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Wooten SV, Amini B, Livingston JA, Hildebrandt MAT, Chandra J, Gilchrist SC, Roth M, Kleinerman E. Poor Sit-to-Stand Performance in Adolescent and Young Adult Patients with Sarcoma. J Adolesc Young Adult Oncol 2023; 12:821-827. [PMID: 37155195 DOI: 10.1089/jayao.2023.0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
Background: Adolescents and young adult (AYA) patients with sarcoma are at heightened risk of reduced physical capacity and disease-related weakness. Sit-to-stand (STS) performance correlates with lower extremity functionality and activities of daily living; however, little is known regarding the relationship between muscular status and STS performance in patients with sarcoma. This study assessed STS performance in patients with sarcoma and the association between STS performance and the skeletal muscle index (SMI) and skeletal muscle density (SMD). Methods: This study included 30 patients with sarcoma (15-39 years old) treated with high-dose doxorubicin. Patients performed the five-times-STS test before starting treatment and 1 year after the baseline test. STS performance was correlated with SMI and SMD. SMI and SMD were quantified using computed tomography scans taken at the level of the 4th thoracic vertebra (T4). Results: Mean performance on the STS test at baseline and 1 year was 2.2-fold and 1.8-fold slower than the age-matched general population, respectively. A lower SMI was associated with worse performance on the STS test (p = 0.01). Similarly, lower SMD at baseline was also associated with poorer STS performance (p < 0.01). Conclusion: Patients with sarcoma have very poor STS performance at baseline and 1 year, which was accompanied by low SMI and SMD at T4.The inability for AYAs to return to healthy age normative STS standards by 1 year may indicate a need for early interventions to enhance skeletal muscle recovery and promote physical activity during and after treatment.
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Affiliation(s)
- Savannah V Wooten
- Department of Pediatrics Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Behrang Amini
- Department of Musculoskeletal Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - J Andrew Livingston
- Department of Pediatrics Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Michelle A T Hildebrandt
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Joya Chandra
- Department of Pediatrics Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Susan C Gilchrist
- Cardiovascular Clinical Trials, LabCorp Drug Development, Houston, Texas, USA
| | - Michael Roth
- Department of Pediatrics Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Eugenie Kleinerman
- Department of Pediatrics Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Al-Husseini A, Gard A, Fransson PA, Tegner Y, Magnusson M, Marklund N, Tjernström F. Long-term postural control in elite athletes following mild traumatic brain injury. Front Neurol 2022; 13:906594. [PMID: 36172026 PMCID: PMC9511028 DOI: 10.3389/fneur.2022.906594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 08/15/2022] [Indexed: 12/02/2022] Open
Abstract
Background Traumas to the head and neck are common in sports and often affects otherwise healthy young individuals. Sports-related concussions (SRC), defined as a mild traumatic brain injury (mTBI), may inflict persistent neck and shoulder pain, and headache, but also more complex symptoms, such as imbalance, dizziness, and visual disturbances. These more complex symptoms are difficult to identify with standard health care diagnostic procedures. Objective To investigate postural control in a group of former elite athletes with persistent post-concussive symptoms (PPCS) at least 6 months after the incident. Method Postural control was examined using posturography during quiet stance and randomized balance perturbations with eyes open and eyes closed. Randomized balance perturbations were used to examine motor learning through sensorimotor adaptation. Force platform recordings were converted to reflect the energy used to maintain balance and spectrally categorized into total energy used, energy used for smooth corrective changes of posture (i.e., <0.1 Hz), and energy used for fast corrective movements to maintain balance (i.e., >0.1 Hz). Results The mTBI group included 20 (13 males, mean age 26.6 years) elite athletes with PPCS and the control group included 12 athletes (9 males, mean age 26.4 years) with no history of SRC. The mTBI group used significantly more energy during balance perturbations than controls: +143% total energy, p = 0.004; +122% low frequency energy, p = 0.007; and +162% high frequency energy, p = 0.004. The mTBI subjects also adapted less to the balance perturbations than controls in total (18% mTBI vs. 37% controls, p = 0.042), low frequency (24% mTBI vs. 42% controls, p = 0.046), and high frequency (6% mTBI vs. 28% controls, p = 0.040). The mTBI subjects used significantly more energy during quiet stance than controls: +128% total energy, p = 0.034; +136% low-frequency energy, p = 0.048; and +109% high-frequency energy, p = 0.015. Conclusion Athletes with previous mTBI and PPCS used more energy to stand compared to controls during balance perturbations and quiet stance and had diminished sensorimotor adaptation. Sports-related concussions are able to affect postural control and motor learning.
