Balance in children with acute lymphoblastic leukemia

Abstract

Although heterogeneity between the studies regarding patient age; age at diagnosis; time since completion of treatment; and methods of quantifying balance make it difficult to reach a single conclusion, the evidence suggests that survivors may experience short- and/or long-term balance difficulties. While there is a need for additional studies to better understand the effects of impaired balance in survivors, clinicians treating both child and adult survivors of ALL need to be aware of these potential risks.

Sensory conflict as a possible reason for disturbed postural stability in the children treated for cancer

“…Disturbed postural resistance is a common finding among the patients treated for cancer doseases, regardless of their exact nosological forms. Researchers describe imbalances in children treated for brain tumors [1,2] and leukemia [3], in adult people treated for lung cancer [4], breast cancer [5], leukemia, lymphomas and other solid tumors [6], etc. According to evidence-based studies meta-analyses, the percentage of leukemia survivors with disturbed postural equilibrium ranged from 27% to 69% during the treatment, being 7% to 65% at later observation terms (over 5 years)…”

“…following the cytostatic therapy [6]. For children treated for medulloblastoma, the development of posterior cranial fossa syndrome is characteristic which may manifest with acute postural imbalance.…”

“…However, imbalance signs in pediatric cancer patients without evident brain lesions suggest some other possible causes of postural instability. A number of researchers attribute postural imbalance to the late toxic effects of radiation therapy [6], or consequences of chemotherapy [7]. In the literature, we have encountered only a few studies on the mechanisms of impaired postural stability in the cancer patients.…”

Physical training interventions for children and teenagers affected by acute lymphoblastic leukemia and related treatment impairments

“…In order to maintain balance, any person needs information from three different sensory systems: visual, somatosensory, and vestibular. Postural control, the ability to control the position and orientation of the body in space is a requirement for maintaining balance during different activities [ 83 , 84 ]. Information about balance is an important component of the assessment of motor skills in children, primarily because of its impact on functional abilities such as play, recreation and activities of daily living.…”

Balance deficits in long-term pediatric ALL survivors

“…The treatment for acute lymphoblastic leukemia (ALL) can impair all of these body systems resulting in difficulties with movement and balance [2]. As adequate balance is a prerequisite for stabilizing the body in upright positions during voluntary movements, deficits in balance may help explain why childhood ALL survivors have lower physical activity levels and lower participation rates in sports [3, 4].…”