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Bongiorno G, Biancuzzi H, Dal Mas F, Miceli L. The rehabilitation tailor: applying personalized medicine to cancer recovery. Front Glob Womens Health 2024; 5:1254562. [PMID: 39318664 PMCID: PMC11420117 DOI: 10.3389/fgwh.2024.1254562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 08/23/2024] [Indexed: 09/26/2024] Open
Affiliation(s)
- Giulia Bongiorno
- Friuli Riabilitazione Rehabilitation Center, Roveredo in Piano, Italy
| | - Helena Biancuzzi
- Department of Economics, Ca’ Foscari University of Venice, Venice, Italy
| | - Francesca Dal Mas
- Department of Management, Ca’ Foscari University of Venice, Venice, Italy
- Collegium Medicum, University of Social Sciences, Łodz, Poland
| | - Luca Miceli
- Department of Pain Medicine, IRCCS C.R.O. National Cancer Institute of Aviano, Aviano, Italy
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De Baets L, Vets N, Emmerzaal J, Devoogdt N, De Groef A. Altered upper limb motor behavior in breast cancer survivors and its relation to pain: A narrative review. Anat Rec (Hoboken) 2024; 307:298-308. [PMID: 36398938 DOI: 10.1002/ar.25120] [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: 07/29/2022] [Revised: 10/24/2022] [Accepted: 11/03/2022] [Indexed: 11/21/2022]
Abstract
Breast cancer is the most commonly diagnosed cancer among women and many women suffer from persistent physical and psychological complaints following their cancer treatment. Altered motor behavior at the shoulder region and upper limb, that is, alterations in movement patterns, spatiotemporal movement characteristics and muscle activation patterns, is a common physical consequence of breast cancer treatment, that can have a clear impact on daily life functioning and quality of life. Furthermore, altered upper limb motor behavior is suggested to relate to upper limb pain, which is very commonly reported in breast cancer survivors (BCS). This review, prepared according to the SANRA guidelines, looks into the current understanding of alterations in motor behavior at shoulder and upper limb in BCS, by discussing the factors related to this altered behavior. In this, we specifically focus on the relation between motor behavior and pain. Results of our search show that cancer treatment modality is predictive for shoulder range of motion. Furthermore, single prospective studies show depressive symptoms, living alone, being non-white and low physical activity levels as predicting factors for reduced shoulder range of motion. Pain as factor related to altered motor behavior is only assessed in cross-sectional research, limiting its interpretation in context of being cause or consequence of motor behavioral adaptations, and on the underlying mechanism explaining their relation. It is concluded that studies which explain the mechanisms how and in which subgroup of BCS motor behavioral alterations are associated with pain at the upper limb, are necessary in future.
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Affiliation(s)
- Liesbet De Baets
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Nieke Vets
- Department of Rehabilitation Sciences, KU Leuven-University of Leuven, Leuven, Belgium
| | - Jill Emmerzaal
- Department of Rehabilitation Sciences, KU Leuven-University of Leuven, Leuven, Belgium
| | - Nele Devoogdt
- Department of Rehabilitation Sciences, KU Leuven-University of Leuven, Leuven, Belgium
- Department of Vascular Surgery, Center for Lymphedema, University Hospitals Leuven, Leuven, Belgium
| | - An De Groef
- Department of Rehabilitation Sciences, KU Leuven-University of Leuven, Leuven, Belgium
- Department of Rehabilitation Sciences and Physiotherapy, MOVANT, University of Antwerp, Antwerp, Belgium
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Bongiorno G, Tomasi A, Vigni G, Rizzardo A, Biancuzzi H, Dal Mas F, Bednarova R, Miceli L. Case report: Movement analysis in oncological rehabilitation: proposal of a kinematic and surface electromyographic protocol in breast oncology. Front Hum Neurosci 2024; 17:1272027. [PMID: 38328676 PMCID: PMC10848327 DOI: 10.3389/fnhum.2023.1272027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 12/27/2023] [Indexed: 02/09/2024] Open
Abstract
Introduction Breast cancer disease often affects the ipsilateral shoulder joint, with pain and joint limitation. Proper pain management, which can be obtained using, for example, pulsed radiofrequency of the suprascapular nerve, can help the physiotherapist mitigate patient pain. The modern technologies of kinematic analysis and surface electromyography of movement analysis can give further support in building a personalized rehabilitation program, based on the quantitative study of movement, in this case of the upper limb. Methods A brief case report was conceived to develop and test the evolution of a shoulder joint analysis protocol based on an inertial accelerometer and non-invasive surface electromyography. Results An analysis algorithm was defined to adapt to the needs of patients operated on at the breast based on a kinematic component (ROM - range of movement - and Jerk index) and an electromyographic one (study of muscle behavior in groups of four). The coactivations were also evaluated, both as an average value and in graphical form, to offer the physiotherapist a complete overview of the movement of the upper limb. Discussion The promising protocol results underline its strengths, including the simplicity of use, combined with the reduced time required for processing the reports and the portability of the PC-sensors complex, making these analyses potentially valuable for patient care.