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Affiliation(s)
- Ali Al-Husseini
- Department of Clinical Sciences Lund, Neurosurgery, Skåne University Hospital, Lund University, Lund, Sweden
| | - Anna Gard
- Department of Clinical Sciences Lund, Neurosurgery, Skåne University Hospital, Lund University, Lund, Sweden
| | - Per-Anders Fransson
- Department of Clinical Sciences, Lund University, Lund, Sweden
- *Correspondence: Per-Anders Fransson
| | - Yelverton Tegner
- Department of Health Sciences, Luleå University of Technology, Luleå, Sweden
| | - Måns Magnusson
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Niklas Marklund
- Department of Clinical Sciences Lund, Neurosurgery, Skåne University Hospital, Lund University, Lund, Sweden
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3
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Rattanakrong N, Promma N, Saraboon C, Waongenngarm P. Physical impairments, sensory disturbance, and functional ability in a cancer patient with and without chemotherapy-induced peripheral neuropathy symptoms. Support Care Cancer 2022; 30:5055-5062. [PMID: 35217909 DOI: 10.1007/s00520-022-06927-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 02/19/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The present study examined the objective and patient-reported measures of physical impairments, sensory disturbance, and functional ability between cancer patients with and without chemotherapy-induced peripheral neuropathy (CIPN) symptoms. METHODS Forty-one cancer survivors exposed to neurotoxic chemotherapies were conveniently recruited and completed a single cross-sectional assessment of patient-reported outcomes (VAS for pain intensity and ABC scale) and objective assessments (SWM test, TUG test, 5xSTS test, Romberg test with eyes open and eyes closed, 6MWT, and FAB scale). RESULTS Cancer patients who had undergone chemotherapy with CIPN symptoms did significantly worse in the SWM test, TUG test, 5xSTS test, Romberg test with eyes closed, 6MWT, FAB scale, and ABC scale (p < 0.05) when compared with cancer survivors without CIPN symptoms. CONCLUSION Cancer survivors with CIPN symptoms have lower physical performance, sensory perception, and functional ability, which may increase the risk of falling and disability. These findings further emphasize the need for effective rehabilitation and interventions to treat CIPN symptoms and related physical impairment and functional deficits.
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Affiliation(s)
- Nida Rattanakrong
- Department of Rehabilitation Medicine, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Noppawan Promma
- Department of Rehabilitation Medicine, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Chanatsupang Saraboon
- Department of Rehabilitation Medicine, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Pooriput Waongenngarm
- Faculty of Health Science Technology, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand.
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4
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Raybin JL, Hendricks-Ferguson V, Cook P, Jankowski C. Associations between demographics and quality of life in children in the first year of cancer treatment. Pediatr Blood Cancer 2021; 68:e29388. [PMID: 34626456 DOI: 10.1002/pbc.29388] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 09/08/2021] [Accepted: 09/10/2021] [Indexed: 11/05/2022]
Abstract
Symptom distress and decreased quality of life (QOL) among children with cancer are well documented. Research is emerging on the child's voice in QOL-symptom reports, but existing QOL questionnaires are burdensome and objective biologic markers are lacking. We examined children's symptoms and QOL from parent and child perspectives and compared the results to one biologic marker (body posture). A cross-sectional secondary analysis of prospective data from children receiving creative arts therapy explored potential associations among demographics with and between QOL measures (PedsQL, Faces Scale, posture). Children (n = 98) ranged in age from 3 to 17 years (M = 7.8) and were in the first year of cancer treatment. No significant associations were found among the child's sex, race/ethnicity, socioeconomic status (SES), or distance from hospital, and total PedsQL. Older age was associated with worse total PedsQL, pain, nausea, worry, and posture (all P < 0.05). Greater worry (β = 0.51) and worse posture (β = 0.41) were the QOL variables most strongly correlated with older age. Poorer posture was associated with worse child PedsQL (total score, nausea, treatment anxiety, cognitive) and parent PedsQL (pain, nausea). Worse scores on the Faces Scale, PedsQL, and posture were all correlated (r = 0.21-0.39, all P < 0.05). Interventions to improve QOL could target nausea, worry, and older patients. Accuracy and interpretation of symptom distress in children are problematic. The Faces Scale and posture may be suitable, readily obtained measures of QOL in pediatric oncology that hold promise.
