Table 1 Movement studies on balance and postural control
From: A review of movement disorders in chemotherapy-induced neurotoxicity
Authors | Population | Procedures | Examined variables | Results/Conclusions | |
|---|---|---|---|---|---|
PAT | CT | ||||
Muller 2020 [33] | Breast cancer patients: N = 35 (tested prior to and 3 weeks after neurotoxic treatment) | Gender, age, height, weight matched healthy controls: N = 35 | Force plate measured CoP during bipedal stance EO, EC; semi-tandem stance EO, EC; monopedal stance EO | CoP: AP and ML mean velocity, 95% ellipse area, AP and ML mean frequency TNSr and TNSc NCS of the peroneal and sural nerves CIPN15-item questionnaire FES-I | PATpost showed more sway than PATpre and CT. Occluding vision resulted in a greater sway increase in PATpost than PATpre and CT. Sway of PATpost correlated strongly with NCS, but weakly to none with the TNSr, TNSc, CIPN15 and FES-I. |
Kneis 2020 [30] | Cancer patients with severe neuropathic symptoms: N = 8 | Age, weight, height matched healthy controls: N = 15 | Force plate measured CoP during bipedal stance EO, EC and during externally perturbed stance | CoP: AP and ML RMS, mean velocity, center frequency Angular excursion of lower and upper body segments NCS of the tibial and sural nerves Vibration sense Achilles and Patellar reflex FACT&GOG-Ntx | Sway amplitude and velocity were larger in PAT than CT. There was a significant group difference between PAT and CT that interacts with vision. PAT’s reactions to perturbations were smaller than CT’s. |
Zahiri 2019 [29] | Cancer survivors: N = 82 (CIPN+: N = 58 and CIPN−: N = 24) | Age-matched controls: N = 57 | IMU on the shins, thighs, and low back measured CoM sway during bipedal stance EO, EC | Area of ankle and hip sway, area of CoM sway, and ML CoM sway Vibration perception threshold FES-I | PAT had greater sway compared to CT with the largest effect observed in ankle sway during EC. The same trend held comparing CIPN+ to CIPN−. Vibration perception threshold was correlated with balance (ML CoM sway EO, area of CoM sway EC) and gait (stride time) parameters, and FES-I. |
McCrary 2019 [40] | Cancer survivors 3 months to 5 years post neurotoxic therapy: N = 190 (symptomatic N = 129, asymptomatic N = 61) | NA | Swaymeter measured postural sway during bipedal stance EO, EC on ground, and bipedal stance EO, EC on foam | Total movement path length of CoM for all 4 tasks TNSc CIPN20 symptom index (first 4 items) CIPN Rasch-built Overall Disability Scale | Both symptomatic and asymptomatic patients had greater postural sway sum score compared to healthy elderly population. Patient-reported numbness/tingling, weakness, and balance deficits, age and vibration perception were strongly linked to the postural sway sum score. |
Fino 2019 [27] | Female cancer survivors: N = 434 Classified into CIPN+ (N = 216) and CIPN− (N = 218) | Controls: N = 49 | IMU at the lumbar spine measured tri-axial accelerations and angular velocities during bipedal stance EO | Principal component (PC) analysis of the IMU data FACT&GOG-Ntx Self-reported fall PC1: sway amplitude PC2: resultant and AP frequency and Jerk PC3: ML frequency | PAT had worse sway (PC1 and PC3) than CT. PAT fallers were likely to have smaller PC3 than PAT non-fallers PC3 was associated with falls if neuropathy was severe. PC2 was associated with falls when neuropathy is mild. |
Morishita 2018 [26] | Cancer survivors: N = 19 | Controls: N = 14 | Force plate measured CoP during bipedal stance EO, EC | CoP: total sway length, sway area, the ratio between length and area TUG Grip strength Knee-extensor strength | PAT had increased sway area and decreased length/area during EO and decreased length/area during EC. PAT had decreased TUG score compared to control. TUG was correlated with muscle strength, but no sway parameters were related to muscle strength. |
Schmitt 2017 [25] | Cancer patients (71% had chemo, 21% was actively receiving rad/chemo): N = 34 | Age-matched (mean age) control: N = 34 | Force plate measured CoP during bipedal stance on rigid and compliant surfaces with EO and EC | CoP: AP and ML RMS, AP and ML mean velocity, 95% ellipse area, AP and ML frequency, 95% power frequency of AP and ML sway | PAT had greater RMS and mean velocity in the ML direction and 95% sway area. |
