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McCarthy E, Marchese VG, Shipper AG, Rock K, Felter C. Identifying causes of balance impairment and exploring sensory contributions to balance in pediatric oncology: A scoping review. Crit Rev Oncol Hematol 2024; 201:104425. [PMID: 38909876 DOI: 10.1016/j.critrevonc.2024.104425] [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: 10/20/2023] [Revised: 05/23/2024] [Accepted: 06/16/2024] [Indexed: 06/25/2024] Open
Abstract
PURPOSE To identify causes of balance impairment in children undergoing treatment for cancer and childhood cancer survivors. METHODS A systematic search was performed according to PRISMA guidelines. Studies were included if participants were 0-19 years of age with a current/past diagnosis of cancer, an objective balance measure was reported, and a cause of balance impairment was either stated or implied. RESULTS The 64 full text studies included identified balance impairments as sequelae secondary to CNS tumors, and/or as an effect of medical treatment including chemotherapy, radiation, and/or surgery. Cancer treatment can result in damage to the visual, vestibular and/or somatosensory systems which in turn can contribute to balance dysfunction. CONCLUSIONS Balance impairments were caused by the cancer itself or the result of medical treatment. Oncology professionals are integral in recognition and treatment of factors affecting balance impairments in childhood cancer; however, further research is needed to identify interventions targeting specific causes of balance impairment.
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Affiliation(s)
- Emily McCarthy
- Department of Physical Therapy and Rehabilitation Science, University of Maryland, School of Medicine, 100 Penn Street, AHRB, Room 208, Baltimore, MD 21021, United States.
| | - Victoria G Marchese
- Department of Physical Therapy and Rehabilitation Science, University of Maryland, School of Medicine, United States
| | | | - Kelly Rock
- Department of Physical Therapy, University of Florida, United States
| | - Cara Felter
- Physician Assistant Leadership and Learning Academy, University of Maryland, Baltimore, United States
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Impact of physical activity on postural stability and coordination in children with posterior fossa tumor: randomized control phase III trial. J Cancer Res Clin Oncol 2022:10.1007/s00432-022-04490-4. [PMID: 36525069 PMCID: PMC10356666 DOI: 10.1007/s00432-022-04490-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 11/18/2022] [Indexed: 12/23/2022]
Abstract
Abstract
Background
Posterior fossa tumor is a type of brain tumor that is located at the borders of both the brain stem and cerebellum. The cerebellum is the brain region in charge of balance and coordination. Pediatric patients diagnosed with posterior fossa tumor have been reported to fall frequently.
Objectives
The aim of this study is to investigate the effectiveness of balance and coordination training in these children.
Methods
This randomized control clinical trial (ClinicalTrials.gov Identifier: NCT04528316) was carried out between September 2020 and April 2021 at Children’s Cancer Hospital-57357. The inclusion criteria were patients with posterior fossa tumor in maintenance phase and, age between 5 and 12 years. The exclusion criteria were patients who had a genetic disorder or suffer from mental retardation, a chronic lung disease, severe cardiomyopathy, or a neuromuscular disease that does not relate to tumor. The study participants were randomly assigned into three groups: Group I/Control group: they received Pilates core stability exercises program, Group II/Postural stability group: they received the same program plus HUMAC balance program, and Group III/Coordination group: they received the same program plus coordination exercises of BOT-2. The semi-parametric proportional odds model was used to compare follow-up scores of the Postural stability group vs Control, and Coordination group vs Control, while adjusting for baseline values. All tests were two sided, with alpha set to 0.05.
Results
Sixty children including 38 boys and 22 girls were enrolled in this study. In all three groups, postural stability and coordination improved significantly in terms of modified clinical test of sensory integration of balance, center of pressure, limits of stability, bilateral coordination, and upper-limb coordination.
Conclusion
The current study supports the value of adding postural stability and coordination training to the physiotherapy plan for children with posterior fossa tumor.
Trial registration number and date of registration
ClinicalTrials.gov Identifier: NCT04528316 on August 27, 2020.