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Affiliation(s)
- Jennifer L Raybin
- Center for Cancer and Blood Disorders, Children's Hospital Colorado, Aurora, Colorado.,University of Colorado Anschutz Medical Campus, College of Nursing and School of Medicine, Aurora, Colorado
| | | | - Paul Cook
- University of Colorado Anschutz Medical Campus, College of Nursing and School of Medicine, Aurora, Colorado
| | - Catherine Jankowski
- University of Colorado Anschutz Medical Campus, College of Nursing and School of Medicine, Aurora, Colorado
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5
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Morishita S, Hirabayashi R, Tsubaki A, Aoki O, Fu JB, Onishi H, Tsuji T. Relationship between balance function and QOL in cancer survivors and healthy subjects. Medicine (Baltimore) 2021; 100:e27822. [PMID: 34797310 PMCID: PMC8601360 DOI: 10.1097/md.0000000000027822] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 10/28/2021] [Indexed: 01/05/2023] Open
Abstract
A previous study reported that cancer survivors exhibit decreased postural stability compared to age-matched controls. Another study showed that cancer survivors have a lower quality of life (QOL) compared to healthy subjects, and there was a significant relationship between muscle strength and QOL in cancer survivors. We aimed to investigate differences in the associations between balance function and QOL in cancer survivors and healthy subjects.Forty-one cancer survivors and 33 healthy subjects were included. Balance function was evaluated using the timed up and go test, and body sway was tested using a force platform. QOL was assessed using the medical outcome study 36-item short-form health survey.Cancer survivors exhibited significantly higher timed up and go and lower QOL than that of healthy subjects (P < .05). There was a significant association between body sway and QOL (P < .05) among cancer survivors. However, healthy subjects had subscales for QOL related to the body sway test parameters more frequently than cancer survivors (P < .05).Cancer survivors' balance function may have little effect on QOL, unlike in healthy subjects.
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Affiliation(s)
- Shinichiro Morishita
- Department of Physical Therapy, School of Health Sciences, Fukushima Medical University, Fukushima, Japan
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Ryo Hirabayashi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Atsuhiro Tsubaki
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Osamu Aoki
- Faculty of Rehabilitation, Shijonawate Gakuen University, Osaka, Japan
| | - Jack B. Fu
- Department of Palliative, Rehabilitation & Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Hideaki Onishi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Tetsuya Tsuji
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
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6
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Murphy SP, Hayward R, Smith JD. Exercise training improves postural steadiness in cancer survivors undergoing chemotherapy. Gait Posture 2021; 87:136-142. [PMID: 33915436 DOI: 10.1016/j.gaitpost.2021.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 04/02/2021] [Accepted: 04/09/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Cancer and cancer treatments negatively affect somatosensory, vestibular, and visual inputs that regulate postural stability and balance, increasing the risk of falling. Exercise training has been shown to mitigate other negative side effects of cancer treatments, such as reducing peripheral neuropathy. RESEARCH QUESTION How does 12 weeks of supervised exercise training influence postural stability in cancer survivors who receive chemotherapy? METHODS Postural stability of cancer survivors (n = 25; mass = 79.0 ± 22.6 kg; height = 1.66 ± 0.08 m; age = 61 ± 10 years) receiving chemotherapy was assessed prior to and following a 12-week individualized exercise training program by quantifying changes in center of pressure data. A series of 2-factor (pre/post x condition) analysis of variance with repeated measures were used to identify differences between conditions and pre- and post- training program on time and frequency domain measures. RESULTS Mediolateral root mean square excursion (p = 0.040; es = 0.20) and resultant mean frequency (p = 0.044; es = 0.29) of the center of pressure trajectory were found to be significantly different between pre- and post-training program. Further, participants dealt better with perturbations after completing the training program by reducing mediolateral root mean square excursion and 95 % confidence ellipse when visual stimulus was removed. SIGNIFICANCE Supervised exercise training in cancer patients undergoing chemotherapy improves postural stability in the mediolateral direction. Given that mediolateral movement of the center of pressure has previously been associated with fallers in other populations, exercise training during cancer treatments may be beneficial.
