ADÖLESAN İDİYOPATİK SKOLYOZLU BİREYLERDE Y-DENGE TESTİ SIRASINDA PREFRONTAL OKSİHEMOGLOBİN DEĞİŞİMLERİ

Abstract

Bu çalışmanın amacı, adölesan idiyopatik skolyozlu bireylerde dinamik denge sırasında prefrontal kortekste ortaya çıkan oksijenli hemoglobin yanıtlarını fNIRS ile inceleyerek, postüral kontrolün kompansatuvar kortikal mekanizmalarını ve fNIRS’in fonksiyonel denge değerlendirmesindeki katkısını ortaya koymaktır. Çalışmaya 8–16 yaş aralığında 15 AİS’li ve 15 sağlıklı kontrol olmak üzere toplam 30 gönüllü dahil edilmiştir. Dinamik denge performansı Y-Denge Testi ile değerlendirilmiş, eş zamanlı olarak prefrontal korteks oksihemoglobin (HbO) yanıtları kaydedilmiştir. Y-Denge performansında gruplar arasında istatistiksel olarak anlamlı fark saptanmamış olmakla birlikte, AİS grubunda tüm yönlerde daha düşük performans eğilimi gözlenmiştir. Buna karşılık fNIRS sonuçları, AİS grubunda dorsolateral ve medial prefrontal korteks ile anterior singulat korteks bölgelerinde kontrol grubuna kıyasla belirgin HbO artışlarını ortaya koymuştur. Bu bulgular, AİS’de dinamik postüral kontrolün davranışsal olarak benzer düzeyde sürdürülmesine karşın, daha yüksek kortikal kaynak kullanımı gerektiren kompansatuvar nörokognitif mekanizmalarla sağlandığını göstermektedir. Ayrıca bu çalışma ile, fNIRS’in AİS’de dinamik denge kontrolünün kortikal temellerini ortaya koymada güçlü ve tamamlayıcı bir yöntem olduğu da ortaya konulmuştur.

Keywords

• fNIRS
• Prefrontal korteks
• Y-Denge Testi
• Adölesan idiyopatik skolyoz
• Postüral kontrol.

Supporting Institution

Akdeniz Üniversitesi

Project Number

TSA-2024-6574

Ethical Statement

Akdeniz Üniversitesi Tıp Fakültesi Klinik Araştırmalar Etik Kurulu (Onay No: KAEK-179, 22 Şubat 2023).

PREFRONTAL OXYHEMOGLOBIN CHANGES DURING Y-BALANCE TESTING IN ADOLESCENTS WITH IDIOPATHIC SCOLIOSIS

Abstract

The aim of this study was to investigate oxygenated hemoglobin responses in the prefrontal cortex during dynamic balance in adolescents with idiopathic scoliosis using functional near-infrared spectroscopy (fNIRS), and to elucidate the compensatory cortical mechanisms underlying postural control as well as the contribution of fNIRS to functional balance assessment. A total of 30 volunteers, including 15 adolescents with AIS and 15 healthy controls aged between 8 and 16 years, were enrolled in the study. Dynamic balance performance was evaluated using the Y-Balance Test, while prefrontal oxyhemoglobin (HbO) responses were recorded simultaneously. Although no statistically significant differences were observed between the groups in Y-Balance performance, the AIS group demonstrated a consistent tendency toward lower performance across all directions. In contrast, fNIRS results revealed significantly increased HbO responses in the dorsolateral and medial prefrontal cortex as well as in the anterior cingulate cortex in the AIS group compared with controls. These findings indicate that, despite comparable behavioral performance, dynamic postural control in AIS is maintained through compensatory neurocognitive mechanisms requiring greater cortical resource utilization. Furthermore, this study demonstrates that fNIRS is a powerful and complementary method for revealing the cortical foundations of dynamic balance control in adolescents with idiopathic scoliosis.

Keywords

• fNIRS
• Prefrontal cortex
• Y-Balance Test
• Adolescent idiopathic scoliosis
• Postural control.

Supporting Institution

Akdeniz University

Project Number

TSA-2024-6574

Ethical Statement

Clinical Research Ethics Committee of Akdeniz University Faculty of Medicine (KAEK-179, February 22, 2023).

