Fig 2 - uploaded by Ramona Ritzmann
Content may be subject to copyright.
COP displacements during (a) bipedal (BS) and (b) monopedal stance (MS) of one representative subject of CON (top) and PAT (bottom). Both subjects showed an increase in COP displacement from BS to MS, more pronounced in PAT.
Source publication
Objective:
Chemotherapy-induced peripheral neuropathy (CIPN) is a common side effect of cancer treatment. Resulting sensory and motor dysfunctions often lead to functional impairments like gait or balance disorders. As the underlying neuromuscular mechanisms are not fully understood, we compared balance performance of CIPN patients with healthy co...
Similar publications
![Abbildung 1.1: Verarbeitungsmechanismus nach Wickens [15, S. 502]](profile/Bettina-Wollesen/publication/310447865/figure/fig1/AS:429335761952768@1479373030835/Abbildung-11-Verarbeitungsmechanismus-nach-Wickens-15-S-502_Q320.jpg)
In der Arbeitswelt 4.0 müssen Benutzeroberflächen für eine fehlerfreie und ergonomische Interaktion zwischen Mensch und Maschine so gestaltet werden, dass sie an die Fertigkeiten und Fähigkeiten des Menschen angepasst sind. Die Wahrnehmung und Verarbeitung vorhandener Reize sowie eine reaktive Bewegungsplanung und Durchführung des Menschen ist für...
Humans excel at recognizing (or inferring) another's distal intentions, and recent experiments suggest that this may be possible using only subtle kinematic cues elicited during early phases of movement. Still, the cognitive and computational mechanisms underlying the recognition of intentional (sequential) actions are incompletely known and it is...
Human survival requires quick and accurate movements, both with and without tools. To overcome the sensorimotor delays and noise, the brain uses internal forward models to predict the sensory consequences of an action. Here, we investigated whether these sensory predictions are computed similarly for actions involving hand-held tools and natural ha...
Anticipatory load forces for dexterous object manipulation in humans are modulated based on visual object property cues, sensorimotor memories of previous experiences with the object, and, when digit positioning varies from trial to trial, the integrating of this sensed variability with force modulation. Studies of the neural representations encodi...
Ideomotor approaches to action control have provided evidence that the activation of an anticipatory image of previously learned action-effects plays a decisive role in action selection. This study sought for converging evidence by combining three previous experimental paradigms: the response–effect compatibility protocol introduced by Kunde (Journ...
Citations
... Additionally, various muscular signs have been documented in up to 62% [22], including muscle weakness (51.5%) [23], foot cramps (29.4%) [8], and stiffness (12.1%) [23]. More generally, muscular disorders associated to CIPN can lead to functional motor impairments, such as gait and balance abnormalities [24], impaired fine motor skilled [25], falls [9], and limitations in activities of daily living (such as shopping, walking, performing light housework, and bathing) [9]. ...
Purpose
Sensory chemotherapy-induced peripheral neuropathy (CIPN) is well-recognized, but motor CIPN remains understudied. This secondary analysis focused on the long-term severity and impact of motor disorders, their relation to sensory CIPN, neuropathic pain, psychological distress, and health-related quality of life (HRQoL) after oxaliplatin-based chemotherapy in colorectal cancer (CRC) survivors.
Methods
Data from a multicenter, cross-sectional study were re-analyzed to explore motor CIPN among CRC survivors up to 5 years post-chemotherapy, with no longitudinal follow-up. Questionnaires assessed sensory and motor CIPN (QLQ-CIPN20), neuropathic pain (DN4), anxiety and depression (HADS), and HRQoL (QLQ-C30).
Results
Among 405 CRC survivors, 31.1% had sensory CIPN as previously described. When categorizing the 405 CRC survivors based on the years since their last oxaliplatin-based chemotherapy, the motor scores derived from the QLQ-CIPN20 showed no significant difference between years (p = 0.08). Motor CIPN scores correlated with female gender, higher oxaliplatin dose intensity, sensory CIPN, and neuropathic pain. Motor CIPN also linked to decreased HRQoL and increased psychological distress.
