Purpose: This study examined the effects of subjective visual vertical perception and head orientation on static balance control. Methods: The subjects were 25 young and healthy adults. The vertical perception was measured using a subjective visual vertical (SVV), and the Center of pressure (COP) parameter was analyzed by continuously measuring the movement of the COP to determine the changes in static postural control. The group was divided based on a deviation of 3° in SVV (11 of SVV≥3°, 14 of SVV<3°) and measured with different head orientations: front, up, down, left, and right in the upright and tandem positions, respectively. Results: In the upright position, the SVV≥3° group had significantly larger values for all COP parameters (Sway length, Surface, Delta X, Delta Y, and Average speed) compared to the SVV<3° group (p<0.05). In the tandem stance, only the Ellipse Surface value was significantly larger among the COP parameters in the group with SVV≥3° compared to the group with SVV<3°(p<0.05). In contrast, the other COP parameters were not significantly different (p>0.05). The effects of static balance control on the head orientation were not statistically significant (p>0.05), and the interactions between the subjective vertical perception and head orientation were not significant (p>0.05). Conclusion These results suggest that pathological deviations in SVV are associated with impaired static balance performance. This study can provide a therapeutic rationale for using visuospatial cognitive feedback training to improve the static balance.

PURPOSE: Gait variability is defined as the intrinsic fluctuations which occur during continuous gait cycles. Increased gait variability is closely associated with increased fall risk in older adults. This study investigated the influence of attention-demanding tasks on gait variability in elderly healthy adults. METHODS: We recruited 15 healthy elderly adults in this study. All participants performed two cognitive tasks: a subtraction dual-task (SDT) and working memory dual-task (WMDT) during gait plus one normal gait. Using the LEGSys+ system, we measured the coefficient of variation (CV %=100×[standard deviation/mean]) for participants' stride time, stride length, and stride velocity. RESULTS: SDT gait showed significant increment of stride time variability compared with usual gait (p < 0.05), however, stride length and velocity variability did not difference between SDT gait and usual gait (p>0.05). WMDT gait showed significant increment of stride time and velocity variability compared with usual gait (p < 0.05). In addition, stride time variability during WMDT gait also significantly increased compared with SDT gait (p < 0.05). CONCLUSION: We reported that SDT and WMDT gait can induce the increment of the gait variability in elderly adults. We assume that attention demanding task based on working memory has the most influence on the interference between cognitive and gait function. Understanding the changes during dual task gait in older ages would be helpful for physical intervention strategies and improved risk assessment.
Adult* ; Aged* ; Aging ; Gait* ; Humans ; Memory, Short-Term ; Risk Assessment

Purpose: Traumatic brain injury (TBI) refers to brain damage caused by external forces or trauma. TBIs can vary in severity and result from accidents, falls, sports injuries, assaults, or other forms of physical trauma. The prefrontal cortex (PFC) is known have roles in various cognitive functions. We report on a patient with traumatic brain injury who showed prefrontal symptoms after injury of thalamocortical connections between mediodorsal nuclei (MD) of thalamus and PFC. Methods: A 54-year-old, male patient suffered a TBI as a result of a heavy object falling on his head. After onset of TBI, he showed typical symptoms of prefrontal lobe injury, including personality changes, memory impairment, and general cognition problem. The thalamocortical connections between MD and PFC (ventrolateral prefrontal cortex (VLPFC), dorsolateral prefrontal cortex (DLPFC), and obrbitofrontal cortex (OFC)) were reconstructed using diffusion tensor tractography. In terms of fractional anisotropy value, the right thalamocortical connections to the OFC were significantly lower than those of control subjects. Results: The value of mean diffusivity in the right thalamocortical connections to the DLPFC was significantly higher than that of control subjects. By contrast, both VLPFC and left OFC showed significant decrement in the tract volume of thalamocortical connections compared with that of control subjects. Conclusion We reported on a patient who showed cognitive and neuropsychiatric impairment due to global injury of the thalamocoritcal connections between MD and PFC following TBI.

Purpose: The stroke patients have gait dysfunction due to impaired neural tracts; corticospinal tract (CST), corticoreticular pathway (CRP), and vestibulospinal tract (VST). In this study, we investigated characteristics of gait pattern according to the injury aspect of the neural track in a stroke patient. Methods: One patient and six control subjects of similar age participated. A 19-year-old male patient with spontaneous intracerebral hemorrhage on right basal ganglia, thalamus, corona radiata and cerebral cortex due to arteriovenous malformation rupture. Diffusion tensor imaging (DTI) data was acquired 21 months after the stroke. Kinematic and spatio-temporal parameters of gait were collected using a three-dimensional gait analysis system. Results: On 21 months DTI, the CST and CRP in affected hemisphere showed severe injury, in contrast, the VST in affected hemisphere showed intact integrity. Result of gait analysis, walking distance and speed were significantly decreased in a patient. The stance rate of unaffected lower limb, the swing rate of affected lower limb and the duration of double stance significantly increased compared with normal control. The knee and hip joint angle were significantly decreased in a patient. Conclusion We found recovered independent gait ability may be associated with unimpaired VST in a patient with severe injury in CST and CRP.