References

1. References
2. Burwell, R. G., Aujla, R. K., Grevitt, M. P., Dangerfield, P. H., Moulton, A., Randell, T. L., Anderson, S. I. 2009. "Pathogenesis of adolescent idiopathic scoliosis in girls-a double neuro-osseous theory involving disharmony between two nervous systems, somatic and autonomic expressed in the spine and trunk: possible dependency on sympathetic nervous system and hormones with implications for medical therapy". Scoliosis, 4(1), 24.
3. Chaloupka, R., Mikl, M., Nováková, M., Repko, M., Rektor, I. 2022. "Modification of Brain Functional Connectivity in Adolescent Thoracic Idiopathic Scoliosis by Lower Extremities Position". Symmetry, 14(10), 2068.
4. Cobb, W., London, G. B., Gastaut, H., Hess Jr, R., Jung, R., Magnus, O., Terzian, H. 1958. "Report of the committee on methods of clinical examination in electroencephalography". Electroencephalogr. Clin. Neurophysiol, 10(2), 370-375.
5. Delpy, D. T., Cope, M., van der Zee, P., Arridge, S., Wray, S., Wyatt, J. 1988. "Estimation of optical pathlength through tissue from direct time of flight measurement". Physics in Medicine & Biology, 33(12), 1433.
6. Domenech, J., García-Martí, G., Martí-Bonmatí, L., Barrios, C., Tormos, J., Pascual-Leone, A. 2011. "Abnormal activation of the motor cortical network in idiopathic scoliosis demonstrated by functional MRI". European Spine Journal, 20, 1069-1078.
7. Ferrari, M., Quaresima, V. 2012. "A brief review on the history of human functional near-infrared spectroscopy (fNIRS) development and fields of application". Neuroimage, 63(2), 921-935.
8. Formaggio, E., Bertuccelli, M., Rubega, M., Di Marco, R., Cantele, F., Gottardello, F., … Masiero, S. 2022. "Brain oscillatory activity in adolescent idiopathic scoliosis". Scientific Reports, 12(1), 17266.