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Affiliation(s)
- Shane P Murphy
- School of Sport and Exercise Science, University of Northern Colorado, Campus Box 39, Greeley, CO, 80639, USA; School of Integrative Physiology & Athletic Training, University of Montana, 32 Campus Drive, Missoula, MT, 59812, USA.
| | - Reid Hayward
- School of Sport and Exercise Science, University of Northern Colorado, Campus Box 39, Greeley, CO, 80639, USA; University of Northern Colorado Cancer Rehabilitation Institute, Campus Box 6, Greeley, CO, 80639, USA.
| | - Jeremy D Smith
- School of Sport and Exercise Science, University of Northern Colorado, Campus Box 39, Greeley, CO, 80639, USA.
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Croarkin E, Zampieri C. On the EDGE of Task Force Recommendations: Computerized Balance Assessment. REHABILITATION ONCOLOGY 2021; 39:64-67. [PMID: 38404645 PMCID: PMC10888498 DOI: 10.1097/01.reo.0000000000000246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Earllaine Croarkin
- Board Certified Neurological Clinical Specialist, Physical Therapist, Clinical Research Center, National Institutes of Health, Bethesda, MD
| | - Cris Zampieri
- Research Physical Therapist, Functional and Applied Biomechanics Laboratory, Clinical Research Center, National Institutes of Health, Bethesda, MD
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8
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Patel M, Nilsson MH, Rehncrona S, Tjernström F, Magnusson M, Johansson R, Fransson PA. Effects of Deep Brain Stimulation on Postural Control in Parkinson's Disease. Comput Biol Med 2020; 122:103828. [DOI: 10.1016/j.compbiomed.2020.103828] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 04/30/2020] [Accepted: 05/19/2020] [Indexed: 10/24/2022]
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9
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Fransson PA, Nilsson MH, Niehorster DC, Nyström M, Rehncrona S, Tjernström F, Magnusson M, Johansson R, Patel M. Exploring the effects of deep brain stimulation and vision on tremor in Parkinson's disease - benefits from objective methods. J Neuroeng Rehabil 2020; 17:56. [PMID: 32334622 PMCID: PMC7183594 DOI: 10.1186/s12984-020-00677-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 04/01/2020] [Indexed: 11/10/2022] Open
Abstract
Background Tremor is a cardinal symptom of Parkinson’s disease (PD) that may cause severe disability. As such, objective methods to determine the exact characteristics of the tremor may improve the evaluation of therapy. This methodology study aims to validate the utility of two objective technical methods of recording Parkinsonian tremor and evaluate their ability to determine the effects of Deep Brain Stimulation (DBS) of the subthalamic nucleus and of vision. Methods We studied 10 patients with idiopathic PD, who were responsive to L-Dopa and had more than 1 year use of bilateral subthalamic nucleus stimulation. The patients did not have to display visible tremor to be included in the study. Tremor was recorded with two objective methods, a force platform and a 3 dimensional (3D) motion capture system that tracked movements in four key proximal sections of the body (knee, hip, shoulder and head). They were assessed after an overnight withdrawal of anti-PD medications with DBS ON and OFF and with eyes open and closed during unperturbed and perturbed stance with randomized calf vibration, using a randomized test order design. Results Tremor was detected with the Unified Parkinson’s Disease Rating Scale (UPDRS) in 6 of 10 patients but only distally (hands and feet) with DBS OFF. With the force platform and the 3D motion capture system, tremor was detected in 6 of 10 and 7 of 10 patients respectively, mostly in DBS OFF but also with DBS ON in some patients. The 3D motion capture system revealed that more than one body section was usually affected by tremor and that the tremor amplitude was non-uniform, but the frequency almost identical, across sites. DBS reduced tremor amplitude non-uniformly across the body. Visual input mostly reduced tremor amplitude with DBS ON. Conclusions Technical recording methods offer objective and sensitive detection of tremor that provide detailed characteristics such as peak amplitude, frequency and distribution pattern, and thus, provide information that can guide the optimization of treatments. Both methods detected the effects of DBS and visual input but the 3D motion system was more versatile in that it could detail the presence and properties of tremor at individual body sections.
