Effects of Peripheral Neuropathy on Sensory Interactions for Balance in Children Undergoing Chemotherapy: Preliminary Results

Tory Gross, SPT and Kyle Behl, SPT

DPT2019 Peripheral Neuropathy Peds Sensory Gross Behl.jpg

(Click on image to expand)

19 Comments on “Effects of Peripheral Neuropathy on Sensory Interactions for Balance in Children Undergoing Chemotherapy: Preliminary Results

  1. Tory and Kyle,

    I would like to commend you on the organization and readability of your poster. The question I have for you is regarding your methods. How long did each participant complete each of the balance conditions?

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    • Hi Courtney, thanks for the question! We used the Bertec BalanceCheck software for this test. Each child performed 3 trials of 10 seconds for each of the four conditions. The average of the trials was then used for analysis.

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  2. Nice job of presenting your research in a poster form. I thought the flow of the poster was easy to follow. I was wondering during your research process if you found literature in favor of your hypothesis? Also, with kids undergoing chemo are they offering PT services to help with balance?

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    • While we were able to find quite a bit of literature on the topic of chemotherapy-induced peripheral neuropathy in the pediatric population, there is not much out there (at least that we found) at the moment that focuses on its effects on balance specifically. That is actually the reason we chose the hypothesis we did – because there is such a significant amount of literature that supports our hypothesis in the adult population. As for your second question, the topic of CIPN in pediatric cancer patients is still lacking research and it is not something that is being screened for routinely after children have gone through treatment. Therefore, a lot of these kids are not being referred for PT services after undergoing chemotherapy treatment.

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  3. Great job presenting this information. When looking at balance in general, I was wondering if strength or ROM of the ankle would impact these results? I wasn’t sure if you collected this data but was curious what your thoughts were on how this could have skewed the results of each balance test?

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  4. Good question Allison, we did measure dorsiflexion strength with a handheld dynamometer as well as measuring ankle plantarflexion and dorsiflexion PROM. Dorsiflexion ROM was also measured with the knee flexed and extended to measure if gastrocnemius length was a factor. Since the study focused more on the relationship between the pedmTNS and BERTEC LOS/sway we did not directly look at these variables in relation to strength or ROM. I definitely think strength and/or ROM could influence the balance testing and in our literature review we found that typically dorsiflexion is weak and dorsiflexion ROM tends to be limited in those with peripheral neuropathy. With our participants I think that all had at least functional strength and ROM with possibly the exception of one participant who had quite a restriction into dorsiflexion. Despite this restriction, the participants balance testing didn’t appear to be limited compared to our other participants. If we would have had a larger sample size and individuals who had higher levels of peripheral neuropathy I feel we would have found larger deficits in ROM and strength which in theory would have translated to poorer scoring on our balance testing. So with a long reply to your question, strength and ROM deficits could “skew” our data but we kind of expected it to.

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  5. I think this topic will be really important clinically as we start to see more and more patients dealing with the long term effects of cancer treatments. Great job presenting your findings! I liked your choice of pictures showing your methods. My question is related to the age of your sample size. Did it appear that different ages had different or more severe deficits? I was wondering if you found anywhere in the literature that discussed at what age might or if the PN becomes permanent or irreversible?

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    • Hey Kristen, good questions. We did not find any distinguishable differences in severity of neuropathy between age groups, but it is important to note that severity of neuropathy was only mild (2.25) and our sample size only consisted of 4 kids. This made it difficult to draw any generalizations from this population. Due to the fact that the actual prevalence of CIPNs in the pediatric cancer populations is not known, given a lack of adequate standardized assessment, measurement, and reporting and because most of the literature on CIPN in the pediatric population is relatively recent, there have not been any longitudinal studies to follow these kids to determine if effects are irreversible or at what age it may be become permanent. What I think is relevant about this research when we are talking about things becoming permanent is that even if symptoms resolve, some of the children we tested are at an age where they are still developing and learning to develop balance strategies. Therefore, if children are experiencing symptoms of CIPN during this time it could alter the way they learn those strategies.

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  6. Lovely presentation poster! Truly well put together! I just had a quick question, in regards to what you both saw in your observations of the testing. Did you notice any difference in strategies between your control group and the group who received the chemotherapy treatments? I know different strategies (ankle, hip, and stepping) all appear at different ages but I was curious if you saw a dominance of one strategy within the DG group over the CG? Or were the different strategies fairly comparable between groups?