9. Fortin, C., Pialasse, J.-P., Knoth, I. S., Lippé, S., Duclos, C., Simoneau, M. 2019. "Cortical dynamics of sensorimotor information processing associated with balance control in adolescents with and without idiopathic scoliosis". Clinical Neurophysiology, 130(10), 1752-1761.
10. Gebel, A., Lehmann, T., Granacher, U. 2020. "Balance task difficulty affects postural sway and cortical activity in healthy adolescents". Experimental brain research, 238(5), 1323-1333.
11. Gramigna, V., Pellegrino, G., Cerasa, A., Cutini, S., Vasta, R., Olivadese, G., … Quattrone, A. 2017. "Near-infrared spectroscopy in gait disorders: is it time to begin?". Neurorehabilitation and neural repair, 31(5), 402-412.
12. Herold, F., Wiegel, P., Scholkmann, F., Müller, N. G. 2018. "Applications of functional near-infrared spectroscopy (fNIRS) neuroimaging in exercise–cognition science: a systematic, methodology-focused review". Journal of clinical medicine, 7(12), 466.
13. Herold, F., Wiegel, P., Scholkmann, F., Thiers, A., Hamacher, D., Schega, L. 2017. "Functional near-infrared spectroscopy in movement science: a systematic review on cortical activity in postural and walking tasks". Neurophotonics, 4(4), 041403-041403.
14. Huppert, T. J., Diamond, S. G., Franceschini, M. A., Boas, D. A. 2009. "HomER: a review of time-series analysis methods for near-infrared spectroscopy of the brain". Applied optics, 48(10), D280-D298.
15. Jones, D. T., Graff-Radford, J. 2021. "Executive dysfunction and the prefrontal cortex". CONTINUUM: Lifelong Learning in Neurology, 27(6), 1586-1601.
16. Kleinfeld, D., Blinder, P., Drew, P. J., Driscoll, J. D., Muller, A., Tsai, P. S., Shih, A. Y. 2011. "A guide to delineate the logic of neurovascular signaling in the brain". Frontiers in neuroenergetics, 3, 1.
17. Koch, S. P., Koendgen, S., Bourayou, R., Steinbrink, J., Obrig, H. 2008. "Individual alpha-frequency correlates with amplitude of visual evoked potential and hemodynamic response". Neuroimage, 41(2), 233-242.
18. Krougly, N., Tsikrikis, K., MacRae, F., Pouliopoulou, D. V., Peters, S. 2025. "Linking brain activation to standing balance performance: A systematic review and meta analysis of functional near-infrared spectroscopy literature". Gait & Posture, 120, 124-135.
19. Lanthier, J., Simoneau, M., Knoth, I. S., Lippe, S., Bluteau, C., Fortin, C. 2020. "Increased EEG alpha peak frequency in adolescents with idiopathic scoliosis during balance control in normal upright standing". Neuroscience letters, 722, 134836.
20. Marusic, U., Verghese, J., Mahoney, J. R. 2018. "Cognitive-based interventions to improve mobility: a systematic review and meta-analysis". Journal of the American Medical Directors Association, 19(6), 484-491.
21. Mierau, A., Pester, B., Hülsdünker, T., Schiecke, K., Strüder, H. K., Witte, H. 2017. "Cortical correlates of human balance control". Brain topography, 30, 434-446.
22. Mihara, M., Miyai, I., Hatakenaka, M., Kubota, K., Sakoda, S. 2008. "Role of the prefrontal cortex in human balance control". Neuroimage, 43(2), 329-336.
23. Mihara, M., Miyai, I., Hattori, N., Hatakenaka, M., Yagura, H., Kawano, T., Kubota, K. 2012. "Cortical control of postural balance in patients with hemiplegic stroke". Neuroreport, 23(5), 314-319.
24. Miyai, I., Tanabe, H. C., Sase, I., Eda, H., Oda, I., Konishi, I., … Kubota, K. 2001. "Cortical mapping of gait in humans: a near-infrared spectroscopic topography study". Neuroimage, 14(5), 1186-1192.
25. Negrini, S., Negrini, F., Fusco, C., Zaina, F. 2011. "Idiopathic scoliosis patients with curves more than 45 Cobb degrees refusing surgery can be effectively treated through bracing with curve improvements". The Spine Journal, 11(5), 369-380.
26. Niedermeyer, E., da Silva, F. L. 2005. "Electroencephalography: basic principles, clinical applications, and related fields". Lippincott Williams & Wilkins.
27. Paramento, M., Passarotto, E., Maccarone, M. C., Agostini, M., Contessa, P., Rubega, M., … Masiero, S. 2024. "Neurophysiological, balance and motion evidence in adolescent idiopathic scoliosis: A systematic review". Plos one, 19(5), e0303086.
