{
  "abstract": "BackgroundBalance control is essential for independence in activities of daily living, and its impairment is a leading contributor to falls in stroke survivors. Stroke-induced brain reorganization alters cortical activation patterns; however, localized changes do not reveal the underlying network dynamics critical for the exchange of task-related information. How stroke affects balance-related cortical network dynamics remains unclear.\n\nMethodsWe studied cortical functional connectivity during a challenging balance task in fifteen chronic stroke survivors and fifteen age- and gender-matched healthy adults. Whole-head electroencephalography (EEG) was recorded while participants performed a balance sway-referenced task. Balance-related cortical sources were localized to the supplementary motor area/premotor area (SMA-PM), posterior cingulate cortex (PCC), and bilateral lateral prefrontal cortex (LPFC). Directed task-related functional connectivity was estimated across multiple frequency bands.\n\nResultsStroke participants demonstrated elevated gamma-band SMA-PM to PCC connectivity, ipsilesional LPFC to SMA-PM connectivity, and SMA-PM to contralesional LPFC connectivity compared to healthy participants. Stroke participants also showed poorer performance on both the clinical Berg Balance Scale (BBS) and the laboratory-based balance task. Stronger SMA-PM to contralesional LPFC connectivity, but not SMA-PM to PCC connectivity, was associated with better BBS scores in stroke survivors.\n\nConclusionsThese findings suggest less reliable SMA-PM to PCC sensorimotor pathways and a compensatory recruitment of SMA-PM to contralesional LPFC pathway for the control of balance post-stroke. Cortical network reorganization after stroke leads to directional connectivity changes adaptive to functional needs, with implications for designing targeted interventions to reduce fall risk in stroke survivors.",
  "abstract_shown": true,
  "affiliations": [
    "University of Houston"
  ],
  "article_type": "PUBLISHAHEADOFPRINT",
  "arxiv": null,
  "author_total": 5,
  "authors": [
    {
      "name": "K. K. Kukkar"
    },
    {
      "name": "T. M. Pham"
    },
    {
      "name": "H. A. Mirza"
    },
    {
      "name": "S. Li"
    },
    {
      "affs": [
        0
      ],
      "name": "P. J. Parikh"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/avav9vf3sb1ed.bib",
  "cited_by": 0,
  "doi": "10.64898/2026.09.08.26362085",
  "fulltext_url": "https://www.medrxiv.org/content/10.64898/2026.09.08.26362085v1.full",
  "id": "avav9vf3sb1ed",
  "issns": [],
  "landing_url": "https://www.medrxiv.org/content/10.64898/2026.09.08.26362085v1",
  "language": null,
  "licence": "CC-BY-NC-ND",
  "licence_label": "CC BY-NC-ND",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "medrxiv",
      "neurology"
    ],
    [
      "openalex",
      "2742|Stroke Rehabilitation and Recovery"
    ]
  ],
  "openalex": "W7212397610",
  "pdf_url": "https://www.medrxiv.org/content/10.64898/2026.09.08.26362085v1.full.pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-09-08",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/avav9vf3sb1ed.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:18:23Z",
      "native_id": "10.64898/2026.09.08.26362085",
      "source": "medrxiv",
      "url": "https://www.medrxiv.org/content/10.64898/2026.09.08.26362085v1"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "medrxiv:neurology",
      "subfield": "neurology"
    }
  ],
  "title": "Cortical Network Reorganization During Balance Control in Chronic Stroke: Premotor-Parietal Behavioral Uncoupling and Directional Prefrontal Compensation.",
  "title_text": "Cortical Network Reorganization During Balance Control in Chronic Stroke: Premotor-Parietal Behavioral Uncoupling and Directional Prefrontal Compensation.",
  "type": "preprint",
  "updated_at": "2026-10-30T12:18:23Z",
  "url": "https://research.draconitic.com/paper/avav9vf3sb1ed",
  "venue": "medRxiv",
  "versions": []
}