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Affiliation(s)
- Giulia Bongiorno
- Friuli Riabilitazione Rehabilitation Center, Roveredo in Piano (PN), Italy
| | | | - Giulio Vigni
- Papa Giovanni XXIII Hospital, Monastier (TV), Italy
| | | | - Helena Biancuzzi
- Department of Economics, Ca Foscari University of Venice, Venice, Italy
| | - Francesca Dal Mas
- Department of Management, Ca Foscari University of Venice, Venice, Italy
- Collegium Medicum University of Social Sciences, Łódź, Poland
| | - Rym Bednarova
- Pain Medicine, Hospital of Latisana (UD), Latisana, Italy
| | - Luca Miceli
- Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano (PN), Italy
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Braudy R, Atoms B, Coghlan J, Staples M, Moga D, Tollefsrud R, Lawrence RL, Ludewig P, Koehler L. Shoulder Kinematics of Axillary Web Syndrome in Women Treated for Breast Cancer. Arch Phys Med Rehabil 2023; 104:403-409. [PMID: 36202228 DOI: 10.1016/j.apmr.2022.09.014] [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] [Received: 03/15/2022] [Revised: 08/29/2022] [Accepted: 09/19/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To better understand how the shoulder moves in breast cancer survivors with axillary web syndrome (AWS), we compared 3-dimensional (3D) shoulder kinematics during shoulder elevation among breast cancer survivors with and without AWS 5 years postoperatively. Although research consistently shows decreased shoulder range of motion with AWS, we do not understand the underlying biomechanics. DESIGN Nested case control study. SETTING University Academic Breast Center. PARTICIPANTS Twenty-five women who had surgery 5 years previously for unilateral breast cancer with the removal of at least 1 lymph node participated in this study (N=25). Twelve participants had AWS; 13 women did not have AWS. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Three-dimensional shoulder kinematic data during shoulder forward flexion, scapular plane abduction, and coronal plane abduction were collected using 3D electromagnetic motion tracking. Kinematic data were extracted at 30°, 60°, 90°, and 120° of arm elevation for scapular upward rotation, internal rotation, and posterior tilt as well as for glenohumeral external rotation. RESULTS Women with AWS demonstrated 15.2° less scapular upward rotation at 120° humerothoracic elevation (95% confidence interval [-25.2, -5.2], P=.005), regardless of plane. No significant between-group differences were found for any other angle of scapular upward rotation, nor for scapular internal rotation, scapular posterior tilt, or glenohumeral axial rotation at any angle. CONCLUSIONS Five years after surgery for breast cancer, women diagnosed with AWS have altered scapulohumeral kinematics that may place them at an increased risk of shoulder pain based on existing kinematic literature in healthy cohorts. This information can help guide rehabilitation programs for breast cancer survivors to facilitate pain-free upper extremity function after treatment.
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Affiliation(s)
- Renata Braudy
- Department of Rehabilitation Medicine, Division of Rehabilitation Science, University of Minnesota, Minneapolis, MN.
