Comparison of forward and backward gait characteristics between those with and without a history of breast cancer

Biomechanical effect of neurologic dance training (NDT) for breast cancer survivors with chemotherapy-induced neuropathy: study protocol for a randomized controlled trial and preliminary baseline data

BACKGROUND

Breast cancer (BC) is among the most common forms of cancer experienced by women. Up to 80% of BC survivors treated with chemotherapy experience chemotherapy-induced neuropathy (CIN), which degrades motor control, sensory function, and quality of life. CIN symptoms include numbness, tingling, and/or burning sensations in the extremities; deficits in neuromotor control; and increased fall risk. Physical activity (PA) and music-based medicine (MBM) are promising avenues to address sensorimotor symptoms. Therefore, we propose that we can combine the effects of music- and PA-based medicine through neurologic dance training (NDT) through partnered Adapted Tango (NDT-Tango). We will assess the intervention effect of NDT-Tango v. home exercise (HEX) intervention on biomechanically-measured variables. We hypothesize that 8 weeks of NDT-Tango practice will improve the dynamics of posture and gait more than 8 weeks of HEX.

METHODS

In a single-center, prospective, two-arm randomized controlled clinical trial, participants are randomly assigned (1:1 ratio) to the NDT-Tango experimental or the HEX active control intervention group. Primary endpoints are change from baseline to after intervention in posture and gait. Outcomes are collected at baseline, midpoint, post, 1-month follow-up, and 6-month follow-up. Secondary and tertiary outcomes include clinical and biomechanical tests of function and questionnaires used to compliment primary outcome measures. Linear mixed models will be used to model changes in postural, biomechanical, and PROs. The primary estimand will be the contrast representing the difference in mean change in outcome measure from baseline to week 8 between treatment groups.

DISCUSSION

The scientific premise of this study is that NDT-Tango stands to achieve more gains than PA practice alone through combining PA with MBM and social engagement. Our findings may lead to a safe non-pharmacologic intervention that improves CIN-related deficits.

TRIAL REGISTRATION

This trial was first posted on 11/09/21 at ClinicalTrials.gov under the identifier NCT05114005.

A Hybrid Assessment of Clinical Mobility Test Items for Evaluating Individuals With Mild Traumatic Brain Injury

BACKGROUND AND PURPOSE

The Functional Gait Assessment (FGA) and High Level Mobility Assessment Tool (HiMAT) are clinical batteries used to assess people with mild traumatic brain injury (mTBI). However, neither assessment was specifically developed for people with mTBI; the FGA was developed to evaluate vestibular deficits, and the HiMAT was developed for individuals with more severe TBI. To maximize the sensitivity and reduce the time burden of these assessments, the purpose of this study was to determine the combination of FGA and HiMAT items that best discriminates persons with persistent symptoms from mTBI from healthy controls.

METHODS

Fifty-three symptomatic civilians with persistent symptoms from mTBI (21% male, aged 31 (9.5) years, 328 [267] days since concussion) and 57 healthy adults (28% male, aged 32 (9.6) years) participated across 3 sites. The FGA and HiMAT were evaluated sequentially as part of a larger study. To determine the best combination of items, a lasso-based generalized linear model (glm) was fit to all data.

RESULTS

The area under the curve (AUC) for FGA and HiMAT total scores was 0.68 and 0.66, respectively. Lasso regression selected 4 items, including FGA Gait with Horizontal Head Turns and with Pivot Turn, and HiMAT Fast Forward and Backward Walk, and yielded an AUC (95% confidence interval) of 0.71 (0.61-0.79) using standard scoring.

DISCUSSION AND CONCLUSIONS

The results provide initial evidence supporting a reduced, 4-Item Hybrid Assessment of Mobility for mTBI (HAM-4-mTBI) for monitoring individuals with mTBI. Future work should validate the HAM-4-mTBI and investigate its utility for tracking progression throughout rehabilitation.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A409 ).

