Balance and the brain: A review of structural brain correlates of postural balance and balance training in humans.
Olivia J Surgent, Olga I Dadalko, Kristen A Pickett and 1 others
PMID 31082657WHAT IT FOUND
Balance was linked most often to cerebellar, basal ganglia, thalamus, hippocampal, and inferior parietal brain regions, but scan changes after training were inconsistent and did not prove a treatment works.
Key findings
01Across 37 studies, 234 findings in 71 brain structures were evaluated, and the brainstem/cerebellar region had the most findings: 79 significant findings from 22 studies.
02Cerebellar gray matter accounted for 58% of brainstem/cerebellar findings, and the direction of the association varied: larger cerebellar gray matter volume was generally associated with better balance across clinical populations, but individuals with ADHD showed an opposite pattern.
03Training-related brain changes were inconsistent: cerebellar volume change direction varied by population, hippocampal volume fluctuated during training, and the direction of gray matter change correlated with balance improvement varied across studies.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
This is a review of structural MRI studies, not a randomized trial of balance training, so it cannot show that a treatment improves balance. The included studies varied in sample size, age, scanner strength, imaging method, and balance measure, so the findings were not directly comparable. Some studies only looked at pre-specified brain regions, so a region may appear important because it was the region the researchers chose to examine. The direction of brain changes associated with balance training was inconsistent across populations and time points, so no single training-related brain change was reliable. The review excluded functional imaging, so it cannot say how these brain regions behave during balance tasks. The literature was not robust enough to identify brain-balance relationships unique to specific clinical populations.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not read this as proof that balance training changes the brain in a clinically useful way. The review reports brain scan associations and inconsistent directions of change across studies, so it does not show that any treatment improves balance.