Conclusion
The study underscores the detrimental impact of motor disorders on CRC survivors post-oxaliplatin-based chemotherapy. Oncologists should prioritize assessing and managing motor manifestations alongside sensory symptoms to enhance post-cancer quality of life.
Trial registration: NCT02970526 (2016-11-22). https://classic.clinicaltrials.gov/ct2/show/NCT02970526?term=NCT02970526&draw=2&rank=1.
... [28]. Sensorimotor training has the potential to influence balance-related issues [29]. Further research is needed to confirm the observation that general exercise can help to preserve sensory nerve function [7]. ...
... Balance training enhances postural control by facilitating neuronal adaptation and increasing muscular output [31]. In individuals with CIPN, postural instability is associated with higher co-contraction of antagonistic muscles [29]. Providing balance exercises can aid in reducing co-contractions which compensate for sensory deficits. ...
Background
Chemotherapy-induced peripheral neuropathy (CIPN) is an adverse effect of frequently used chemotherapy agents in cancer treatment. It is a painful and dose-limiting condition of the peripheral nerves. Exercise is known to limit the progression of CIPN and reduce sensory and motor symptoms. CIPN can be disabling as it leads to loss of balance control, gait disturbances and frequent falls. The study aims to review the effectiveness of different exercise interventions in improving gait speed and postural control in individuals who underwent chemotherapy.
Method
Randomized controlled trials assessing the effect of exercise on postural control and gait are selected. A search strategy was performed in PubMed, PEDro, Scopus, and Web of Science databases. Data were extracted using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines.
Result
A total of 1450 search results were found, and 4 studies were selected. Exercises like endurance training, balance exercises and sensorimotor training are beneficial in CIPN for reducing postural sway and increasing gait speed. Twice weekly sessions for 30 min each for 4–18 weeks are common exercise regime given to the participants. A combination of more than one type of exercise was shown to be effective in reducing CIPN symptoms.
Conclusion
Exercise is beneficial in improving the postural control and gait parameters in individuals with CIPN. Further studies are required to analyze the potential effect of different exercises to improve gait and balance.
... Most studies reporting mobility impairments due to CIPN have multiple limitations: cross-sectional design, reliance on complex measures that are impractical to capture in a clinic setting, and lack of power to capture falls. Moreover, these studies do not examine heterogeneity across patients, which may be central to identifying patients at greatest risk for poor outcomes [4,15,16]. Longitudinal studies reporting trajectories of CIPN symptoms and mobility deficits have been conducted, but none have linked mobility impairments to falls or the onset of disability [17,18]. Additionally, it remains unknown when CIPN symptoms become severe enough to impair functioning and increase fall risk. ...
Background
Chemotherapy-induced peripheral neuropathy (CIPN) is a debilitating and dose-limiting side effect of systemic cancer therapy. In many cancer survivors, CIPN persists after treatment ends and is associated with functional impairments, abnormal gait patterns, falls, and diminished quality of life. However, little is known regarding which patients are most likely to develop CIPN symptoms that impair mobility and increase fall risk, when this risk develops, or the optimal timing of early intervention efforts to mitigate the impact of CIPN on functioning and fall risk. This study will address these knowledge gaps by (1) characterizing trajectories of symptoms, functioning, and falls before, during, and after treatment in adults prescribed neurotoxic chemotherapy for cancer; and (2) determining the simplest set of predictors for identifying individuals at risk for CIPN-related functional decline and falls.
Methods
We will enroll 200 participants into a prospective, observational study before initiating chemotherapy and up to 1 year after completing chemotherapy. Eligible participants are aged 40–85 years, diagnosed with stage I-III cancer, and scheduled to receive neurotoxic chemotherapy. We perform objective assessments of vibratory and touch sensation (biothesiometry, tuning fork, monofilament tests), standing and dynamic balance (quiet stance, Timed-Up-and-Go tests), and upper and lower extremity strength (handgrip dynamometry, 5-time repeated chair stand test) in the clinic at baseline, every 4–6 weeks during chemotherapy, and quarterly for 1 year post-chemotherapy. Participants wear devices that passively and continuously measure daily gait quality and physical activity for 1 week after each objective assessment and self-report symptoms (CIPN, insomnia, fatigue, dizziness, pain, cognition, anxiety, and depressive symptoms) and falls via weekly electronic surveys. We will use structural equation modeling, including growth mixture modeling, to examine patterns in trajectories of changes in symptoms, functioning, and falls associated with neurotoxic chemotherapy and then search for distinct risk profiles for CIPN.