The Immediate Effect of Backward Walking on External Knee Adduction Moment in Healthy Individuals

Backward walking (BW) has been recommended as a rehabilitation intervention to prevent, manage, or improve diseases. However, previous studies showed that BW significantly increased the first vertical ground reaction force (GRF) during gait, which might lead to higher loading at the knee. Published reports have not examined the effects of BW on medial compartment knee loading. The objective of this study was to investigate the effects of BW on external knee adduction moment (EKAM). Twenty-seven healthy adults participated in the present study. A sixteen-camera three-dimensional VICON gait analysis system, with two force platforms, was used to collect the EKAM, KAAI, and other biomechanical data during BW and forward walking (FW). The first ( $P<0.001$ ) and second ( $P<0.001$ ) EKAM peaks and KAAI ( $P=0.02$ ) were significantly decreased during BW when compared with FW. The BW significantly decreased the lever arm length at the first EKAM peak ( $P=0.02$ ) when compared with FW. In conclusion, BW was found to be a useful strategy for reducing the medial compartment knee loading even though the first peak ground reaction force was significantly increased.

Use of Backward Walking Speed to Screen Dynamic Balance and Mobility Deficits in Older Adults Living Independently in the Community

BACKGROUND AND PURPOSE

Older adults who live independently in the community are higher functioning and routinely ambulate in the community. Unrestricted community ambulation increases the likelihood of encountering precarious situations challenging balance. Sufficient dynamic balance is necessary to avoid falls. Currently used balance and mobility assessments may not sufficiently challenge dynamic balance to uncover mobility deficits in independent community-dwelling older adults. The purpose of this study was to investigate whether backward walking speed (BWS) can serve as an outcome measure to screen dynamic balance and mobility deficits in independent community-dwelling older adults.

METHODS

A convenience sample of 30 older adults (73.68 ± 6.54 years) participated in this cross-sectional study. Participants walked backward on an instrumented walkway to record BWS. Other outcomes included forward walking speed (FWS), Community Balance and Mobility (CB&M) Scale, Falls Efficacy Scale-International (FES-I), Timed Up and Go (TUG) test, and 7-day average step count (ASC). A multivariate analysis of variance investigated the overall group differences between older adults at fall risk and those not at risk and was followed up by univariate tests. Pearson and spearman coefficients investigated associations between study outcomes. Youden's index assessed diagnostic accuracy.

RESULTS AND DISCUSSION

Backward walking speed, CB&M, FES-I, ASC discriminated older adults at fall risk from those not at risk (P < .01) whereas FWS and TUG did not. Backward walking speed strongly correlated with challenging assessments of balance and mobility (CB&M, FES-I, and ASC) but only moderately correlated with the TUG. The CB&M Scale independently explained 53% variance in the BWS performance (P < .01). Youden's index was highest (Y = 0.6, sensitivity = 93%, and specificity = 67%) for BWS (0.73 m/s) compared with other study outcomes.

CONCLUSIONS

Preliminary results suggest that BWS can screen for dynamic balance and mobility deficits in independent community-dwelling older adults. Accurate screening is the first step to capture early decline in function for independent community-dwelling older adults. Longitudinal follow-up studies are warranted to validate BWS as a screening tool.

A review of movement disorders in chemotherapy-induced neurotoxicity

Chemotherapy agents used in the standard treatments for many types of cancer are neurotoxic and can lead to lasting sensory and motor symptoms that compromise day-to-day movement functions in cancer survivors. To date, the details of movement disorders associated with chemotherapy are known largely through self-reported symptoms and functional limitations. There are few quantitative studies of specific movement deficits, limiting our understanding of dysfunction, as well as effective assessments and interventions. The aim of this narrative review is to consolidate the current understanding of sensorimotor disabilities based on quantitative measures in cancer survivors who received chemotherapy. We performed literature searches on PubMed and found 32 relevant movement studies. We categorized these studies into three themes based on the movement deficits investigated: (1) balance and postural control; (2) gait function; (3) upper limb function. This literature suggests that cancer survivors have increased postural sway, more conservative gait patterns, and suboptimal hand function compared to healthy individuals. More studies are needed that use objective measures of sensorimotor function to better characterize movement disabilities and investigate the underlying causes, as required for developing targeted assessments and interventions. By updating our understanding of movement impairments in this population, we identify significant gaps in knowledge that will help guide the direction of future research.