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Affiliation(s)
| | - Maria H Nilsson
- Department of Health Sciences, Lund University, S-221 85, Lund, Sweden.,Memory Clinic, Skåne University Hospital, S-212 24, Malmö, Sweden.,Clinical Memory Research Unit, Faculty of Medicine, Lund University, S-221 85, Lund, Sweden
| | - Diederick C Niehorster
- Lund University Humanities Lab, Lund University, S-221 00, Lund, Sweden.,Department of Psychology, Lund University, S-221 00, Lund, Sweden.,Lund University Cognitive Science, Lund University, S-221 00, Lund, Sweden
| | - Marcus Nyström
- Lund University Humanities Lab, Lund University, S-221 00, Lund, Sweden
| | - Stig Rehncrona
- Department of Neurosurgery, Lund University, S-221 85, Lund, Sweden
| | - Fredrik Tjernström
- Department of Clinical Sciences, Lund University, S-221 85, Lund, Sweden
| | - Måns Magnusson
- Department of Clinical Sciences, Lund University, S-221 85, Lund, Sweden
| | - Rolf Johansson
- Department of Automatic Control, Lund University, S-221 00, Lund, Sweden
| | - Mitesh Patel
- Division of Brain Sciences, Imperial College London, London, W6 8RF, UK.,Faculty of Science and Engineering, University of Wolverhampton, Wolverhampton, WV1 1LZ, UK
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10
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The Effect of Chemotherapy on Balance, Gait, and Falls Among Cancer Survivors: A Scoping Review. REHABILITATION ONCOLOGY 2020. [DOI: 10.1097/01.reo.0000000000000238] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kandula T, Farrar MA, Cohn RJ, Mizrahi D, Carey K, Johnston K, Kiernan MC, Krishnan AV, Park SB. Chemotherapy-Induced Peripheral Neuropathy in Long-term Survivors of Childhood Cancer: Clinical, Neurophysiological, Functional, and Patient-Reported Outcomes. JAMA Neurol 2019; 75:980-988. [PMID: 29799906 DOI: 10.1001/jamaneurol.2018.0963] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Importance In light of the excellent long-term survival of childhood cancer patients, it is imperative to screen for factors affecting health, function, and quality of life in long-term survivors. Objective To comprehensively assess chemotherapy-induced peripheral neuropathy in childhood cancer survivors to define disease burden and functional effect and to inform screening recommendations. Design, Setting, and Participants In this cross-sectional observational study, cancer survivors who were treated with chemotherapy for extracranial malignancy before age 17 years were recruited consecutively between April 2015 and December 2016 from a single tertiary hospital-based comprehensive cancer survivorship clinic and compared with healthy age-matched controls. Investigators were blinded to the type of chemotherapy. A total of 169 patients met inclusion criteria, of whom 48 (28.4%) were unable to be contacted or declined participation. Exposures Chemotherapy agents known to be toxic to peripheral nerves. Main Outcomes and Measures The clinical peripheral neurological assessment using the Total Neuropathy Score was compared between recipients of different neurotoxic chemotherapy agents and control participants and was correlated with neurophysiological, functional, and patient-reported outcome measures. Results Of the 121 childhood cancer survivors included in this study, 65 (53.7%) were male, and the cohort underwent neurotoxicity assessments at a median (range) age of 16 (7-47) years, a median (range) 8.5 (1.5-29) years after treatment completion. Vinca alkaloids and platinum compounds were the main neurotoxic agents. Clinical abnormalities consistent with peripheral neuropathy were common, seen in 53 of 100 participants (53.0%) treated with neurotoxic chemotherapy (mean Total Neuropathy Score increase, 2.1; 95% CI, 1.4-2.9; P < .001), and were associated with lower limb predominant sensory axonal neuropathy (mean amplitude reduction, 5.8 μV; 95% CI, 2.8-8.8; P < .001). Functional deficits were seen in manual dexterity, distal sensation, and balance. Patient-reported outcomes demonstrating reduction in global quality of life and physical functioning were associated with the Total Neuropathy Score. Cisplatin produced long-term neurotoxicity more frequently than vinca alkaloids. Conclusions and Relevance Clinical abnormalities attributable to peripheral neuropathy were common in childhood cancer survivors and persisted long term, with concurrent deficits in patient-reported outcomes. Both the type of neurotoxic agent and a targeted clinical neurological assessment are important considerations when screening survivors for long-term neuropathy. Further development of peripheral neuropathy-specific pediatric assessment tools will aid research into neuroprotective and rehabilitative strategies.
