A scoping review of 61 neuroimaging studies demonstrated that reactive balance relies on a distributed cortico-subcortical network, with aging and pathology heightening cortical activation.
What are the cortical and subcortical mechanisms underlying reactive balance and how are they altered by aging and pathology?
Reactive balance relies on a distributed cortico-subcortical network, and increased cortical activation in aging and neurological conditions suggests reduced automaticity and greater reliance on compensatory control.
Background/Objectives: Rapid postural reactions are critical for preventing falls, yet the neural systems supporting these responses are not fully understood, particularly with respect to aging and neurological disorders. Understanding how the brain detects, interprets, and responds to balance disturbances is essential for developing new interventions. This scoping review aimed to synthesize evidence from neuroimaging studies to identify the cortical and subcortical mechanisms underlying reactive balance and to characterize how these mechanisms are altered by aging and pathology. Methods: A structured search of EMBASE, PubMed, and CINAHL (7 November 2024) identified studies examining neural activity during experimentally induced balance perturbations. Sixty-one studies met inclusion criteria (EEG n = 45; MRI n = 9; fNIRS n = 8; PET n = 1) and were analyzed for patterns of regional activation and age- or disease-related differences. Results: Evidence converges on a distributed network supporting reactive balance. Sensorimotor, premotor, supplementary motor, and prefrontal cortices show consistent involvement, while cerebellar, brainstem, and basal ganglia structures contribute to rapid, automatic responses. Aging and neurological conditions commonly heighten cortical activation, suggesting reduced automaticity and increased reliance on compensatory control. Conclusions: Reactive balance emerges from coordinated activity across cortico-subcortical systems that are altered by aging and pathology. Further research incorporating multimodal imaging approaches and more ecologically realistic perturbation paradigms is needed to clarify mechanistic pathways and inform precision-based fall-prevention strategies.
Monaghan et al. (Sat,) conducted a review in Reactive balance control (n=61). Neuroimaging (EEG, MRI, fNIRS, PET) was evaluated on Patterns of regional activation and age- or disease-related differences. A scoping review of 61 neuroimaging studies demonstrated that reactive balance relies on a distributed cortico-subcortical network, with aging and pathology heightening cortical activation.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: