{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T13:07:14Z","timestamp":1789477634807,"version":"build-2803163510"},"posted":{"date-parts":[[2026,9,11]]},"group-title":"Neurology","reference-count":94,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T00:00:00Z","timestamp":1789084800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"name":"National Institutes of Health Eunice Kennedy Shriver National Institute of Child Health and Human Development","award":["P2CHD086844"],"award-info":[{"award-number":["P2CHD086844"]}]},{"name":"National Institutes of Health Eunice Kennedy Shriver National Institute of Child Health and Human Development","award":["R25HD106896"],"award-info":[{"award-number":["R25HD106896"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,9,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Balance 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.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We 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.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Stroke 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.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>These 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.<\/jats:p>\n                <\/jats:sec>","DOI":"10.64898\/2026.09.08.26362085","type":"posted-content","created":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T04:20:24Z","timestamp":1789186824000},"source":"Crossref","is-referenced-by-count":0,"title":["Cortical Network Reorganization During Balance Control in Chronic Stroke: Premotor-Parietal Behavioral Uncoupling and Directional Prefrontal Compensation"],"prefix":"10.64898","author":[{"given":"Komal K.","family":"Kukkar","sequence":"first","affiliation":[{"name":"Center for Neuromotor and Biomechanics Research, Department of Health and Human Performance, University of Houston, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tina M.","family":"Pham","sequence":"additional","affiliation":[{"name":"Center for Neuromotor and Biomechanics Research, Department of Health and Human Performance, University of Houston, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Humza A.","family":"Mirza","sequence":"additional","affiliation":[{"name":"Center for Neuromotor and Biomechanics Research, Department of Health and Human Performance, University of Houston, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheng","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center \u2013 Houston, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pranav J.","family":"Parikh","sequence":"additional","affiliation":[{"name":"Center for Neuromotor and Biomechanics Research, Department of Health and Human Performance, University of Houston, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"54368","reference":[{"key":"2026091505501288000_2026.09.08.26362085v1.1","doi-asserted-by":"publisher","DOI":"10.1093\/GERONA\/55.1.M10"},{"key":"2026091505501288000_2026.09.08.26362085v1.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuroscience.2019.05.063"},{"key":"2026091505501288000_2026.09.08.26362085v1.3","doi-asserted-by":"crossref","unstructured":"Kukkar KK , Rao N , Huynh D , Shah S , Contreras-Vidal JL , Parikh PJ . 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