28. Perrey, S. 2014. "Possibilities for examining the neural control of gait in humans with fNIRS". Frontiers in Physiology, 5, 204.
29. Picelli, A., Negrini, S., Zenorini, A., Iosa, M., Paolucci, S., Smania, N. 2016. "Do adolescents with idiopathic scoliosis have body schema disorders? A cross-sectional study". Journal of back and musculoskeletal rehabilitation, 29(1), 89-96.
30. Piper, S. K., Krueger, A., Koch, S. P., Mehnert, J., Habermehl, C., Steinbrink, J., … Schmitz, C. H. 2014. "A wearable multi-channel fNIRS system for brain imaging in freely moving subjects". Neuroimage, 85, 64-71.
31. Scholkmann, F., Spichtig, S., Muehlemann, T., Wolf, M. 2010. "How to detect and reduce movement artifacts in near-infrared imaging using moving standard deviation and spline interpolation". Physiological measurement, 31(5), 649.
32. Shaffer, S. W., Teyhen, D. S., Lorenson, C. L., Warren, R. L., Koreerat, C. M., Straseske, C. A., Childs, J. D. 2013. "Y-balance test: a reliability study involving multiple raters". Military medicine, 178(11), 1264-1270.
33. Surgent, O. J., Dadalko, O. I., Pickett, K. A., Travers, B. G. 2019. "Balance and the brain: A review of structural brain correlates of postural balance and balance training in humans". Gait & Posture, 71, 245-252.
34. Suzen, E., Tombak, K., Simsek, B., Colak, O. H., Ozen, S. 2025. "Evaluation of Prefrontal Cortex Activation and Static Balance Mechanisms in Adolescent Idiopathic Scoliosis Using fNIRS". Medicina, 61(4), 667.
35. Süzen, E., Özkan, Ö., Özkan, Ö., Çolak, Ö. H., Doğan, E. A., Şimşek, B., … Özen, Ş. 2025. "Determination of Hemodynamic Response Using fNIRS in Lower Extremity Amputee and Replant Patients". International Wound Journal, 22(11), e70792.
36. Takakusaki, K. 2017. "Functional neuroanatomy for posture and gait control". Journal of movement disorders, 10(1), 1.
37. Weiss, H., Negrini, S., Rigo, M., Kotwicki, T., Hawes, M. C., Grivas, T. B., … Landauer, F. 2008. "Indications for conservative management of scoliosis (SOSORT guidelines)". Studies in health technology and informatics, 135, 164.
38. Wu, Y., Dong, Y., Tang, Y., Wang, W., Bo, Y., Zhang, C. 2023. "Relationship between motor performance and cortical activity of older neurological disorder patients with dyskinesia using fNIRS: a systematic review". Frontiers in Physiology, 14, 1153469.
39. Y. Baradaran, R. F. Rojas, R. Goecke, M. Ghahramani. 2023. "A Systematic Review on Functional Near-Infrared Spectroscopy Concurrent With Quantitative Balance Assessment". IEEE Access, 11, 66641-66671.
40. Yang, M., Yang, Z., Yuan, T., Feng, W., Wang, P. 2019. "A systemic review of functional near-infrared spectroscopy for stroke: current application and future directions". Frontiers in neurology, 10, 58.
41. Yeung, N. 2013. "Conflict Monitoring and Cognitive Control". İçinde K. N. Ochsner & S. Kosslyn (Ed.), The Oxford Handbook of Cognitive Neuroscience: Volume 2: The Cutting Edges (s. 0). Oxford University Press.
42. Zimeo Morais, G. A., Balardin, J. B., Sato, J. R. 2018. "fNIRS Optodes’ Location Decider (fOLD): a toolbox for probe arrangement guided by brain regions-of-interest". Scientific reports, 8(1), 3341.
43. Burwell, R. G., Aujla, R. K., Grevitt, M. P., Dangerfield, P. H., Moulton, A., Randell, T. L., Anderson, S. I. 2009. "Pathogenesis of adolescent idiopathic scoliosis in girls-a double neuro-osseous theory involving disharmony between two nervous systems, somatic and autonomic expressed in the spine and trunk: possible dependency on sympathetic nervous system and hormones with implications for medical therapy". Scoliosis, 4(1), 24.
44. Chaloupka, R., Mikl, M., Nováková, M., Repko, M., Rektor, I. 2022. "Modification of Brain Functional Connectivity in Adolescent Thoracic Idiopathic Scoliosis by Lower Extremities Position". Symmetry, 14(10), 2068.
45. Cobb, W., London, G. B., Gastaut, H., Hess Jr, R., Jung, R., Magnus, O., Terzian, H. 1958. "Report of the committee on methods of clinical examination in electroencephalography". Electroencephalogr. Clin. Neurophysiol, 10(2), 370-375.
