Department of Mechanical and Industrial Engineering, Montana State University, Bozeman, MT, USA; Department of Mechanical and Aerospace Engineering, The Ohio State University, Columbus, OH, USA.
Center for Biostatistics, The Ohio State University, Columbus, OH, USA.
Gait Posture. 2019 Jun;71:62-68. doi: 10.1016/j.gaitpost.2019.04.002. Epub 2019 Apr 6.
Impairments in central and/or peripheral nervous systems are known to be associated with altered gait; however, the interplay between cognitive function, peripheral sensation, and orbital gait stability remains largely unclear. Elucidating these relationships is expected to provide a clearer understanding of potential fall risk factors across various populations and targets for novel interventions. Many patients diagnosed with cancer are treated with chemotherapy agents known to be neurotoxic to the central and/or peripheral nervous systems that can contribute to movement deficiencies, making this population a novel model to investigate these relationships.
The purpose of this exploratory study was to investigate how central and peripheral nervous system impairments associate with orbital stability during single- and dual-task gait.
Twenty cancer survivors were enrolled and separated into three groups: no prior chemotherapy exposure (CON, n = 6), and prior treatment with chemotherapy and having no/mild chemotherapy-induced peripheral neuropathy (CIPN) symptoms (-CIPN, n = 8) or moderate/severe CIPN symptoms (+CIPN, n = 6). Testing included single- and dual-task (i.e., serial sevens) treadmill walking as well as a computerized test of executive function. Maximum Floquet multipliers were calculated to assess orbital stability during gait.
Worse executive function was associated with decreased orbital stability during the dual-task condition in the +CIPN group (Spearman's ρ = 0.94, P = 0.017). Additionally, decreased orbital stability during dual-task gait was observed for the -CIPN group compared to the CON group (ES = 1.96, P = 0.019).
Executive dysfunction was associated with decreased gait stability during challenging dual-task gait in survivors with sensory symptoms of CIPN. The association between combined central and peripheral nervous system impairments and decreased gait stability in cancer survivors provides a novel demonstration of potential compensatory strategies that accompany deficiencies in these functions. Future work is needed to confirm these relationships and whether they hold in other populations.
已知中枢和/或周围神经系统的损伤与步态改变有关；然而，认知功能、周围感觉和轨道步态稳定性之间的相互作用在很大程度上仍不清楚。阐明这些关系有望更清楚地了解各种人群的潜在跌倒危险因素和新的干预靶点。许多被诊断患有癌症的患者接受化疗药物治疗，这些药物已知对中枢和/或周围神经系统具有神经毒性，会导致运动缺陷，使这一人群成为研究这些关系的新模型。
本探索性研究的目的是调查中枢和周围神经系统损伤如何与单任务和双任务步态期间的轨道稳定性相关。
招募了 20 名癌症幸存者，并将其分为三组：无先前化疗暴露（CON，n=6），先前接受过化疗且无/轻度化疗诱导的周围神经病（CIPN）症状（-CIPN，n=8）或中度/重度 CIPN 症状（+CIPN，n=6）。测试包括单任务和双任务（即连续七）跑步机行走以及计算机执行功能测试。计算最大 Floquet 乘数以评估步态期间的轨道稳定性。
在+CIPN 组中，执行功能越差，双任务条件下的轨道稳定性越差（Spearman's ρ=0.94，P=0.017）。此外，与 CON 组相比，-CIPN 组在双任务步态期间的轨道稳定性下降（ES=1.96，P=0.019）。
在有 CIPN 感觉症状的幸存者中，执行功能障碍与挑战性双任务步态期间的步态稳定性下降有关。癌症幸存者中中枢和周围神经系统损伤与步态稳定性下降之间的关联提供了潜在补偿策略的新演示，这些策略伴随着这些功能的缺陷。需要进一步的工作来确认这些关系以及它们在其他人群中是否成立。
