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

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.

Study Overview

• Status: Completed
• Conditions: Balance; Cerebellum
• Intervention / Treatment: Behavioral: Balance and Proprioceptive Training

Detailed Description

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.

• Study Type: Interventional
• Enrollment (Actual): 22
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Korea, Republic of
  • Yeongdeungpo-gu
    • Seoul, Yeongdeungpo-gu, Korea, Republic of, 07345
      • Yeouido St. Mary's Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 20 years to 74 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

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

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Basic Science
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

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

What is the study measuring?

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 interestCorticospinal tract (CST)Cortico-ponto-cerebellar tract (CPCT)Dentato-rubro-thalamo-cortical tract (DRTCT)Dorsal spinocerebellar tract (DSCT); Measurement of DTI-derived parameterFractional anisotropy (FA) values of the CST, CPCT, DRTCT, and DSCT; Units and scoring of the MeasurementFANo unit.The measurement ranges from 0 to 1Higher scores indicate better microstructural integrity.	Four weeks
Community Balance & Mobility Scale	Performance measure before and after balance and proprioceptive training; Measurement13 domainUnilateral 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 MeasurementNo units.The measurement ranges from 0 to 96Higher 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 interestCSTCPCTDRTCTDSCT; Measurement of DTI-derived parameterMean Diffusivity (MD) values of the CST, CPCT, DRTCT, and DSCT; Units and scoring of the MeasurementMDmm^2/secondThere 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 interestCSTCPCTDRTCTDSCT; Measurement of DTI-derived parameterTract volume (TV) values of the CST, CPCT, DRTCT, and DSCT; Units and scoring of the MeasurementTVmm^3There is no limit on the range.Higher scores indicate better microstructural integrity.	Four weeks

Collaborators and Investigators

• Sponsor: The Catholic University of Korea
• Investigators: Principal Investigator: Youngkook Kim, Ph.D., Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea

Publications and helpful links

General Publications

• Kim JS, Kim SH, Lim SH, Im S, Hong BY, Oh J, Kim Y. Degeneration of the Inferior Cerebellar Peduncle After Middle Cerebral Artery Stroke: Another Perspective on Crossed Cerebellar Diaschisis. Stroke. 2019 Oct;50(10):2700-2707. doi: 10.1161/STROKEAHA.119.025723. Epub 2019 Aug 26.
• Kim Y, Kim SH, Kim JS, Hong BY. Modification of Cerebellar Afferent Pathway in the Subacute Phase of Stroke. J Stroke Cerebrovasc Dis. 2018 Sep;27(9):2445-2452. doi: 10.1016/j.jstrokecerebrovasdis.2018.04.039. Epub 2018 May 22.
• Kim Y, Im S, Kim SH, Park GY. Laterality of cerebellar afferent and efferent pathways in a healthy right-handed population: A diffusion tensor imaging study. J Neurosci Res. 2019 May;97(5):582-596. doi: 10.1002/jnr.24378. Epub 2018 Dec 24.

Study record dates

Study Major Dates

• Study Start (Actual): May 24, 2021
• Primary Completion (Actual): October 30, 2021
• Study Completion (Actual): December 31, 2021

Study Registration Dates

• First Submitted: June 7, 2021
• First Submitted That Met QC Criteria: June 18, 2021
• First Posted (Actual): June 22, 2021

Study Record Updates

• Last Update Posted (Actual): June 13, 2022
• Last Update Submitted That Met QC Criteria: June 9, 2022
• Last Verified: June 1, 2022

More Information

Terms related to this study

• Keywords: Balance; Diffusion Tensor Imaging; Cerebellum; White matter tract
• Other Study ID Numbers: SC20FISI0152

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: No

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No