46. Delpy, D. T., Cope, M., van der Zee, P., Arridge, S., Wray, S., Wyatt, J. 1988. "Estimation of optical pathlength through tissue from direct time of flight measurement". Physics in Medicine & Biology, 33(12), 1433.
47. Domenech, J., García-Martí, G., Martí-Bonmatí, L., Barrios, C., Tormos, J., Pascual-Leone, A. 2011. "Abnormal activation of the motor cortical network in idiopathic scoliosis demonstrated by functional MRI". European Spine Journal, 20, 1069-1078.
48. Ferrari, M., Quaresima, V. 2012. "A brief review on the history of human functional near-infrared spectroscopy (fNIRS) development and fields of application". Neuroimage, 63(2), 921-935.
49. Formaggio, E., Bertuccelli, M., Rubega, M., Di Marco, R., Cantele, F., Gottardello, F., … Masiero, S. 2022. "Brain oscillatory activity in adolescent idiopathic scoliosis". Scientific Reports, 12(1), 17266.
50. Fortin, C., Pialasse, J.-P., Knoth, I. S., Lippé, S., Duclos, C., Simoneau, M. 2019. "Cortical dynamics of sensorimotor information processing associated with balance control in adolescents with and without idiopathic scoliosis". Clinical Neurophysiology, 130(10), 1752-1761.
51. Gebel, A., Lehmann, T., Granacher, U. 2020. "Balance task difficulty affects postural sway and cortical activity in healthy adolescents". Experimental brain research, 238(5), 1323-1333.
52. Gramigna, V., Pellegrino, G., Cerasa, A., Cutini, S., Vasta, R., Olivadese, G., … Quattrone, A. 2017. "Near-infrared spectroscopy in gait disorders: is it time to begin?". Neurorehabilitation and neural repair, 31(5), 402-412.
53. Herold, F., Wiegel, P., Scholkmann, F., Müller, N. G. 2018. "Applications of functional near-infrared spectroscopy (fNIRS) neuroimaging in exercise–cognition science: a systematic, methodology-focused review". Journal of clinical medicine, 7(12), 466.
54. Herold, F., Wiegel, P., Scholkmann, F., Thiers, A., Hamacher, D., Schega, L. 2017. "Functional near-infrared spectroscopy in movement science: a systematic review on cortical activity in postural and walking tasks". Neurophotonics, 4(4), 041403-041403.
55. Huppert, T. J., Diamond, S. G., Franceschini, M. A., Boas, D. A. 2009. "HomER: a review of time-series analysis methods for near-infrared spectroscopy of the brain". Applied optics, 48(10), D280-D298.
56. Jones, D. T., Graff-Radford, J. 2021. "Executive dysfunction and the prefrontal cortex". CONTINUUM: Lifelong Learning in Neurology, 27(6), 1586-1601.
57. Kleinfeld, D., Blinder, P., Drew, P. J., Driscoll, J. D., Muller, A., Tsai, P. S., Shih, A. Y. 2011. "A guide to delineate the logic of neurovascular signaling in the brain". Frontiers in neuroenergetics, 3, 1.
58. Koch, S. P., Koendgen, S., Bourayou, R., Steinbrink, J., Obrig, H. 2008. "Individual alpha-frequency correlates with amplitude of visual evoked potential and hemodynamic response". Neuroimage, 41(2), 233-242.
59. Krougly, N., Tsikrikis, K., MacRae, F., Pouliopoulou, D. V., Peters, S. 2025. "Linking brain activation to standing balance performance: A systematic review and meta analysis of functional near-infrared spectroscopy literature". Gait & Posture, 120, 124-135.
60. Lanthier, J., Simoneau, M., Knoth, I. S., Lippe, S., Bluteau, C., Fortin, C. 2020. "Increased EEG alpha peak frequency in adolescents with idiopathic scoliosis during balance control in normal upright standing". Neuroscience letters, 722, 134836.
61. Marusic, U., Verghese, J., Mahoney, J. R. 2018. "Cognitive-based interventions to improve mobility: a systematic review and meta-analysis". Journal of the American Medical Directors Association, 19(6), 484-491.
62. Mierau, A., Pester, B., Hülsdünker, T., Schiecke, K., Strüder, H. K., Witte, H. 2017. "Cortical correlates of human balance control". Brain topography, 30, 434-446.
63. Mihara, M., Miyai, I., Hatakenaka, M., Kubota, K., Sakoda, S. 2008. "Role of the prefrontal cortex in human balance control". Neuroimage, 43(2), 329-336.
64. Mihara, M., Miyai, I., Hattori, N., Hatakenaka, M., Yagura, H., Kawano, T., Kubota, K. 2012. "Cortical control of postural balance in patients with hemiplegic stroke". Neuroreport, 23(5), 314-319.
