A new approach to characterize postural deficits in chemotherapy-induced peripheral neuropathy and to analyze postural adaptions after an exercise intervention

Kneis, Sarah; Wehrle, Anja; Dalin, Daniela; Wiesmeier, Isabella Katharina; Lambeck, Johann; Gollhofer, Albert; Bertz, Hartmut; Maurer, Christoph

doi:10.1186/s12883-019-1589-7

Cited by 13 publications

(31 citation statements)

References 71 publications

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“…Characterization of spontaneous postural sway in cancer survivors with CIN reveals postural instability. Nine studies compared the spontaneous sway of cancer survivors to that of healthy controls when standing with eyes open [ 21 , 24 – 30 ]. Sway amplitude, including the root mean square (RMS) of the resultant sway [ 30 ], the mediolateral (ML) sway [ 25 , 29 ], and the total sway area [ 25 , 26 , 28 ] were greater in cancer survivors than healthy controls.…”

Section: Resultsmentioning

confidence: 99%

“…Nine studies compared the spontaneous sway of cancer survivors to that of healthy controls when standing with eyes open [ 21 , 24 – 30 ]. Sway amplitude, including the root mean square (RMS) of the resultant sway [ 30 ], the mediolateral (ML) sway [ 25 , 29 ], and the total sway area [ 25 , 26 , 28 ] were greater in cancer survivors than healthy controls. Sway velocity, including the mean velocity of ML sway [ 25 , 28 ] and mean velocity of the resultant sway [ 24 ] were also greater in cancer survivors than that in controls.…”

Section: Resultsmentioning

confidence: 99%

“…This evidence suggests that cancer survivors with CIN are unstable in standing. Among the eight studies that investigated direction-dependent sway characteristics, seven identified ML sway deficits (RMS, velocity, and frequency) [ 25 , 27 – 29 , 31 – 33 ], whereas two also identified AP deficits [ 30 , 33 ], suggesting that cancer survivors may be more unstable in frontal balance control. Impaired ML sway has been shown to be an important predictor of retrospective and prospective falls in older adults [ 34 – 36 ].…”

Section: Resultsmentioning

confidence: 99%

“…The greater weighting of the visual system by cancer survivors suggests potential deficits in the somatosensory and/or vestibular systems. Kneis et al 2020 ruled out potential vestibular dysfunction via the rotational chair test [ 30 ]. They further dissociated the relative weighting of somatosensory and vestibular systems in postural control by perturbing standing posture using a tilting platform and measuring the subsequent excursions of the upper (shoulder-hip) and lower (hip-ankle) body and center of pressure displacements.…”

Section: Resultsmentioning

confidence: 99%

“…To begin to address these outstanding issues, researchers and clinicians should work in concert to integrate and act upon objective measures deployed across the cancer treatment continuum. While this review characterized significant heterogeneity in evaluative tools and methodology for understanding CIN-related movement dysfunction, Kneis et al provide a framework on which to build future clinical studies [ 30 ]. By integrating more sensitive and reliable tools, the authors not only gained information about baseline group level deficits resulting from the effects of chemotherapy but also the capability to precisely monitor treatment effects.…”

Section: Discussionmentioning

confidence: 99%

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A review of movement disorders in chemotherapy-induced neurotoxicity

Wang

Housley

Flores

et al. 2021

J NeuroEngineering Rehabil

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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.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

A review of movement disorders in chemotherapy-induced neurotoxicity

Wang

Housley

Flores

et al. 2021

J NeuroEngineering Rehabil

View full text Add to dashboard Cite

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Type of exercise may influence postural adaptations in chemotherapy‐induced peripheral neuropathy

Kneis

Wehrle

Müller

et al. 2021

Ann Clin Transl Neurol

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Objective Traditional posturography measurements characterize postural instability in patients with chemotherapy‐induced peripheral neuropathy (CIPN), while underlying postural control mechanisms remain unclear. Taking a model‐based approach can yield insights into these mechanisms. This study’s aim was to characterize the modifications in postural control of CIPN patients associated with exercise in relation to the postural behavior of healthy control participants (hCON) via an exploratory approach. Methods Thirty‐one CIPN patients were randomly assigned to two interventions (balance plus moderate endurance training vs. moderate endurance training only) and exercised twice per week over 12 weeks. Baseline data were compared to 36 matched hCONs. We recorded spontaneous sway and postural reactions to platform tilts using Optotrak and a Kistler force platform pre‐ and post‐intervention. Data interpretation relied on a model‐based parameter identification procedure. Results Spontaneous sway amplitudes were larger and postural reactions smaller, with a relative phase advance, in our pre‐intervention patients than the hCONs. Post‐intervention, spontaneous sway, and postural reactions were reduced and the sensory‐motor ratio larger in both groups, while the postural reaction timing differed between groups. Interpretation The abnormally small postural reactions in CIPN patients before the intervention can be interpreted as the consequence of abnormally strong velocity control—a strategy modification that may serve as a prediction mechanism to compensate for the lack of timely and accurate proprioceptive signals. While both groups reduced postural sway and showed an adapted sensory‐motor ratio post‐intervention, the interventions seemed to trigger different velocity control strategies. This study emphasizes the need for taking a more differentiated perspective on intervention effects. Trial registration German Clinical Trials Register (DRKS) number: DRKS00005419, prospectively registered on November 19, 2013.

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