| | - Brittany Atoms
- Department of Rehabilitation Medicine, Division of Physical Therapy, University of Minnesota, Minneapolis, MN
| | - Jenna Coghlan
- Department of Rehabilitation Medicine, Division of Physical Therapy, University of Minnesota, Minneapolis, MN
| | - Meaghan Staples
- Department of Rehabilitation Medicine, Division of Physical Therapy, University of Minnesota, Minneapolis, MN
| | - David Moga
- Department of Rehabilitation Medicine, Division of Physical Therapy, University of Minnesota, Minneapolis, MN
| | - Ryan Tollefsrud
- Department of Rehabilitation Medicine, Division of Physical Therapy, University of Minnesota, Minneapolis, MN
| | - Rebekah L Lawrence
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO
| | - Paula Ludewig
- Department of Rehabilitation Medicine, Division of Rehabilitation Science, University of Minnesota, Minneapolis, MN; Department of Rehabilitation Medicine, Division of Physical Therapy, University of Minnesota, Minneapolis, MN
| | - Linda Koehler
- Department of Rehabilitation Medicine, Division of Rehabilitation Science, University of Minnesota, Minneapolis, MN; Department of Rehabilitation Medicine, Division of Physical Therapy, University of Minnesota, Minneapolis, MN
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Fuentes-Abolafio IJ, Roldán-Jiménez C, Campos MI, Pajares-Hachero BI, Alba-Conejo E, Cuesta-Vargas A. Forearm Muscle Activity During the Handgrip Test in Breast Cancer Survivors: A Cross-Sectional Study. Clin Breast Cancer 2023; 23:e175-e181. [PMID: 36803839 DOI: 10.1016/j.clbc.2023.01.008] [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: 09/27/2022] [Revised: 01/13/2023] [Accepted: 01/16/2023] [Indexed: 01/21/2023]
Abstract
INTRODUCTION/BACKGROUND Breast cancer survivors (BCS) frequently show upper limb dysfunctions. The forearm muscle activity measured by surface electromyography (sEMG) in this population has not been studied. This study aimed to describe forearm muscle activity in BCS, as well as to assess its possible relationship with other variables related to upper limb functionality and cancer-related fatigue (CRF). MATERIALS AND METHODS A cross-sectional study was carried out including 102 BCS as volunteers at a secondary care in Malaga, Spain. BCS were included if they were aged between 32 and 70 years old, without evidence of cancer recurrence at the time of recruitment. The forearm muscle activity (microvolts, µV) was assessed by sEMG during the handgrip test. The handgrip strength was assessed by dynamometry (kg), the upper limb functionality (%) was measured by the upper limb functional index (ULFI) questionnaire and the CRF was also assessed by revised Piper Fatigue Scale (0-10 points). RESULTS BCS reported reduced forearm muscle activity (287.88 µV) and reduced handgrip strength (21.31 Kg), a good upper limb functionality (68.85%), and a moderate cancer-related fatigue (4.74). Forearm muscle activity showed a poor significant correlation (r = -0.223, P = .038) with the CRF. Handgrip strength showed a poor correlation with the upper limb functionality (r = 0.387, P < .001) and age (r=-0.200, P = .047). CONCLUSION BCS showed a reduced forearm muscle activity. BCS also presented a poor correlation between forearm muscle activity and handgrip strength. Both outcomes tended to lower values with higher levels of CRF, while preserving a good upper limb functionality.
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Affiliation(s)
- Iván José Fuentes-Abolafio
- Departamento de Fisioterapia, Facultad de Ciencias de la Salud, Universidad de Málaga, Andalucia Tech, Málaga, España; Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, Málaga, España
| | - Cristina Roldán-Jiménez
- Departamento de Fisioterapia, Facultad de Ciencias de la Salud, Universidad de Málaga, Andalucia Tech, Málaga, España; Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, Málaga, España.
| | - Marcos Iglesias Campos
- UGCI Oncología Médica Hospitales Universitarios Regional y Virgen de la Victoria Campus de Teatinos, S/N, 29010. Málaga, España
| | - Bella I Pajares-Hachero
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, Málaga, España; UGCI Oncología Médica Hospitales Universitarios Regional y Virgen de la Victoria Campus de Teatinos, S/N, 29010. Málaga, España
| | - Emilio Alba-Conejo
- UGCI Oncología Médica Hospitales Universitarios Regional y Virgen de la Victoria Campus de Teatinos, S/N, 29010. Málaga, España
| | - Antonio Cuesta-Vargas
- Departamento de Fisioterapia, Facultad de Ciencias de la Salud, Universidad de Málaga, Andalucia Tech, Málaga, España; Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, Málaga, España; School of Clinical Science, Faculty of Health Science, Queensland University Technology, Brisbrane, Queensland,Australia
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Leonardis JM, Lulic-Kuryllo T, Lipps DB. The impact of local therapies for breast cancer on shoulder muscle health and function. Crit Rev Oncol Hematol 2022; 177:103759. [PMID: 35868499 PMCID: PMC9706536 DOI: 10.1016/j.critrevonc.2022.103759] [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] [Received: 05/24/2022] [Revised: 07/15/2022] [Accepted: 07/15/2022] [Indexed: 11/19/2022] Open
Abstract
Advances in breast cancer treatment have improved patient survival but have also created complications, such as shoulder morbidity, impacting the patient's quality of life. Local therapies for breast cancer influence shoulder muscle health through changes to the muscular microenvironment, macroscopic muscle morphology, and neuromuscular function. Our findings suggest both surgery and radiation therapy compromise the healthy functioning of shoulder musculature. Mastectomy and post-mastectomy breast reconstruction directly affect shoulder function through muscle morphology and neuromuscular function alterations. Radiation therapy damages satellite cells and myocytes, causing cell death both during treatment and years after recovery. This damage creates an environment limited in its ability to prevent atrophy. However, research to date is limited to a small number of analyses with small experimental populations and a lack of control for covariates. Future research to uncover the pathophysiological mechanisms underlying shoulder morbidity after breast cancer treatment must integrate measures of shoulder muscle health and shoulder function.