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    • Hey Haley,

      At least from my perspective, strategies seemed fairly comparable between groups. If we would have had more subjects, it might have been easier to observe noticeable differences between the two groups. We also were not specifically measuring/analyzing different strategies. For instance, I was running the software and was not always watching the subjects and the strategies they were using. It would be of interest to video record each individual to then compare strategies.

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  7. Awesome job! As you stated, there is research and literature that supports this in the adult population. This may be because it’s easier to recruit adults for research than it is for children. I am wondering what processes/procedures your group used to recruit children to participate in your research and what struggles and challenges you faced targeting the pediatric population. Also, did you stumble across any ways or tips to increase participation/recruits from the pediatric population?

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    • Hey Hailey! Thanks for the question. Subjects were recruited through invitations distributed by oncologists in the region, poster and Facebook advertisements, and word of mouth. As you noted, it’s very difficult to recruit children for research, especially when these kids are going through chemotherapy treatment and are being put through so much already. I think physicians were also hesitant to distribute our invitations due to confidentiality concerns and issues with IRB logistics. Because we had trouble recruiting, we actually added a $50 incentive for participants, so that’s a possibility to improve recruitment! Otherwise, do whatever you can to get the word out, as it’s hard to rely on other people distributing things for you. Use whatever resources/contacts you have and personally talk to people about your research.

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    • Hi Hailey,

      We distributed a handout to physicians and physical therapists at the Sanford Childrens Hospital to recruit children receiving chemotherapy. We created an advertisement that was distributed across a variety of local support groups. The control group was a sample of convenience. We initially had only a few children to volunteer, Dr. Berg-Poppe was fortunate enough to receive some funding to encourage additional volunteers which I think did help. I feel when attempting to get pediatric volunteers is likely harder compared to adults as parents maybe hesitant to enroll their children into a research study. On top of that with our population receiving chemotherapy for cancer treatment to ask the family to give up half of their Saturday may also have been another struggle limiting overall recruitment.

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  8. The results table is clear, concise, and easy to follow. I was wondering how valid and reliable the force plate and P-CTSIB are. You mentioned high reliably and validity for the ped-mTNS in your discussion. Does this reliability span across all ages as well?

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    • Hi Eric,

      Good question Eric, I couldnt find specifics on validity and reliability of the Bertec force plate however I believe the device is the standard in finding postural sway and LOS. The p-CTSIB interrater and test-retest reliabilty were .90 and .78 respectively. The validity was .68. The ped-mTNS is just a modified version specifically for use in pediatrics. There would be an mTNS which would be utilized for adults.

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  9. The purpose of your study is reflected effectively in your results. A question I have is related to the subject selection. Were the participants in both groups matched for activity level? A thought I had while reading the study is that the individuals undergoing chemotherapy may be receiving physical therapy to improve expected deficits that may be seen from using chemotherapy.

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    • Hey Carl! That is a good question. To our knowledge, none of the children in the control group were receiving physical therapy intervention. However, none of our participants were matched for or asked about activity level so this could have biased our results. This is a good question and should be considered for future research.

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  10. Excellent poster, just a couple questions for you! One question I had in regards to the data collection, was there any interference with data collection in regards to the population of the study (kids), such as boredom, confusion, or fatigue? Next, as you stated there were findings that were not expected in regards to your hypothesis. What do you guys believe is the reasoning for the findings from the study? Thanks!

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    • Hi Jacob,

      I feel that the duration of the testing definitely could have influenced the results. We performed our testing but another group also performed testing on the kids. Each child was involved with testing for roughly two hours which definitely could have resulted in some fatigue. With all children overall attention could also be a limiting factor when participating in research. In particular, children undergoing chemotherapy treatment are also prone to develop cognitive deficits especially ADD.

      A few things could explain our unexpected results. We did have a very small sample and with our “diagnostic group” who recieved chemotherapy the participants had very mild peripheral neuropathy if any. We likely just didnt get a large enough population with moderate to severe peripheral neuropathy to see the expected results. Also, we assumed our “control” group was a representation of the normal population although as they were a sample of convenience they could have been worse than “normal.”

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