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CLINICAL BOTTOM LINE

Commentary on “Gait Patterns in Children With Cancer and Vincristine Neuropathy”

Pickett, Rasheedah PT, DPT; Wong, Jeremy PT, DPT, PCS

Author Information
Pediatric Physical Therapy: Spring 2016 - Volume 28 - Issue 1 - p 23
doi: 10.1097/PEP.0000000000000220
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“How could I apply this information?”

This study supports that children with chemotherapy-induced peripheral neuropathy (CIPN) walk with decreased velocity and step length. Walking at age-appropriate velocity is frequently a key physical therapy treatment goal, and this relevant study directs the therapist toward addressing the specific gait deviation of decreased step length, as it relates to decreased ankle dorsiflexion range of motion (ROM) and decreased balance.

“What should I be mindful about when applying this information?”

Increasing gait velocity by increasing step length of a child with CIPN bears further investigation. Other relevant distal impairments affect step length, including decreased plantarflexor strength, impaired heel and toe rockers, and heel versus forefoot strike. Velocity also relates to a child's endurance. The 6-Minute Walk Test did not appear to appropriately fatigue these children as both groups increased walking speed posttest. More suitable tests for this population may be a 9 or 12-Minute Walk-Run Test,1 or 20-Meter Shuttle Test.2

Other well-documented adverse complications for this population may also affect gait velocity, including decreased activity level, cardiorespiratory compromise, depression, and decreased psychosocial health.3 In this study, obesity was a complication identified between groups, which may affect velocity. Interdisciplinary care with nutrition, psychology, social work, and pulmonology may better leverage physical therapy intervention. In addition, the amount of vincristine administered widely varied, and a dose-response relationship to CIPN should be clarified, given a variety of cancer stages and chemotherapy protocols.

Children in this study were likely in the maintenance phase of chemotherapy and were functioning at an outpatient level. However, emerging impairments, relating to ankle ROM and gait compensation, may better be addressed in the acute setting, closer to time of diagnosis. Early use of night splints and a stretching home exercise program may better address ankle ROM and prevent significant plantarflexor contractures.4

Rasheedah Pickett, PT, DPT

Jeremy Wong, PT, DPT, PCS

Division of Pediatric Rehabilitation Medicine

Children's Hospital Los Angeles

Los Angeles, California

REFERENCES

1. Drinkard B, McDuffie J, McCann S, Uwaifo GI, Nicholson J, Yanovski JA. Relationships between walk/run performance and cardiorespiratory fitness in adolescents who are overweight. Phys Ther. 2001;81(12):1889–1896.
2. Braam KI, van der Torre P, Takken T, Veening MA, van Dulmen-den Broeder E, Kaspers GJ. Physical exercise training interventions for children and young adults during and after treatment for childhood cancer. Cochrane Database Syst Rev. 2013;4:DC008796.
3. Mishra SI, Scherer RW, Geigle PM, et al. Exercise interventions on health-related quality of life for cancer survivors. Cochrane Database Syst Rev. 2012;8:CD007566.
4. Wong J, Fetters L. Effects of exercise intervention for children with acute lymphoblastic leukemia: a systematic review. Rehabil Oncol. 2014;32(3):40–51.
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