Discussion
Identifying simple, early predictors of functional decline and fall risk in adults with cancer receiving neurotoxic chemotherapy will help identify individuals who would benefit from early and targeted interventions to prevent CIPN-related falls and disability.
Trial registration
This study was retrospectively registered with ClinicalTrials.gov (NCT05790538) on 3/30/2023.
... [16][17][18] The sensory and motor nerve changes due to CIPN have been shown to negatively affect physical function, such as muscle strength, 19 gait velocity, 20,21 and balance function in patients with cancer. 20,22,23 Of major concern is the high risk of falls in patients with CIPN during or after chemotherapy. [24][25][26] Falls among older patients with cancer treated with neurotoxic chemotherapy may have more severe consequences, such as fractures, than falls among older patients without cancer. ...
... 27 Previous studies have found that patients with CIPN have an increased risk of falls and deterioration of physical function. [19][20][21][22]25,26,28 However, other studies have failed to show that CIPN is significantly associated with fall risk. 24,29 Similarly, previous studies found no statistically significant association between CIPN and physical dysfunction. ...
Background
This systematic review and meta-analysis aimed to determine whether chemotherapy-induced peripheral neuropathy (CIPN) affects the risk of falls and physical function in patients with cancer.
Methods
A literature search was conducted in the CINAHL, Scopus, and PubMed databases for articles published from January 1950 to April 2022. Seven review authors retrieved studies using predetermined eligibility criteria, extracted the data, and evaluated the quality.
Results
Nine studies were included in the analysis. Patients with CIPN had a significantly higher risk of falls than those without CIPN (risk ratio = 1.38, 95% confidence interval [CI] =1.18-1.62). Patients with CIPN had lower grip strength (standardized mean difference [SMD] =−0.42, 95% CIs = −0.70 to −0.14, P = .003), longer chair stand time (SMD = 0.56, 95% CIs = −0.01 to 1.17, P = .05), worse timed up and go test time (SMD = 0.79, 95% CIs = 0.41 to 1.17, P < .0001), and lower mean Fullerton Advanced Balance scale score (SMD = −0.81, 95% CIs = −1.27 to −0.36, P = .005) than patients without CIPN. There were no significant differences in gait speed ( P = .38) or Activities-specific Balance Confidence Scale score ( P = .09) between patients with and without CIPN.
Conclusions
This systematic review and meta-analysis demonstrated that patients with CIPN are prone to falls and impaired balance function and muscle strength.
... At the end of the determined period, the performance is determined (Hrysomallis, 2011). Previous studies show that enhanced postural skills are accompanied by neuromuscular adaptations (Kneis et al., 2016;Taube et al., 2007;Zech et al., 2010). It is recommended to use balance exercises for postural and neuromuscular control improvements (Zech et al., 2010). ...
Neuromuscular activity also increases as we try to maintain our balance. Neuromuscular activity also causes changes in heart-rate-variability parameters. In the measurement of heart-rate-variability, recordings are generally taken for 5-minutes or longer. However, in recent years, ultra-short-term heart-rate-variability measurements from 5-minutes to 10-seconds have been made, especially in physical capacity measurement. The aim of the present study is to compare the heart-rate-variability parameters between the groups formed according to the performance before, during and, after the dynamic balance test. The sixty-three healthy males were recruited (age=25.8±3.3 years; height=176.6±5.5; weight=77.6±8.0) participated voluntarily. Heart-rate-variability was recorded for 60-seconds prior to testing. Afterwards, the participants were taken to the platform without shoes.Heart-rate-variability was recorded for 60-seconds at this time and 60-seconds at the end of the test. At the end of the balance test, according to the test procedure of the balance device, those who could stay in the A, B, C, D regions the most, that is, in the region closest to the center point, were grouped as the 1st group (n=38) and the others as the 2nd group (n=25). As a result of the study, a statistically significant difference was found between the groups in terms of heart rate variability changes for normalized low-frequency and normalized high-frequency significant differences were found between which groups (p<0.05). As a result, it was concluded in our study that participants with better balance skills had higher heart-rate-variability values. Considering that heart rate variability is also an indicator of fatigue, we can say that the implementation of exercises aimed at improving balance skills will contribute to the autonomic nervous system of the athletes.
