Cortical Network Reorganization During Balance Control in Chronic Stroke: Premotor-Parietal Behavioral Uncoupling and Directional Prefrontal Compensation.
- 1University of Houston
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.
MethodsWe 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.
ResultsStroke 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.
ConclusionsThese 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.
Related
- Normal aging limits cortical network reorganization and behavioral recovery after experimental stroke
- Selective behavioral and prefrontal transcriptomic correlates of acute clozapine exposure in socially isolated mice
- Maternal Immune Activation by Lipopolysaccharide Reduced Parvalbumin Levels and Increased Perineuronal Nets in the Prefrontal Cortex Without Inducing Schizophrenia-like Behavioral Deficits in PV-Cre Long-Evans Rats
- Repeated prefrontal transcranial direct current stimulation improves behavioral regulation and modulates resting-state EEG microstate dynamics in young adults with problematic smartphone use: a randomized sham-controlled longitudinal study
- The Role of Uncoupling Protein 2 in Renal Adaptation to Hypertension: Mechanistic Insights
BibTeX
@misc{kukkar2026cortical,
title = {{Cortical Network Reorganization During Balance Control in Chronic Stroke: Premotor-Parietal Behavioral Uncoupling and Directional Prefrontal Compensation.}},
author = {K. K. Kukkar and T. M. Pham and H. A. Mirza and S. Li and P. J. Parikh},
howpublished = {medRxiv},
year = {2026},
month = sep,
doi = {10.64898/2026.09.08.26362085},
url = {https://www.medrxiv.org/content/10.64898/2026.09.08.26362085v1},
note = {CC BY-NC-ND},
}
RIS
TY - UNPB
TI - Cortical Network Reorganization During Balance Control in Chronic Stroke: Premotor-Parietal Behavioral Uncoupling and Directional Prefrontal Compensation.
AU - K. K. Kukkar
AU - T. M. Pham
AU - H. A. Mirza
AU - S. Li
AU - P. J. Parikh
PY - 2026
DA - 2026/09/08
PB - medRxiv
DO - 10.64898/2026.09.08.26362085
UR - https://www.medrxiv.org/content/10.64898/2026.09.08.26362085v1
AB - 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. MethodsWe 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. ResultsStroke 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. ConclusionsThese 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.
ER -