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Affiliation(s)
| | | | - David B Lipps
- School of Kinesiology, University of Michigan, Ann Arbor, MI, USA; Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA.
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Bongiorno G, Biancuzzi H, Dal Mas F, Bednarova R, Miceli L. The Rehabilitation Tailor: Applying Personalized Medicine to Cancer Recovery. Front Glob Womens Health 2022; 3:914302. [PMID: 35903486 PMCID: PMC9314649 DOI: 10.3389/fgwh.2022.914302] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 06/16/2022] [Indexed: 11/19/2022] Open
Affiliation(s)
| | - Helena Biancuzzi
- Pain Medicine, IRCCS National Cancer Institute of Aviano, Aviano, Italy
| | - Francesca Dal Mas
- Department of Management, Ca Foscari University of Venice, Venice, Italy
| | - Rym Bednarova
- Pain Medicine, Hospital of Latisana, Latisana, Italy
| | - Luca Miceli
- Pain Medicine, IRCCS National Cancer Institute of Aviano, Aviano, Italy
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Gala-Alarcón P, Prieto-Gómez V, Bailón-Cerezo J, Yuste-Sánchez MJ, Arranz-Martín B, Torres-Lacomba M. Changes in shoulder outcomes using ultrasonographic assessment of breast cancer survivors: a prospective longitudinal study with 6-month follow-up. Sci Rep 2021; 11:23016. [PMID: 34837018 PMCID: PMC8626448 DOI: 10.1038/s41598-021-02379-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 11/15/2021] [Indexed: 11/08/2022] Open
Abstract
This study aimed to describe changes in supraspinatus tendon thickness, acromiohumeral distance, and the presence of fluid in the subacromial bursa as measured by ultrasound, as well as shoulder range of motion and strength, perceived shoulder disability, and health-related quality of life in women before and after breast cancer treatment. Women who underwent surgery for unilateral breast cancer who did not suffer from shoulder pain or difficulty performing activities of daily living in the 6 months prior to surgery were included. One pre-surgical (A0) and three post-surgical assessments at 7-10 days (A1), 3 months (A2), and 6 months (A3) after surgery were carried out. The thickness of the supraspinatus tendon on the affected side decreased between post-surgical (A1) and 6-month (A3) follow-up assessments (p = 0.029), although the minimal detectable change was not reached. The active range of motion of the affected shoulder decreased after surgery. Strength changes were observed in both shoulders after surgery. The intensity of shoulder pain increased between post-surgical and 6-month follow-up assessments. Shoulder function was decreased at the post-surgical assessment and increased throughout the follow-ups. Health-related quality of life declined after surgery. A trend of decreasing thickness of the supraspinatus tendon of the affected shoulder was observed. Detecting these possible structural changes early would allow for early or preventive treatment.
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Affiliation(s)
- Paula Gala-Alarcón
- Physiotherapy in Women's Health (FPSM) Research Group, Physiotherapy Department, Faculty of Medicine and Health Sciences, University of Alcalá, 28805, Madrid, Spain
| | - Virginia Prieto-Gómez
- Physiotherapy in Women's Health (FPSM) Research Group, Physiotherapy Department, Faculty of Medicine and Health Sciences, University of Alcalá, 28805, Madrid, Spain
| | - Javier Bailón-Cerezo
- Physiotherapy in Women's Health (FPSM) Research Group, Physiotherapy Department, Faculty of Medicine and Health Sciences, University of Alcalá, 28805, Madrid, Spain
| | - María José Yuste-Sánchez
- Physiotherapy in Women's Health (FPSM) Research Group, Physiotherapy Department, Faculty of Medicine and Health Sciences, University of Alcalá, 28805, Madrid, Spain
| | - Beatriz Arranz-Martín
- Physiotherapy in Women's Health (FPSM) Research Group, Physiotherapy Department, Faculty of Medicine and Health Sciences, University of Alcalá, 28805, Madrid, Spain.
| | - María Torres-Lacomba
- Physiotherapy in Women's Health (FPSM) Research Group, Physiotherapy Department, Faculty of Medicine and Health Sciences, University of Alcalá, 28805, Madrid, Spain
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