65. Miyai, I., Tanabe, H. C., Sase, I., Eda, H., Oda, I., Konishi, I., … Kubota, K. 2001. "Cortical mapping of gait in humans: a near-infrared spectroscopic topography study". Neuroimage, 14(5), 1186-1192.
66. Negrini, S., Negrini, F., Fusco, C., Zaina, F. 2011. "Idiopathic scoliosis patients with curves more than 45 Cobb degrees refusing surgery can be effectively treated through bracing with curve improvements". The Spine Journal, 11(5), 369-380.
67. Niedermeyer, E., da Silva, F. L. 2005. "Electroencephalography: basic principles, clinical applications, and related fields". Lippincott Williams & Wilkins.
68. Paramento, M., Passarotto, E., Maccarone, M. C., Agostini, M., Contessa, P., Rubega, M., … Masiero, S. 2024. "Neurophysiological, balance and motion evidence in adolescent idiopathic scoliosis: A systematic review". Plos one, 19(5), e0303086.
69. Perrey, S. 2014. "Possibilities for examining the neural control of gait in humans with fNIRS". Frontiers in Physiology, 5, 204.
70. Picelli, A., Negrini, S., Zenorini, A., Iosa, M., Paolucci, S., Smania, N. 2016. "Do adolescents with idiopathic scoliosis have body schema disorders? A cross-sectional study". Journal of back and musculoskeletal rehabilitation, 29(1), 89-96.
71. Piper, S. K., Krueger, A., Koch, S. P., Mehnert, J., Habermehl, C., Steinbrink, J., … Schmitz, C. H. 2014. "A wearable multi-channel fNIRS system for brain imaging in freely moving subjects". Neuroimage, 85, 64-71.
72. Scholkmann, F., Spichtig, S., Muehlemann, T., Wolf, M. 2010. "How to detect and reduce movement artifacts in near-infrared imaging using moving standard deviation and spline interpolation". Physiological measurement, 31(5), 649.
73. Shaffer, S. W., Teyhen, D. S., Lorenson, C. L., Warren, R. L., Koreerat, C. M., Straseske, C. A., Childs, J. D. 2013. "Y-balance test: a reliability study involving multiple raters". Military medicine, 178(11), 1264-1270.
74. Surgent, O. J., Dadalko, O. I., Pickett, K. A., Travers, B. G. 2019. "Balance and the brain: A review of structural brain correlates of postural balance and balance training in humans". Gait & Posture, 71, 245-252.
75. Suzen, E., Tombak, K., Simsek, B., Colak, O. H., Ozen, S. 2025. "Evaluation of Prefrontal Cortex Activation and Static Balance Mechanisms in Adolescent Idiopathic Scoliosis Using fNIRS". Medicina, 61(4), 667.
76. Süzen, E., Özkan, Ö., Özkan, Ö., Çolak, Ö. H., Doğan, E. A., Şimşek, B., … Özen, Ş. 2025. "Determination of Hemodynamic Response Using fNIRS in Lower Extremity Amputee and Replant Patients". International Wound Journal, 22(11), e70792.
77. Takakusaki, K. 2017. "Functional neuroanatomy for posture and gait control". Journal of movement disorders, 10(1), 1.
78. Weiss, H., Negrini, S., Rigo, M., Kotwicki, T., Hawes, M. C., Grivas, T. B., … Landauer, F. 2008. "Indications for conservative management of scoliosis (SOSORT guidelines)". Studies in health technology and informatics, 135, 164.
79. Wu, Y., Dong, Y., Tang, Y., Wang, W., Bo, Y., Zhang, C. 2023. "Relationship between motor performance and cortical activity of older neurological disorder patients with dyskinesia using fNIRS: a systematic review". Frontiers in Physiology, 14, 1153469.
80. Y. Baradaran, R. F. Rojas, R. Goecke, M. Ghahramani. 2023. "A Systematic Review on Functional Near-Infrared Spectroscopy Concurrent With Quantitative Balance Assessment". IEEE Access, 11, 66641-66671.
81. Yang, M., Yang, Z., Yuan, T., Feng, W., Wang, P. 2019. "A systemic review of functional near-infrared spectroscopy for stroke: current application and future directions". Frontiers in neurology, 10, 58.
82. Yeung, N. 2013. "Conflict Monitoring and Cognitive Control". İçinde K. N. Ochsner & S. Kosslyn (Ed.), The Oxford Handbook of Cognitive Neuroscience: Volume 2: The Cutting Edges (s. 0). Oxford University Press.
83. Zimeo Morais, G. A., Balardin, J. B., Sato, J. R. 2018. "fNIRS Optodes’ Location Decider (fOLD): a toolbox for probe arrangement guided by brain regions-of-interest". Scientific reports, 8(1), 3341.