RESEARCH REPORTS: CLINICAL BOTTOM LINE
“How should I apply this information?”
This study highlights the need for physical therapists to continue to monitor and address balance impairments in children with non–central nervous system cancers at least 6 months post-neurotoxic treatment, and likely longer, in order to improve long-term functional outcomes for this population. Although balance scores on the Bruininks-Osteresky Balance subscale (BOT-2) improved posttreatment, they remained below the scores of their age- and gender-matched peers. In addition, this study demonstrates an improvement posttreatment in chemotherapy-induced peripheral neuropathy (CIPN) as measured with the ped-mTNS that is also associated with balance impairment. However, even children who recovered from CIPN continued to have balance impairments. Physical therapists should consider that this may be one of many factors affecting balance in this population.
“What should I be mindful about when applying this information?”
Success in balance tasks requires input and processing by multiple body systems. Other components that are common impairments in children with cancer posttreatment are decreased ankle range of motion, decreased endurance, and decreased proximal muscle strength. Another possible factor that the authors describe is an association between balance impairment and body mass index. The ped-mTNS does measure distal muscle strength, but it does not measure proximal muscles that may factor in some balance tasks. Many children undergoing chemotherapy treatment also receive high-dose steroids, which places them at higher risk of developing weakness in their proximal muscle groups. It would be informative to continue to track these children over time and even into adulthood for more information about how these early factors affect long-term functional outcomes and health.
Melissa Waite, MSPT
Minal Jain, PT, DSc, PCS
Rehabilitation Medicine Department, Clinical Center, National Institutes of Health