated with measures derived from conventional MRI and diffusion tensor imaging (DTI), and whether an X-Box One Kinect balance training (6 weeks, 5 days/week, 30 min/session) could induce neuroplastic changes in CP. Twelve children with spastic CP (age:11.3 ± 2.3y) underwent balance evaluation and MRI examination, at baseline and after training. Nine age-matched typically developing (TD) children underwent baseline measurements. Balance control was evaluated testing advanced motor skills (Challenge score) and during gait (medio-lateral Margin of Stability, MoS). With conventional MRI, but especially with DTBM (DTI-based VBM), we found smaller volumes of several deep grey matter structures and within the right inferior parietal cortex, right supramarginal cortex, and left postcentral cortex, and lower fractional anisotropy (FA) and smaller volumes of various white matter regions in CP compared to TD. Within the CP group alone, no correlations within brain tissue were found. After training, Challenge scores of children with CP improved. In an exploratory analysis DTBM showed a trend for volume increase within the right inferior parietal cortex, volume decrease within the right retrolenticular limb of the internal capsule, and an increase of FA within the right corticospinal tract. This indicates that a 6-week balance intervention may induce neuroplastic changes in children with CP. CP-RehOP (trial registration number: NTR6034/NL5854, date of registration: August 26th 2016).