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: 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: 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 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*

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.

Purpose: This study aimed to examine the effects of forward head posture on the flexion-relaxation ratio (FRR) and muscle activity during sustained neck flexion and to investigate the correlation between craniovertebral angle and FRR. Methods: Nineteen subjects participated in this study and were allocated to a forward head posture (FHP) group or a non-forward head posture (NFHP) group. Craniovertebral angle (CVA) and FRR were measured in all subjects, and all participants performed a standardized cervical flexion-extension movement in two phases: Phase I, sustained cervical full flexion for 5s; and Phase II, cervical extension with the return to the starting position for 5s. The value of CVA has calculated three times, and the value of FRR was measured three times in order to obtain the mean value. Results: FRR values in the FHP and NFHP group were significantly different (p<0.05). Phase I was significantly different, but the Phase II was not significantly different between the FHP and NFHP group (p>0.05). There was a significant correlation between the muscle activity of Phase I and CVA (p<0.05). However, FRR and the muscle activity of the Phase II were not a significant correlation with the CVA (p>0.05). Conclusion FHP increases the muscle activity of the cervical erector spinae during sustained neck flexion and reduces FRR, which can cause fatigue in the cervical erector spinae. In addition, for those with a smaller CVA, muscle activity of the cervical erector spinae is increased during sustained neck flexion, which can increase neck muscle tension.

Purpose: The subjective visual vertical (SVV) test is used to evaluate the otolith function in the inner ear. This study compared the different balance ability according to the results of the SVV in healthy adults. Methods: This study recruited 30 normal healthy subjects who did not have neurological and musculoskeletal disorders. The subjects were divided into experimental and control groups based on the results of SVV: experimental group, >2°; control group, <2°. The static balance ability was evaluated using the Fourier Index, which could evaluate the balance capacity objectively and quantitatively. Results: The mean angle of the SVV in the experimental and control groups was 4.44° and 0.59°, respectively. In the result of the Fourier series, the F1 frequency band in the experimental group showed a significantly higher value under one condition compared to the control group (p<0.05). In the F2-4 and F5-6 frequency bands, the experimental group showed a significant increase in the Fourier series value under the four conditions compared to the control group (p<0.05). In the F7-8 frequency band, significantly higher values of the Fourier series were observed in the experimental group under the three different conditions (p<0.05). Conclusion These results showed increased trunk sway while maintaining static balance in the experimental group who showed a larger SVV angle compared to the control group. The SVV can be applied to evaluate the vestibular system and balance ability in normal adults.

Purpose: This study was to investigate the effect of dorsal neck muscle fatigue on the cervical range of motion (CROM) and proprioception in adults with the forward head posture (FHP). Methods: Thirty pain-free subjects were enrolled in this study. All subjects were measured the forward head angle by taking the capture of the sagittal plane of their upper body to determine the FHP. Subjects were distributed into two groups: the FHP group (n=14) and Control group (n=16). All subjects were measured the CROM and the Head repositioning accuracy (HRA) for joint proprioception before and after inducing muscle fatigue of the dorsal neck. The CROM and HRA were measured in neck flexion, extension, right-left lateral flexion, and right-left rotation. Sorenson’s test was used to induce muscle fatigue of the dorsal neck. Results: Total CROMs were significantly decreased after dorsal neck muscle fatigue in both groups (p<0.05). Total HRAs were significantly increased after dorsal neck muscle fatigue in the FHP group (p<0.05), but there were no significant differences in the control group (p>0.05). Total CROM changes were not significant differences between groups (p>0.05), but total HRA changes were significant differences between groups (p<0.05) except for right and left lateral flexion (p>0.05). Conclusion Immediate CROM and proprioception reduction after the dorsal neck muscle fatigue were observed in adults with the FHP. Therefore, FHP can significantly affect the CROM and positioning consistency of cervical proprioception.