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Affiliation(s)
- Tejaswi Kandula
- School of Women's and Children's Health, University of New South Wales Medicine, University of New South Wales Sydney, Sydney, New South Wales, Australia.,Department of Neurology, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Michelle Anne Farrar
- School of Women's and Children's Health, University of New South Wales Medicine, University of New South Wales Sydney, Sydney, New South Wales, Australia.,Department of Neurology, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Richard J Cohn
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - David Mizrahi
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, New South Wales, Australia.,School of Medical Sciences, University of New South Wales Medicine, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Kate Carey
- School of Women's and Children's Health, University of New South Wales Medicine, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Karen Johnston
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Matthew C Kiernan
- Brain and Mind Centre, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Arun V Krishnan
- Prince of Wales Clinical School, University of New South Wales Medicine, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Susanna B Park
- Brain and Mind Centre, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Prince of Wales Clinical School, University of New South Wales Medicine, University of New South Wales Sydney, Sydney, New South Wales, Australia
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12
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Varedi M, Lu L, Howell CR, Partin RE, Hudson MM, Pui CH, Krull KR, Robison LL, Ness KK, McKenna RF. Peripheral Neuropathy, Sensory Processing, and Balance in Survivors of Acute Lymphoblastic Leukemia. J Clin Oncol 2018; 36:2315-2322. [PMID: 29812998 PMCID: PMC6067801 DOI: 10.1200/jco.2017.76.7871] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Purpose To compare peripheral nervous system function and balance between adult survivors of childhood acute lymphoblastic leukemia (ALL) and matched controls and to determine associations between peripheral neuropathy (PN) and limitations in static balance, mobility, walking endurance, and quality of life (QoL) among survivors. Patients and Methods Three hundred sixty-five adult survivors of childhood ALL and 365 controls with no cancer history completed assessments of PN (modified Total Neuropathy Score [mTNS]), static balance (Sensory Organization Test [SOT]), mobility (Timed Up and Go), walking endurance (6-minute walk test), QoL (Medical Outcomes Study 36-Item Short Form Survey), and visual-motor processing speed (Wechsler Adult Intelligence Scale). Results PN, but not impairments, in performance on SOT was more common in survivors than controls (41.4% v 9.5%, respectively; P < .001). In multivariable models, higher mTNS scores were associated with longer time to complete the Timed Up and Go (β = 0.15; 95% CI, 0.06 to 0.23; P < .001), shorter distance walked in 6 minutes (β = -4.39; 95% CI, -8.63 to -0.14; P = .04), and reduced QoL (β = -1.33; 95% CI, -1.79 to -0.87; P < .001 for physical functioning; β = -1.16; 95% CI, -1.64 to -0.67; P < .001 for role physical; and β = -0.88; 95% CI, -1.34 to -0.42; P < .001 for general health). Processing speed (β = 1.69; 95% CI, 0.98 to 2.40; P < .001), but not mTNS score, was associated with anterior-posterior sway on the SOT. Conclusion PN in long-term ALL survivors is associated with movement, including mobility and walking endurance, but not with static standing balance. The association between processing speed and sway suggests that static balance impairment in ALL survivors may be influenced by problems with CNS function, including the processing of sensory information.