... The proprioceptors' signal carries velocity information relying on changes in lengths (tendons or muscles) or the joint angles that are primarily used to control motion accurately (Allum et al., 1998;Dietz, 2002;Masani et al., 2003;Shaffer and Harrison, 2007). Because of their proprioceptive deficit, PNP patients often suffer from postural instability, which manifests in balance problems (Horlings et al., 2008;Sawacha et al., 2009;Brown et al., 2015;Kneis et al., 2016Kneis et al., , 2020bMustapa et al., 2016) and gait disturbances (Allet et al., 2008;Sawacha Step time (s) F = 32.70 p < 0.001 F = 122.86 p < 0.001 F = 0.06 p = 0.942 ...
Introduction
Gait disturbances are a common consequence of polyneuropathy (PNP) and a major factor in patients’ reduced quality of life. Less is known about the underlying mechanisms of PNP-related altered motor behavior and its distribution across the body. We aimed to capture whole body movements in PNP during a clinically relevant mobility test, i.e., the Timed Up and Go (TUG). We hypothesize that joint velocity profiles across the entire body would enable a deeper understanding of PNP-related movement alterations. This may yield insights into motor control mechanisms responsible for altered gait in PNP.
Methods
20 PNP patients (61 ± 14 years) and a matched healthy control group (CG, 60 ± 15 years) performed TUG at (i) preferred and (ii) fast movement speed, and (iii) while counting backward (dual-task). We recorded TUG duration (s) and extracted gait-related parameters [step time (s), step length (cm), and width (cm)] during the walking sequences of TUG and calculated center of mass (COM) velocity [represents gait speed (cm/s)] and joint velocities (cm/s) (ankles, knees, hips, shoulders, elbows, wrists) with respect to body coordinates during walking; we then derived mean joint velocities and ratios between groups.
Results
Across all TUG conditions, PNP patients moved significantly slower (TUG time, gait speed) with prolonged step time and shorter steps compared to CG. Velocity profiles depend significantly on group designation, TUG condition, and joint. Correlation analysis revealed that joint velocities and gait speed are closely interrelated in individual subjects, with a 0.87 mean velocity ratio between groups.
Discussion
We confirmed a PNP-related slowed gait pattern. Interestingly, joint velocities in the rest of the body measured in body coordinates were in a linear relationship to each other and to COM velocity in space coordinates, despite PNP. Across the whole body, PNP patients reduce, on average, their joint velocities with a factor of 0.87 compared to CG and thus maintain movement patterns in terms of velocity distributions across joints similarly to healthy individuals. This down-scaling of mean absolute joint velocities may be the main source for the altered motor behavior of PNP patients during gait and is due to the poorer quality of their somatosensory information.
Clinical Trial Registration
https://drks.de/search/de, identifier DRKS00016999.
... is a ratio of the activity produced in agonist v. antagonist muscles of the leg that provides unique insight into neuropathy effects [99]. We calculate this ratio from electromyographic (EMG) signals of the tibialis anterior, gastrocnemius, and soleus muscles. ...
Background
Breast cancer (BC) is among the most common forms of cancer experienced by women. Up to 80% of BC survivors treated with chemotherapy experience chemotherapy-induced neuropathy (CIN), which degrades motor control, sensory function, and quality of life. CIN symptoms include numbness, tingling, and/or burning sensations in the extremities; deficits in neuromotor control; and increased fall risk. Physical activity (PA) and music-based medicine (MBM) are promising avenues to address sensorimotor symptoms. Therefore, we propose that we can combine the effects of music- and PA-based medicine through neurologic dance training (NDT) through partnered Adapted Tango (NDT-Tango). We will assess the intervention effect of NDT-Tango v. home exercise (HEX) intervention on biomechanically-measured variables. We hypothesize that 8 weeks of NDT-Tango practice will improve the dynamics of posture and gait more than 8 weeks of HEX.