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Rajabalee N, Kozlowska K, Lee SY, Savage B, Hawkes C, Siciliano D, Porges SW, Pick S, Torbey S. Neuromodulation Using Computer-Altered Music to Treat a Ten-Year-Old Child Unresponsive to Standard Interventions for Functional Neurological Disorder. Harv Rev Psychiatry 2022; 30:303-316. [PMID: 35616609 PMCID: PMC9470039 DOI: 10.1097/hrp.0000000000000341] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Malbari F, Gill J, Daigle A, Rodriguez LL, Raghubar KP, Davis KC, Scheurer M, Ma MM, Kralik SF, Meoded A, Okcu MF, Chintagumpala MM, Aldave G, Weiner HL, Kahalley LS. Cerebellar Mutism Syndrome in Pediatric Neuro-oncology: A Multidisciplinary Perspective and Call for Research Priorities. Pediatr Neurol 2022; 132:4-10. [PMID: 35598587 DOI: 10.1016/j.pediatrneurol.2022.04.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 03/28/2022] [Accepted: 04/28/2022] [Indexed: 10/18/2022]
Abstract
Cerebellar mutism syndrome (CMS), also known as posterior fossa syndrome, occurs in a subset of children after posterior fossa tumor resection, most commonly medulloblastoma. Patients with this syndrome exhibit often transient, although protracted, symptoms of language impairment, emotional lability, cerebellar, and brainstem dysfunction. However, many patients experience persistent neurological deficits and lasting neurocognitive impairment. Historically, research and clinical care were hindered by inconsistent nomenclature, poorly defined diagnostic criteria, and uncertainty surrounding risk factors and etiology. Proposed diagnostic criteria include two major symptoms, language impairment and emotional lability, as proposed by the international Board of the Posterior Fossa Society in their consensus statement as well as other experts in this field. Risk factors most commonly associated with development of CMS include midline tumor location, diagnosis of medulloblastoma and specific tumor subtype, younger age at diagnosis, and preoperative language impairment. A proposed etiology of CMS includes disruption of the cerebellar outflow tracts, the cerebellar nuclei, and their efferent projections through the superior cerebellar peduncle. Treatment for CMS remains supportive. Herein, we present a comprehensive overview of CMS etiology, diagnosis, risk factors, clinical presentation, and clinical management. In addition, we identify essential multidisciplinary research priorities to advance diagnostics, prevention, and intervention efforts for patients with, or at risk for, development of CMS.
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Affiliation(s)
- Fatema Malbari
- Division of Neurology and Developmental Neurosciences, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas.
| | - Jason Gill
- Division of Neurology and Developmental Neurosciences, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Amy Daigle
- Division of Physical Medicine and Rehabilitation, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Lisa L Rodriguez
- Division of Physical Medicine and Rehabilitation, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Kimberly P Raghubar
- Section of Psychology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Kimberly C Davis
- Section of Psychology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Michael Scheurer
- Department of Pediatrics, Texas Children's Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Marina M Ma
- Division of Physical Medicine and Rehabilitation, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Stephen F Kralik
- Division of Radiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Avner Meoded
- Division of Radiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - M Fatih Okcu
- Department of Pediatrics, Texas Children's Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Murali M Chintagumpala
- Department of Pediatrics, Texas Children's Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Guillermo Aldave
- Division of Neurosurgery, Department of Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Howard L Weiner
- Division of Neurosurgery, Department of Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Lisa S Kahalley
- Section of Psychology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
