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J Child Neurol. 2020 Mar 23:883073820909274. doi: 10.1177/0883073820909274. [Epub ahead of print]

Brain Stiffness Relates to Dynamic Balance Reactions in Children With Cerebral Palsy.

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Department of Biomedical Engineering, University of Delaware, Newark, Delaware, USA.
Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, USA.
Department of Psychological and Brain Sciences, University of Delaware, Newark, Delaware, USA.
Department of Physical Therapy, University of Delaware, Newark, Delaware, USA.
Department of Orthopedic Surgery, Nemours/A.I. duPont Hospital for Children, Wilmington, Delaware, USA.
Department of Biomedical Research, Nemours/A.I. duPont Hospital for Children, Wilmington, Delaware, USA.


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 in vivo 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 (P = .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.


balance; brain; magnetic resonance elastography; pediatric cerebral palsy; stiffness


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