Using wearables to screen motor performance deterioration because of cancer and chemotherapy-induced peripheral neuropathy (CIPN) in adults - Toward an early diagnosis of CIPN

Abstract

Objective: An essential component for optimizing quality of life in adults with cancer is determining the degree to which therapy may negatively impact motor-performance, so that patients can maintain their quality of life and independence. This study examined whether instrumented gait and balance could determine the magnitude of deterioration in motor-performance from chemotherapy-induced peripheral neuropathy (CIPN). Methods: We recruited 84 adults with cancer (age = 71.1 ± 9.7 years old, BMI = 26.8 ± 6.2 kg/m 2 , gender = 56%female) and 57 age-matched non-cancer patients (age = 69.5 ± 9.8 years old, BMI = 27.1 ± 6.0 kg/m 2 , gender = 79%female). Based on clinical screening, the group with cancer was classified into two groups: participants with CIPN (CIPN+) and without CIPN (CIPN-). Gait and balance were quantified using validated wearables. The Vibration Perception Threshold (VPT) test was used to stratify the CIPN+ group into mild (Mild-CIPN) and severe (Severe-CIPN) subgroups. Results: All gait and balance parameters were deteriorated in the group with cancer compared to noncancer group with the largest effects observed for stride-time (11%, Cohen's effect size d = 1.00, p < 0.001) and eyes-closed ankle sway (94%, d = 0.49, p = 0.001). The same trend was observed when the Severe-CIPN subgroup was compared to the Mild-CIPN. VPT correlates significantly with motor deterioration, with the largest correlation found in stride-time (Rho = 0.37, p = 0.007). Severe-CIPN subjects were significantly older and overall had more deterioration in the majority of motor-performance parameters after adjusting for age (p < 0.050). Conclusion: These results confirmed the negative impact of CIPN on motor-performance with the largest effects on ankle stability and stride-time. VPT is a predictor of motor deterioration and may be used to determine the severity of CIPN symptom.

Daily Use of Bilateral Custom‐Made Ankle‐Foot Orthoses for Fall Prevention in Older Adults: A Randomized Controlled Trial

“…Also, our previous study revealed a significant reduction in ankle sway (an indicator of ankle stability) and center of mass sway (an indicator of postural control) compared to baseline and compared to the CG in response to daily use of AFOs . Prior studies have suggested that reduction in fear of falling and postural sway are linked to lower fall risk in older adults . Additionally, the high adherence and the high acceptability of AFOs reported in our previous study could be an important factor that contributed to converting the improvement in the balance and fear of falling to an actual reduction in falls.…”

“…23 Prior studies have suggested that reduction in fear of falling and postural sway are linked to lower fall risk in older adults. [34][35][36] Additionally, the high adherence and the high acceptability of AFOs reported in our previous study 23 could be an important factor that contributed to converting the improvement in the balance and fear of falling to an actual reduction in falls.…”

Sensor-Based Daily Physical Activity: Towards Prediction of the Level of Concern about Falling in Peripheral Neuropathy

“…In order to assess the severity of PN, we measured vibration perception threshold (VPT) in the plantar surface of the foot (the first and fifth metatarsal heads, and the heel) using a standard biothesiometer (Bio-Medical Instrument, Newbury, Ohio, United States) as performed in previous studies [23][24][25][26][27]. Briefly, the probe of the biothesiometer was placed on the plantar surface of the foot, and electrical vibration was gradually increased from 0 volts until participants felt the electrical vibration.…”

Role of Kinematics Assessment and Multimodal Sensorimotor Training for Motion Deficits in Breast Cancer Chemotherapy-Induced Polyneuropathy: A Perspective on Virtual Reality Avatars

“…Providing a richer depiction of patient's motion parameters, the next level in CIPN sensorimotor rehabilitation focuses on the use of wearable sensors in physical training (8,17,19). Such an approach is an inexpensive, robust, and efficient method to screen motor performance deterioration by assessing spatio-temporal parameters of gait and balance [as shown by (8,18)]. Extending the range of wearable rehabilitation modalities, whole-body vibration (WBV) training, has proven to attenuate sensorimotor deficits by de-conditioning skeletal muscles in order to reduce fall frequency (9).…”

“…Wearable sensors (8) Sensorimotor balance training (9) Specialized physical exercise training (10-13) Physiotherapy (14,15) Joint stabilizers and orthotics (16) Impact and vibration training (17,18) Closed kinematic chain exercise (19) Visual computer-feedback balance training (20,21) Transcutaneous electrical stimulation (22) These studies have laid the foundation for using technology in assessing, monitoring and controlling sensorimotor deficits associated with CIPN. Yet, none of them considered wholebody kinematic assessment of deficits and closed-loop deficit compensation.…”