Methods
In a single-center, prospective, two-arm randomized controlled clinical trial, participants are randomly assigned (1:1 ratio) to the NDT-Tango experimental or the HEX active control intervention group. Primary endpoints are change from baseline to after intervention in posture and gait. Outcomes are collected at baseline, midpoint, post, 1-month follow-up, and 6-month follow-up. Secondary and tertiary outcomes include clinical and biomechanical tests of function and questionnaires used to compliment primary outcome measures. Linear mixed models will be used to model changes in postural, biomechanical, and PROs. The primary estimand will be the contrast representing the difference in mean change in outcome measure from baseline to week 8 between treatment groups.
Discussion
The scientific premise of this study is that NDT-Tango stands to achieve more gains than PA practice alone through combining PA with MBM and social engagement. Our findings may lead to a safe non-pharmacologic intervention that improves CIN-related deficits.
Trial registration
This trial was first posted on 11/09/21 at ClinicalTrials.gov under the identifier NCT05114005.
... Signs of anxiety, concentration disturbance, and depression have expressed the emotional function. The comforting environment patients requested were a bed, chair, and relaxing environment during chemotherapy because they sensed increased simultaneous antagonistic muscle activation (Kneis et al., 2016). Moreover, drug-induced immune thrombocytopenia (DITP) is a severe complication during chemotherapy. ...
Objective:
The study aims to develop and psychometric validate Patient-Reported Outcomes Measures for Assessing Comfort during Chemotherapy in Breast Cancer Patients (PROMs BCC-20).
Methods:
This study was conducted in two phases: 1) items were developed from the literature review and in-depth interviews, and 2) Exploratory factor analysis (EFA), Confirmatory factor analysis (CFA), and concurrent validity were performed to evaluate construct validity. The participants were cancer stage I-IIIC, adult females, performance status was assessed by Eastern Cooperative Oncology Group (ECOG) score ≤ 2 after receiving the second cycle of adjuvant chemotherapy and selected by purposive sampling method. For each group of EFA and CFA was 250 participants.
Result:
Five hundred breast cancer patients during adjuvant chemotherapy were recruited from three tertiary cancer centers. A succession of EFA using principal axis factoring with Promax rotation revealed four dimensions yielded a seven factors solution, explaining a 60.07 percent variance. CFA contains 20 items with five factors; 1) social function, four items; 2) digestive function, three items; 3) emotional function, six items; 4) environmental function, three items; and 5) sleep quality, four items via maximum likelihood with bootstrapping indicated a good fit model (SRMR = 0.045, RMSEA = 0.040, CFI = 0.947, and TLI = 0.935). The Cronbach's alpha of 0.86 demonstrated strong internal consistency reliability. Pearson's correlation coefficient showed acceptable criterion validity.
Conclusion:
The PROMS BCC-20 provides good psychometric properties and practical patients' direct reports of comfort in breast cancer patients during chemotherapy. The PROMs BCC-20 should be standardized for comfort measurement and tailor-made nursing care to provide patient satisfaction and good nursing outcomes.
... is a ratio of the activity produced in agonist v. antagonist muscles of the leg that provides unique insight into neuropathy effects (107). We calculate this ratio from electromyographic (EMG) signals of the tibialis anterior, gastrocnemius, and soleus muscles. ...
Background
Breast cancer (BC) is among the most common forms of cancer experienced by women. Up to 80% of BC survivors treated with chemotherapy experience chemotherapy-induced neuropathy (CIN), which degrades motor control, sensory function, and quality of life. CIN symptoms include numbness, tingling, and/or burning sensations in the extremities; deficits in neuromotor control; and increased fall risk. Physical activity (PA) and music-based medicine (MBM) are promising avenues to address sensorimotor symptoms. Therefore, we propose that we can combine the effects of music- and PA-based medicine through Neurologic Dance Training (NDT) through partnered Adapted Tango (NDT-Tango). We will assess the intervention effect of NDT-Tango v. home exercise (HEX) intervention on biomechanically-measured variables. We hypothesize that 8 weeks of NDT-Tango practice will improve the dynamics of posture and gait more than 8 weeks of HEX.