PURPOSE: The elucidation of thalamocortical connections between the mediodorsal nucleus (MD) of thalamus and the prefrontal cortex (PFC) is important in the clinical fields of neurorehabilitation and psychiatry. However, little is known about these connections in human brain. We attempted to identify and investigate the anatomical characteristics of the thalamocortical connection between MD and PFC in human brain using diffusion tensor tractography (DTT). MATERIALS AND METHODS: Thirty-two healthy volunteers were recruited for this study. Diffusion tensor images were scanned using a 1.5-T. A seed region of interest was placed at the MD of the thalamus on coronal images, and target regions of interest were placed on the dorsolateral prefrontal cortex (DLPFC), the ventrolateral prefrontal cortex (VLPFC), and the orbitofrontal cortex (OFC), respectively. The three thalamocortical connections found were reconstructed using Functional Magnetic Resonance Imaging of the Brain (FMRIB) software. RESULTS: The three thalamocortical connections were arranged in subcortical white matter in the following order from upper to lower levels: the DLPFC, the VLPFC, and the OFC. In terms of fractional anisotropy and mean diffusivity values, no significant differences were observed between the DLPFC, VLPFC and OFC (p>0.05). In contrast, the OFC tract volume was higher than those of the DLPFC and the VLPFC (p<0.05). CONCLUSION: Three thalamocortical connections were reconstructed between MD and PFCs in human brain using DTT. We believe that the results of this study would be helpful to clinicians in treating frontal network syndrome and psychiatric diseases.
Adult ; Brain/*anatomy & histology ; Diffusion Tensor Imaging/*methods ; Female ; Healthy Volunteers ; Humans ; Male ; Mediodorsal Thalamic Nucleus/*anatomy & histology ; Middle Aged ; Prefrontal Cortex/*anatomy & histology ; Thalamus/*anatomy & histology ; Young Adult

PURPOSE: The prefrontal lobe, supplementary motor area, cerebellum, and basal ganglia are activated during gait. In addition, gait is controlled by nerves, such as the corticospinal tract (CST) and corticoreticular pathway (CRP). In this study, the presence of an injury to the CST and CRP was identified by diffusion tensor imaging and the characteristics of the gait pattern were investigated according to inferior cerebral artery infarction. METHODS: One patient and six control subjects of a similar age participated. A 69-year-old female patient had an injury to the left basal ganglia, insular gyrus, corona radiata, dorsolateral prefrontal cortex, and postcentral gyrus due to an inferior cerebral artery infarction. Diffusion tensor imaging (DTI) data was acquired 4 weeks after the stroke. The kinematic and spatio-temporal parameters of gait were collected using a three-dimensional gait analysis system. RESULTS: On 4 weeks DTI, the CST and CRP in the affected hemisphere did not show injury to the affected and unaffected hemisphere. Gait analysis showed that the cadence of spatio-temporal parameter was decreased significantly in the patient. The angle of the knee joint was decreased significantly in the affected and unaffected sides compared to the control group. CONCLUSION: The results of diffusion tensor imaging showed that although the patient was evaluated to be capable of an independent gait, the quality and quantity of gait might be reduced. This study could help better understand the gait ability analysis of stroke patients and the abnormal gait pattern of patients with a brain injury.
Aged ; Basal Ganglia ; Brain Injuries ; Cerebellum ; Cerebral Arteries ; Diffusion Tensor Imaging ; Female ; Gait* ; Humans ; Infarction ; Knee Joint ; Motor Cortex ; Prefrontal Cortex ; Pyramidal Tracts* ; Somatosensory Cortex ; Stroke*