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Esper NB, Franco AR, Soder RB, Bomfim RC, Nunes ML, Radaelli G, Esper KB, Kotoski A, Pripp W, Neto FK, Azambuja LS, Mathias NA, da Costa DI, Portuguez MW, da Costa JC, Buchweitz A. Zika virus congenital microcephaly severity classification and the association of severity with neuropsychomotor development. Pediatr Radiol 2022; 52:941-950. [PMID: 35229185 DOI: 10.1007/s00247-022-05284-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 09/14/2021] [Accepted: 11/11/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Zika virus infection during pregnancy is linked to birth defects, most notably microcephaly, which is associated with neurodevelopmental delays. OBJECTIVE The goals of the study were to propose a method for severity classification of congenital microcephaly based on neuroradiologic findings of MRI scans, and to investigate the association of severity with neuropsychomotor developmental scores. We also propose a semi-automated method for MRI-based severity classification of microcephaly. MATERIALS AND METHODS We conducted a cross-sectional investigation of 42 infants born with congenital Zika infection. Bayley Scales of Infant and Toddler Development III (Bayley-III) developmental evaluations and MRI scans were carried out at ages 13-39 months (mean: 24.8 months; standard deviation [SD]: 5.8 months). The severity score was generated based on neuroradiologist evaluations of brain malformations. Next, we established a distribution of Zika virus-microcephaly severity score including mild, moderate and severe and investigated the association of severity with neuropsychomotor developmental scores. Finally, we propose a simplified semi-automated procedure for estimating the severity score based only on volumetric measures. RESULTS The results showed a correlation of r=0.89 (P<0.001) between the Zika virus-microcephaly severity score and the semi-automated method. The trimester of infection did not correlate with the semi-automated method. Neuropsychomotor development correlated with the severity classification based on the radiologic readings and semi-automated method; the more severe the imaging scores, the lower the neuropsychomotor developmental scores. CONCLUSION These severity classification methods can be used to evaluate severity of microcephaly and possible association with developmental consequences. The semi-automated methods thus provide an alternative for predicting severity of microcephaly based on only one MRI sequence.
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Affiliation(s)
- Nathalia Bianchini Esper
- Brain Institute of Rio Grande do Sul (BraIns), Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Avenue Ipiranga, 6690, Building 63, Porto Alegre, 90610-000, Brazil
- School of Medicine, Neurosciences, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Alexandre Rosa Franco
- Center for the Developing Brain, Child Mind Institute, New York, NY, USA
- Center for Biomedical Imaging and Neuromodulation, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, USA
- Department of Psychiatry, New York University Grossman School of Medicine, New York, NY, USA
| | - Ricardo Bernardi Soder
- Brain Institute of Rio Grande do Sul (BraIns), Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Avenue Ipiranga, 6690, Building 63, Porto Alegre, 90610-000, Brazil
- School of Medicine, Neurosciences, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | | | - Magda Lahorgue Nunes
- Brain Institute of Rio Grande do Sul (BraIns), Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Avenue Ipiranga, 6690, Building 63, Porto Alegre, 90610-000, Brazil
- School of Medicine, Neurosciences, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Graciane Radaelli
- Brain Institute of Rio Grande do Sul (BraIns), Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Avenue Ipiranga, 6690, Building 63, Porto Alegre, 90610-000, Brazil
| | - Katherine Bianchini Esper
- School of Technology, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Aline Kotoski
- School of Medicine, Neurosciences, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Willian Pripp
- School of Technology, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Felipe Kalil Neto
- Brain Institute of Rio Grande do Sul (BraIns), Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Avenue Ipiranga, 6690, Building 63, Porto Alegre, 90610-000, Brazil
| | - Luciana Schermann Azambuja
- Brain Institute of Rio Grande do Sul (BraIns), Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Avenue Ipiranga, 6690, Building 63, Porto Alegre, 90610-000, Brazil
- Graduate Program in Pediatrics, School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Nathália Alves Mathias
- Graduate Program in Pediatrics, School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Danielle Irigoyen da Costa
- Brain Institute of Rio Grande do Sul (BraIns), Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Avenue Ipiranga, 6690, Building 63, Porto Alegre, 90610-000, Brazil
- School of Life and Health Sciences, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Mirna Wetters Portuguez
- Brain Institute of Rio Grande do Sul (BraIns), Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Avenue Ipiranga, 6690, Building 63, Porto Alegre, 90610-000, Brazil
- School of Medicine, Neurosciences, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Jaderson Costa da Costa
- Brain Institute of Rio Grande do Sul (BraIns), Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Avenue Ipiranga, 6690, Building 63, Porto Alegre, 90610-000, Brazil.
