Functional Connectivity Density and Balance in Young Patients with Traumatic Axonal Injury

Our previous study provided some evidence for the relationship between abnormal structural connectivity and poor balance performance in young traumatic axonal injury (TAI) patients. An enhanced understanding of the functional connectivity following TAI may allow targeted treatments geared toward improving brain function and postural control. Twelve patients with TAI and 28 normally developing children (aged 9-19 years) performed the sensory organization test (SOT) protocol of the EquiTest (Neurocom). All participants were scanned using resting-state functional magnetic resonance imaging series along with anatomical scans. We applied "functional connectivity density mapping'' (FCDM), a voxel-wise data-driven method that calculates individual functional connectivity maps to obtain both short-range and long-range FCD. Findings revealed that the TAI group scored generally lower than the control group on the SOT, especially when proprioceptive feedback was compromised. Between-group maps noted significantly decreased long-range FCD in the TAI group in frontal and subcortical regions and significantly increased short-range FCD in frontal regions, left inferior parietal, and cerebellar lobules. Moreover, lower balance levels in TAI patients were associated with a lower long-range FCD in left putamen and cerebellar vermis. These findings suggest that long-range connections may be more vulnerable to TAI than short-range connections. Moreover, higher values of short-range FCD may suggest adaptive mechanisms in the TAI group. Finally, this study supports the view that FCDM is a valuable tool for selectively predicting functional motor deficits in TAI patients.