Institute of Sports and Sport Science, Heidelberg University, Im Neuenheimer Feld 700, 69120 Heidelberg, Germany; German Cancer Research Center, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; Working Group Exercise Oncology, Division of Medical Oncology, National Center for Tumor Diseases (NCT) and Heidelberg University Hospital, Im Neuenheimer Feld 460, 69120 Heidelberg, Germany.
BioMotion Center, Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Engler-Bunte-Ring 15, 76131 Karlsruhe, Germany; Department of Sport and Sport Science, University of Freiburg, Schwarzwaldstr. 175, 79117 Freiburg, Germany.
Gait Posture. 2020 Mar;77:156-163. doi: 10.1016/j.gaitpost.2020.01.012. Epub 2020 Jan 15.
Chemotherapy-induced peripheral neuropathy (CIPN) is a serious side effect deriving from neurotoxic chemotherapeutic agents. The underlying nerve injury can affect proprioception causing impaired postural control, gait difficulties and a higher risk of falling. Overall, the symptoms and functional limitations negatively affect patients' independence and quality of life.
Our objective was to analyze postural control in cancer patients before and after neurotoxic chemotherapy and to compare these data to healthy controls.
Participants were 35 cancer patients (PAT) and 35 healthy, one-to-one gender, age, height, and weight matched controls (HMC). Postural control of HMC was tested once, whereas PAT were tested prior to (PAT) and three weeks after completion of neurotoxic chemotherapy (PAT). Temporal, spatial and frequency domain measures of the center of pressure (COP) were calculated using a force plate. The following balance conditions were analyzed: bipedal stance with open (BP) and closed eyes (BP), semi-tandem (ST, ST) and monopedal stance (MP). CIPN was assessed clinically (Total Neuropathy Score) and via questionnaire. Time and group differences were determined by using Wilcoxon-signed-rank tests. Spearman correlation was applied to analyze associations between severity of CIPN and postural control.
PAT showed significantly increased temporal and spatial measures of the COP (p < .05) - both after neurotoxic chemotherapy (PAT-PAT) and in comparison to HMC. Withdrawal of visual control resulted in greater temporal and spatial COP displacements in PAT than in the comparative groups (PAT, HMC). Correlation analyzes revealed moderate associations of COP measures with clinical CIPN measures and low to none for the questionnaires.
Three weeks after completion of neurotoxic chemotherapy, PAT showed significant balance deficits compared to PAT and HMC. Especially the deficits in the standing conditions with closed eyes may indicate an impaired proprioception. This hypothesis is supported by the finding that stronger CIPN symptoms were associated with poorer postural control. However, future studies need to take further influencing factors on postural control into account (e.g. strength) in order to generate efficacious rehabilitation measures.
化疗引起的周围神经病变（CIPN）是一种源自神经毒性化疗药物的严重副作用。潜在的神经损伤会影响本体感觉，导致姿势控制受损、步态困难和更高的跌倒风险。总的来说，这些症状和功能限制会严重影响患者的独立性和生活质量。
我们的目的是分析癌症患者在接受神经毒性化疗前后的姿势控制情况，并将这些数据与健康对照组进行比较。
参与者为 35 名癌症患者（PAT）和 35 名健康、一对一性别、年龄、身高和体重匹配的对照组（HMC）。HMC 的姿势控制仅测试一次，而 PAT 在接受神经毒性化疗前（PAT）和完成后 3 周（PAT）进行测试。使用力板计算压力中心（COP）的时间、空间和频域测量值。分析以下平衡条件：闭眼（BP）和睁眼（BP）的双足站立、半前后位（ST，ST）和单足站立（MP）。通过临床（总神经病变评分）和问卷评估 CIPN。使用 Wilcoxon 符号秩检验确定时间和组间差异。Spearman 相关分析用于分析 CIPN 严重程度与姿势控制之间的关联。
PAT 在接受神经毒性化疗后（PAT-PAT）和与 HMC 相比，COP 的时间和空间测量值显著增加（p <.05）。与对照组相比，PAT 去除视觉控制后，COP 的时间和空间位移更大（PAT、HMC）。相关分析显示，COP 测量值与临床 CIPN 测量值中度相关，与问卷低度或无相关。
在接受神经毒性化疗后 3 周，PAT 与 PAT 和 HMC 相比，平衡能力明显下降。尤其是闭眼站立条件下的缺陷可能表明本体感觉受损。这一假设得到了更强的 CIPN 症状与较差的姿势控制相关的发现的支持。然而，未来的研究需要考虑对姿势控制有进一步影响的因素（例如力量），以制定有效的康复措施。
