Association Between Balance and the Integrity of Cerebellar White Matter Tracts in a Healthy Population

Study Overview
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Brief Summary
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The cerebellum is involved in regulating balance and walking and plays a crucial role in the locomotor adaptation and learning processes. This study aims to investigate the association between balance and the integrity of the cerebellar white matter tracts in a healthy population. Healthy participants will undergo four weeks of balance training. The investigators will analyze changes in the microstructural integrity of the cerebellar white matter tract before and after four weeks of balance training.

Detailed Description
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The cerebellum is involved in regulating balance and walking and plays a crucial role in the locomotor adaptation and learning processes. The cerebellum's intermediate zone, which receives afferent stimuli from the sensorimotor cortex (via the cortico-ponto-cerebellar tract) and peripheral muscles (via the dorsal spinocerebellar tract), contributes to maintaining body posture and regulating walking. Proprioceptive information from the peripheral muscles passes through the dorsal spinocerebellar tract, enters the ipsilateral cerebellar hemisphere via the inferior cerebellar peduncle, and finally projects to the contralateral motor cortex through the cerebello-thalamo-cortical pathways. Diffusion tensor imaging (DTI) enables microstructural evaluation of the white matter tracts. Both diffusion tensor tractography, to determine the structural connectivity of the whole tract, and DTI-derived parameters, to determine the microstructural organization, can represent the integrity of the cerebellar white matter tracts. The investigators will evaluate the motor-related white matter tracts, including the corticospinal tract, the cortico-ponto-cerebellar tract, the dorsal spinocerebellar tract, and the dentato-rubro-thalamo-cortical tract. Healthy participants will perform the four weeks of balance training, and DTI will be acquired before and after exercise. The investigators will analyze the DTI-derived parameters of the relevant white matter tracts and analyze the longitudinal changes. The investigators hypothesized that the four weeks of balance training would enhance the integrity of the cerebellar white matter tracts.

Official Title
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Association Between Balance and the Integrity of Cerebellar White Matter Tracts in a Healthy Population

Conditions
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Balance, Cerebellum

Intervention / Treatment
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* Behavioral: Balance and Proprioceptive Training


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Mini-mental state examination >=26 Independent outdoor ambulator Exclusion Criteria: Men/women with any metal implants in their body A prior history of psychopathology or a neurological disorders A prior history of osteoporosis, advanced osteoarthritis (K-L grade >=3), surgical history of hip or knee arthroplasty If any structural abnormalities are detected on their scan

Ages Eligible for Study
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Minimum Age: 20 Years
Maximum Age: 74 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Basic Science
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Balance training<br>A single training group | Behavioral: Balance and Proprioceptive Training<br>* Step-by-step training (5 levels) 30 minute per training 3 times per week Four weeks<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Fractional anisotropy of the cerebellar white matter tracts | Measurement of the change of DTI-derived parameters before and after balance and proprioceptive training Tracts of interest Corticospinal tract (CST) Cortico-ponto-cerebellar tract (CPCT) Dentato-rubro-thalamo-cortical tract (DRTCT) Dorsal spinocerebellar tract (DSCT) Measurement of DTI-derived parameter Fractional anisotropy (FA) values of the CST, CPCT, DRTCT, and DSCT Units and scoring of the Measurement FA No unit. The measurement ranges from 0 to 1 Higher scores indicate better microstructural integrity. | Four weeks | 
| Community Balance & Mobility Scale | Performance measure before and after balance and proprioceptive training Measurement 13 domain Unilateral stance, Tandem walking, 180° tandem pivot, Lateral foot scooting, Hopping forward, Crouch and walk, Lateral dodging, Walking & looking, Running with controlled stop, Forward to backward walking, Walk look and carry, Descending stairs, Step-ups x 1 step Scoring of the Measurement No units. The measurement ranges from 0 to 96 Higher scores indicate better postural balance and mobility. | Four weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Mean diffusivity of the cerebellar white matter tracts | Measurement of the change of DTI-derived parameters before and after balance and proprioceptive training Tracts of interest CST CPCT DRTCT DSCT Measurement of DTI-derived parameter Mean Diffusivity (MD) values of the CST, CPCT, DRTCT, and DSCT Units and scoring of the Measurement MD mm^2/second There is no limit on the range (usually ranges 0.00005 - 0.0001 mm^2/second). Higher scores indicate worse microstructural integrity. | Four weeks | 
| Tract volume of the cerebellar white matter tracts | Measurement of the change of DTI-derived parameters before and after balance and proprioceptive training Tracts of interest CST CPCT DRTCT DSCT Measurement of DTI-derived parameter Tract volume (TV) values of the CST, CPCT, DRTCT, and DSCT Units and scoring of the Measurement TV mm^3 There is no limit on the range. Higher scores indicate better microstructural integrity. | Four weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Cerebellum, White matter tract, Diffusion Tensor Imaging, Balance