Purpose: Pneumoconiosis is a chronic lung disease in which the lungs become hardened due to the accumulation of fine mineral dust that has been breathed in at industrial sites. The lungs are unable to function properly, resulting in complications of several respiratory diseases. Methods: The subjects were 36 elderly adults (pneumoconiosis patients 18, healthy elderly 18) over the age of 65 years. The respiratory function was assessed using a spirometer to measure forced vital capacity (FVC), first second of forced expiration (FEV1), FEV1/FVC, and peak expiratory flow n(PEF). The static balance function test was determined by the center of mass (COM), ankle angle range, hip angle range, sway parameters, and reciprocal compensatory index (RCI). Cognitive function was measured by applying MoCA-k. Results: Comparison of respiration functions between the two groups showed statistically significant differences in FVC, FEV1, FEV1/FVC, and PEFs (p< 0.05). Cognitive abilities showed statistically significant differences due to higher cognitive skills in the control group as compared to the patient group (p< 0.05). Most results of the static balance capability measurements showed statistically significant differences between the groups (p< 0.05). However, no statistically significant differences were obtained for COM AP Range, Angle AP Range, RCI ML Range, and AP Range (p> 0.05). Conclusion The results of the current study indicate that patients suffering from pneumoconiosis have less cognitive ability and balance function as compared to healthy elderly people. Therefore, we expect an improvement in the balance ability and cognitive function through systematic management and strengthening lung function training to improve the quality of life of pneumoconiosis patients.

Purpose: The purpose of this study was to determine whether the degree of dizziness affects static balance due to the disruption or absence of the senses involved in balance. To this end, the correlation between the Dizziness Handicap Inventory (DHI), which objectively evaluates dizziness, the Fourier Index (FI; Frequency bands of postural oscillation, F1, F2-4, F5-6, F7-8) and the Stability Index (ST), which evaluates static balance ability, were examined. Methods: This study investigated balance and dizziness issues in 30 healthy young adults. Participants underwent multiple tests like the DHI and tetra-ataxiometric posturography (Tetrax) under different conditions (eyes open/closed, standing on a foam-rubber pillow, and with the head in various orientations). Results: We found that F1 exhibited a weak positive correlation with dizziness under normal conditions, as well as when the eyes were closed (r= 0.396, p< 0.05) and the head was tilted back (r= 0.375, p< 0.05). Meanwhile, F5-6 showed a moderate positive correlation with dizziness in both head-back (HB: r= 0.471, p< 0.05) and head-forward postures (r= 0.404, p< 0.05). Lastly, both F7-8 and ST demonstrated a moderate positive correlation with dizziness when the head was in a forward posture (F7-8: r= 0.483; ST: r= 0.403, p< 0.05). Conclusion The study results indicate that the severity of dizziness affects sensory systems and balance. It also suggests that head movements, especially forward and backward, further stimulate the vestibular system, intensifying dizziness, and balance problems in affected individuals.

Purpose: This study investigated the influence of attention-demanding tasks on gait and measured differences in the temporal, spatial and kinematic characteristics between young healthy adults and elderly healthy adults. Methods: We recruited 16 healthy young adults and 15 healthy elderly adults in this study. All participants performed two cognitive tasks:a subtraction dual-task (SDT) and working memory dual-task (WMDT) during gait plus one normal gait. Using the LEGSys+ system, knee and hip-joint kinematic data during stance and swing phase and spatiotemporal parameter data were assessed in this study. Results: In the elderly adult group, attention-demanding tasks with gait showed a significant decrease in hip-joint motion during the stance phase, compared to the normal gait. Step length, stride length and stride velocity of the elderly adult group were significantly decreased in WMDT gait compared to normal gait (p< 0.05). In the young adult group, kinematic data did not show any significant difference. However, stride velocity and cadence during SDT and WMDT gaits were significantly decreased compared to those of normal gait (p < 0.05). Conclusion We determined that attention-demanding tasks during gait in elderly adults can induce decreased hip-joint motion during stance phase and decreased gait speed and stride length to maintain balance and prevent risk of falling. We believe that understanding the changes during gait in older ages, particularly during attention-demanding tasks, would be helpful for intervention strategies and improved risk assessment.

Objectives: The nigrostriatal tract (NST) connect from the substantia nigra pars compacta to the striatum. A few previous studies have reported on the NST in the Parkinson’s disease using a proboblistic tractography method. However, no study has been conducted for identification of the NST using streamline DTT technique. In the current study, we used streamline DTI technique to investigate the reconstruction method and characteristics of the NST in normal subjects. Methods: Eleven healthy subjects were recruited in this study. The NST from the substantia nigra of the midbrain and the striatum of basal ganglia was reconstructed using DTI data. Fractional anisotropy, apparent diffusion coefficient (ADC) values and fiber numbers of the NST were measured. Results: In all subjects, the NST between the substantia nigra of the midbrain and the striatum. Mean values for FA, ADC, and tract volume were 0.460, 0.818, and 154.3 in the right NST, and 0.485, 0.818, and 176.3 in the left NST respectively. Conclusions we reconstructed the NRT from the substantia nigra of the midbrain and the striatum of the basal ganglia using streamline tractography method. We believe that the findings and the proposed streamline reconstruction method of this study would be useful in future researches on the NST of the human brain.