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Affiliation(s)
- Mitra Varedi
- Mitra Varedi and Raymond F. McKenna, Stony Brook University, Stony Brook, NY; and Lu Lu, Carrie R. Howell, Robyn E. Partin, Melissa M. Hudson, Ching-Hon Pui, Kevin R. Krull, Leslie L. Robison, and Kirsten K. Ness, St Jude Children's Research Hospital, Memphis, TN
| | - Lu Lu
- Mitra Varedi and Raymond F. McKenna, Stony Brook University, Stony Brook, NY; and Lu Lu, Carrie R. Howell, Robyn E. Partin, Melissa M. Hudson, Ching-Hon Pui, Kevin R. Krull, Leslie L. Robison, and Kirsten K. Ness, St Jude Children's Research Hospital, Memphis, TN
| | - Carrie R Howell
- Mitra Varedi and Raymond F. McKenna, Stony Brook University, Stony Brook, NY; and Lu Lu, Carrie R. Howell, Robyn E. Partin, Melissa M. Hudson, Ching-Hon Pui, Kevin R. Krull, Leslie L. Robison, and Kirsten K. Ness, St Jude Children's Research Hospital, Memphis, TN
| | - Robyn E Partin
- Mitra Varedi and Raymond F. McKenna, Stony Brook University, Stony Brook, NY; and Lu Lu, Carrie R. Howell, Robyn E. Partin, Melissa M. Hudson, Ching-Hon Pui, Kevin R. Krull, Leslie L. Robison, and Kirsten K. Ness, St Jude Children's Research Hospital, Memphis, TN
| | - Melissa M Hudson
- Mitra Varedi and Raymond F. McKenna, Stony Brook University, Stony Brook, NY; and Lu Lu, Carrie R. Howell, Robyn E. Partin, Melissa M. Hudson, Ching-Hon Pui, Kevin R. Krull, Leslie L. Robison, and Kirsten K. Ness, St Jude Children's Research Hospital, Memphis, TN
| | - Ching-Hon Pui
- Mitra Varedi and Raymond F. McKenna, Stony Brook University, Stony Brook, NY; and Lu Lu, Carrie R. Howell, Robyn E. Partin, Melissa M. Hudson, Ching-Hon Pui, Kevin R. Krull, Leslie L. Robison, and Kirsten K. Ness, St Jude Children's Research Hospital, Memphis, TN
| | - Kevin R Krull
- Mitra Varedi and Raymond F. McKenna, Stony Brook University, Stony Brook, NY; and Lu Lu, Carrie R. Howell, Robyn E. Partin, Melissa M. Hudson, Ching-Hon Pui, Kevin R. Krull, Leslie L. Robison, and Kirsten K. Ness, St Jude Children's Research Hospital, Memphis, TN
| | - Leslie L Robison
- Mitra Varedi and Raymond F. McKenna, Stony Brook University, Stony Brook, NY; and Lu Lu, Carrie R. Howell, Robyn E. Partin, Melissa M. Hudson, Ching-Hon Pui, Kevin R. Krull, Leslie L. Robison, and Kirsten K. Ness, St Jude Children's Research Hospital, Memphis, TN
| | - Kirsten K Ness
- Mitra Varedi and Raymond F. McKenna, Stony Brook University, Stony Brook, NY; and Lu Lu, Carrie R. Howell, Robyn E. Partin, Melissa M. Hudson, Ching-Hon Pui, Kevin R. Krull, Leslie L. Robison, and Kirsten K. Ness, St Jude Children's Research Hospital, Memphis, TN
| | - Raymond F McKenna
- Mitra Varedi and Raymond F. McKenna, Stony Brook University, Stony Brook, NY; and Lu Lu, Carrie R. Howell, Robyn E. Partin, Melissa M. Hudson, Ching-Hon Pui, Kevin R. Krull, Leslie L. Robison, and Kirsten K. Ness, St Jude Children's Research Hospital, Memphis, TN
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Faraji Aylar M, Jafarnezhadgero AA, Salari Esker F. Sit-to-stand ground reaction force characteristics in blind and sighted female children. Gait Posture 2018. [PMID: 29524795 DOI: 10.1016/j.gaitpost.2018.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND The association between visual sensory and sit-to-stand ground reaction force characteristics is not clear. Impulse is the amount of force applied over a period of time. Also, free moment represents the vertical moment applied in the center of pressure (COP). RESEARCH QUESTION How the ground reaction force components, vertical loading rate, impulses and free moment respond to long and short term restricted visual information? METHODS Fifteen female children with congenital blindness and 45 healthy girls with no visual impairments participated in this study. The girls with congenital blindness were placed in one group and the 45 girls with no visual impairments were randomly divided into three groups of 15; eyes open, permanently eyes closed, and temporary eyes closed. The participants in the permanently eyes closed group closed