Methods
In a single-center, prospective, two-arm randomized controlled clinical trial, participants are randomly assigned (1:1 ratio) to the NDT-Tango experimental or the HEX active control intervention group. Primary endpoints are change from baseline to after intervention in posture and gait. Outcomes are collected at baseline, midpoint, post, 1mo follow up, and 6mo follow up. Secondary and tertiary outcomes include clinical and biomechanical tests of function and questionnaires used to compliment primary outcome measures. Linear mixed models will be used to model changes in postural, biomechanical, and PROs. The primary estimand will be the contrast representing the difference in mean change in outcome measure from baseline to week 8 between treatment groups.
Discussion
The scientific premise of this study is that NDT-Tango stands to achieve more gains than PA practice alone through combining PA with MBM and social engagement. Our findings may lead to a safe non-pharmacologic intervention that improves CIN-related deficits.
Trial Registration
This trial was first posted on 11/09/21 at ClinicalTrials.gov under the identifier NCT05114005.
... Most studies included in this group are concerned with evaluating the curvature of the spine, with frequent use of the photogrammetric posture analysis 12,17,25,29,32,39,41,43 and cobb's angle measurement at X-ray scans. 35,42,44,46,49,50 other evaluation techniques often employed in these studies are body stabilometry on a force platform, 14,24,28,30,33,34,37,47,48 used for static postural balance; surface electromyography, 13,27,30,31 used for muscular intensity and timing of activation; dynamometric analysis, 22, 51 used to quantify muscular strength. these instrumental measurements are frequently complemented by the administration of physical tests (i.e. ...
... Most studies included in this group are concerned with evaluating the curvature of the spine, with frequent use of the photogrammetric posture analysis 12,17,25,29,32,39,41,43 and cobb's angle measurement at X-ray scans. 35,42,44,46,49,50 other evaluation techniques often employed in these studies are body stabilometry on a force platform, 14,24,28,30,33,34,37,47,48 used for static postural balance; surface electromyography, 13,27,30,31 used for muscular intensity and timing of activation; dynamometric analysis, 22, 51 used to quantify muscular strength. these instrumental measurements are frequently complemented by the administration of physical tests (i.e. ...
Introduction:
The constant improvement of the diagnostic process and the crescent efficacy of treatment options for Breast Cancer have led to an increase in the survival rate of patients. Thereby, it has become fundamental for Breast Care Units to deal with short-, medium-, and long-term sequelae of the disease and its treatment. Among these, changes in posture seem to have a crucial role. This review aims to collect and summarize the current knowledge on postural disorders in Breast Cancer Survivors, focusing on evaluation methods and rehabilitation protocols.
Evidence acquisition:
A systematic research was conducted on PubMed, Scopus and World of Science databases, considering all the studies published up to 2021. Case reports, case series, cross-sectional, retrospective and prospective studies were included. Narrative and Systematic reviews were excluded.
Evidence synthesis:
After applying the eligibility criteria and bibliographic expansion, 55 articles were selected. Forty-four studies focused on the analysis and the quantification of postural abnormalities, showing a huge variability in population characteristics, valuative methods and outcome measures. Most of them are cross-sectional studies. Rehabilitation treatments have been considered in only 12 studies: all the rehabilitative treatments proved to be effective but, the heterogeneity among the evaluation methods has made a comparison impossible. Hence, we designed a complete evaluation protocol for the assessment of postural abnormalities in Breast Cancer Survivors. Our protocol has been drawn following the structure of International Classification of Functioning, Disability and Health.
Conclusions:
Our review pointed out the crescent interest of the current Literature on analysis and treatment of postural alterations in breast cancer survivors. Since the extreme variety of outcome measures made it impossible to give a clear indication for evaluation and treatment of this disorder, we designed a complete evaluation protocol for the assessment of postural abnormalities in breast cancer survivors, with the goal of guiding the design of new clinical trials on these subjects.