Monfort 2017 [32] | Patients with breast cancer prior to, during and 1–3 months after taxane chemotherapy: N = 33 | NA | Force plate measured bipedal stance with EO A custom-built timing gate assessed gait speed and step length during fast forward 10-m walking | CoP: ML RMS sway mTNS CIPN20 C30 Brief Pain Inventory Gait: step length, walking speed | All measures progressively worsen over time. PATpost had significant increased ML RMS sway. CIPN20 sensory subscale was significantly correlated with ML RMS. |
Monfort 2016 [31] | Patients with breast cancer prior to, during and 1–3 months after taxane chemotherapy: N = 33 | NA | Force plate measured bipedal stance with EO and EO | CoP: ML and AP RMS, ML and AP mean velocity, and 95% ellipse area | All parameters were impaired over the course of treatment; deficits were more pronounced during EC. |
Kneis 2016 [21] | Patients with breast cancer and diagnosis of CIPN: N = 20 | Sex, age, height, weight matched healthy controls: N = 16 | Force plate measured CoP during bipedal and monopedal stance | Total CoP Ankle and hip angle H-reflex EMG of lower limb muscles to calculate co-contraction indices Neuropathy deficit score FACT&GOG-Ntx | CoP displacement was greater than CT during monopedal stance. Total CoP was correlated with co-contraction of soleus and tibialis anterior muscles and self-reported CIPN symptoms. PAT revealed prolonged H-wave latency, decreased H-reflex elicitability, and increased H-reflexed sensitivity from bi- to monopedal stance. |
Monfort 2019 [64] | Cancer patients with mild CIPN: N = 8; Cancer patients with severe CIPN: N = 6 | Cancer patients who had not received chemotherapy: N = 6 | Balance pad assessed CoP during bipedal stance during seven conditions: (1) EO, head upright, rigid surface; (2) EC, head upright, rigid surface; (3) EO, head upright, foam surface; (4) EC, head upright, foam surface; (5) EO, head tilt, rigid surface; (6) EC, head tilt, rigid surface; (7) EC, head tilt, foam surface | CoP: 95% ellipse area, ML RMS, ML mean velocity and resultant mean velocity | CIPN+ group had significant deficits in summary CoP measures compared to that of CT and CIPN−. CIPN+ had greater ML sway deficits compared to CIPN−, particularly during rigid surface conditions. |
Varedi 2018 [41] | Adult survivors of childhood acute lymphoblastic leukemia: N = 365 | Sex-, race-, and age- (within 5 years) matched controls: N = 365 | Dynamic posturography implemented the Sensory Organization Test (SOT) | SOT score, somatosensory ratio, vision ratio and vestibular ratio TUG 6MWT quality of life mTNS AROM of DF and PF Visual-motor processing speed | SOT score was not different between PAT and CT. Higher mTNS score was associated with longer TUG, shorter 6MWT, and reduced quality of life. Poorer visual-motor processing speed was associated with poorer SOT, TUG, and quality of life. PAT with impaired SOT score had lower vision and vestibular ratios than those without impaired SOT, but there was no difference in somatosensory ratio. |
Ness 2013 [43] | Adult childhood cancer survivor at least 10 years post neurotoxic chemotherapy: N = 475 | Healthy adults: N = 343 | Sensory Organization Test: percent of time spent inside a 12-deg sway envelope during 6 conditions (SMART EquiTest): < 70% indicates problem with functional balance | mTNS peak dorsiflexion strength TUG 6MWT | 12% PAT had problem with functional balance. 18% PAT had dorsiflexion weakness associated with Vincristine exposure. 20% PAT had sensory impairment associated with platinum exposure. Sensory impairment was associated with poor 6MWT and poor TUG. |
Wampler 2007 [24] | Patients with breast cancer within 30 days of their final cycle of chemotherapy: N = 20 | Age, weight and height matched healthy controls: N = 20 | Sensory Organization Test: 6 standing conditions Force plate assessed CoP during bipedal stance with (1) EO head straight; (2) EC head tilt; (3) EC, head straight; (4) EO, head tilt | SOT score CoP: mean velocity Fullerton advanced balance scale TUG mTNS | PAT had worse performance on all measures compared to CT. The mTNS was moderately correlated with the total SOT score, explaining 44% of the variance in the SOT score. |
Winters-Stone 2011 [46] | Breast cancer survivors within 2 years of treatment: N = 59 | NA | Sensory Organization Test: 6 standing conditions | SOT score, equilibrium scores for each condition and sensory ratios Visual assessment battery Muscle mass Rep max leg press Timed stair climb Gait speed by 4 m walk Retrospective falls (last year) and prospective falls (6 months) | Past fallers had lower SOT scores with vestibular deficit patterns and took longer time to read letters on the contrast sensitivity chart. Vestibular score mediated fallers vs. non-fallers model. |