their eyes for 20 min before the test, whereas temporary eyes closed group did tests with their eyes closed throughout, and those in the eyes open group kept their eyes open. RESULTS Congenital blindness was associated with increased vertical loading rate, range of motion of knee and hip in the medio-lateral plane. Also, medio-lateral and vertical ground reaction force impulses. Similar peak negative and positive free moments were observed in three groups. SIGNIFICANCE In conclusion, the results reveal that sit-to-stand ground reaction force components in blind children may have clinical importance for improvement of balance control of these individuals.
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Affiliation(s)
- Mozhgan Faraji Aylar
- Division of Biomechanics, Department of Mechanical Engineering, Sahand University of Thechnology, Sahand New Town, Tabriz, 51335-1996, Iran.
| | - Amir Ali Jafarnezhadgero
- Departments of Physical Education and Sport Science, Faculty of Educational Sciences and Psychology, University of Mohaghegh Ardabili, Ardabil, Iran
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14
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Einarsson EJ, Patel M, Petersen H, Wiebe T, Fransson PA, Magnusson M, Moëll C. Elevated visual dependency in young adults after chemotherapy in childhood. PLoS One 2018; 13:e0193075. [PMID: 29466416 PMCID: PMC5821353 DOI: 10.1371/journal.pone.0193075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Accepted: 02/05/2018] [Indexed: 11/21/2022] Open
Abstract
Chemotherapy in childhood can result in long-term neurophysiological side-effects, which could extend to visual processing, specifically the degree to which a person relies on vision to determine vertical and horizontal (visual dependency). We investigated whether adults treated with chemotherapy in childhood experience elevated visual dependency compared to controls and whether any difference is associated with the age at which subjects were treated. Visual dependency was measured in 23 subjects (mean age 25.3 years) treated in childhood with chemotherapy (CTS) for malignant, solid, non-CNS tumors. We also stratified CTS into two groups: those treated before 12 years of age and those treated from 12 years of age and older. Results were compared to 25 healthy, age-matched controls. The subjective visual horizontal (SVH) and vertical (SVV) orientations was recorded by having subjects position an illuminated rod to their perceived horizontal and vertical with and without a surrounding frame tilted clockwise and counter-clockwise 20° from vertical. There was no significant difference in rod accuracy between any CTS groups and controls without a frame. However, when assessing visual dependency using a frame, CTS in general (p = 0.006) and especially CTS treated before 12 years of age (p = 0.001) tilted the rod significantly further in the direction of the frame compared to controls. Our findings suggest that chemotherapy treatment before 12 years of age is associated with elevated visual dependency compared to controls, implying a visual bias during spatial activities. Clinicians should be aware of symptoms such as visual vertigo in adults treated with chemotherapy in childhood.
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Affiliation(s)
- Einar-Jón Einarsson
- Department of Clinical Sciences, Lund University, Lund, Sweden
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Mitesh Patel
- Division of Brain Sciences, Imperial College London, London, United Kingdom
| | - Hannes Petersen
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- Department of Otorhinolaryngology, Landspitali University Hospital, Reykjavik, Iceland
| | - Thomas Wiebe
- Department of Pediatrics, Skåne University Hospital, Lund, Sweden
| | | | - Måns Magnusson
- Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Otorhinolaryngology, Skåne University Hospital, Lund, Sweden
| | - Christian Moëll
- Department of Pediatrics, Skåne University Hospital, Lund, Sweden
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