- School of Medicine, Neurosciences, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil.
| | - Augusto Buchweitz
- Brain Institute of Rio Grande do Sul (BraIns), Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Avenue Ipiranga, 6690, Building 63, Porto Alegre, 90610-000, Brazil
- School of Life and Health Sciences, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
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Dreneva AA, Skvortsov DV. Postural balance in pediatric posterior fossa tumor survivors: Through impairments to rehabilitation possibilities. Clin Biomech (Bristol, Avon) 2020; 71:53-58. [PMID: 31704535 DOI: 10.1016/j.clinbiomech.2019.10.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 10/20/2019] [Accepted: 10/29/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND The rehabilitation after pediatric brain tumors is a pressing issue in current neuro-oncology. The purpose of this study was to reveal the peculiarities of postural stability in pediatric posterior fossa tumor survivors as compared to the healthy controls. Additionally, we aimed to determine the feasibility of the balance biofeedback training for these patients. METHODS We measured 6 postural stability parameters with the eyes opened and closed in 35 patients and 25 healthy controls aged 7-17. Further, the patients were divided into two groups: the intervention and waitlist. The intervention group was the first to undergo a 2-week biofeedback training designed to enhance balance control, while the waitlist group performed only the usual exercises. Then the groups were interchanged. Pre- and post-stability scores were measured in each condition. FINDINGS The current results suggest the pronounced deficiency of stability in the patients. Their results in both opened and closed eyes conditions were similar. The post-training measurements revealed that some stability parameters were improved: ellipse square and mean root square oscillations in the frontal and sagittal planes. INTERPRETATION The patients predictably demonstrated the significantly worse stability measurements as compared to the healthy controls. Moreover, they were shown not to use visual information to correct postural balance thus prompting us to assume severe deficits of the eye movements control due to the cerebellar pathology. This specificity, as well as the post-training significant improvement, emphasizes the clinical necessity to consider them when designing the rehabilitation protocols for posterior fossa tumor survivors.
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Affiliation(s)
- Anna A Dreneva
- Faculty of Psychology, Lomonosov Moscow State University, Mokhovaya st. 11/9, 125009 Moscow, Russia.
| | - Dmitry V Skvortsov
- Clinical Rehabilitation Research Center, Dmitry Rogachev National Research Center of Pediatric Hematology, Oncology and Immunology, Samory Mashela str. 1, 117997 Moscow, Russia
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Ospina PA, McNeely ML. A Scoping Review of Physical Therapy Interventions for Childhood Cancers. Physiother Can 2019; 71:287-296. [PMID: 31719724 PMCID: PMC6830414 DOI: 10.3138/ptc.2018-13.pp] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Purpose: Children and adolescents undergoing cancer treatment are at high risk of developing serious adverse effects, many of which respond to physical therapy (PT). This scoping review aims to (1) outline the state of the research involving PT for children with cancer and (2) identify gaps in the literature for future research. Method: From January 2002 to October 2017, we conducted electronic searches of three major databases and conference proceedings and checked references of screened articles. Results: A total of 12 articles were included in the review: one randomized controlled trial, one pilot randomized trial, five pilot or feasibility studies, two prospective studies, one case series, one case report, and one retrospective study. The research to date supports the feasibility of PT interventions for children with cancer, but the current evidence is not yet at a level to inform clinical practice. To better elucidate treatment protocols and assess their benefits for tumour-specific impairments, research needs to examine the effects of PT on specific impairments or for specific cancer tumour types. Conclusions: Collaborative efforts to conduct multi-centre trials are needed to further the field of paediatric oncology PT.
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Affiliation(s)
- Paula A. Ospina
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta
| | - Margaret L. McNeely
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta
- Department of Rehabilitation Medicine/Department of Oncology, Cross Cancer Institute, Edmonton, Alta
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Technology. Pediatr Phys Ther 2014; 26:375. [PMID: 25251788 DOI: 10.1097/pep.0000000000000095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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