Department of Biomedical Engineering, Northwestern University, 355 E Erie St 21st Floor, Evanston, IL, 60611, USA.
Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA.
J Neuroeng Rehabil. 2022 Mar 23;19(1):32. doi: 10.1186/s12984-022-01010-w.
Oxaliplatin (OX) chemotherapy for colorectal cancer is associated with adverse neurotoxic effects that can contribute to long-term sensorimotor impairments in cancer survivors. It is often thought that the sensorimotor impairments are dominated by OX-induced dying-back sensory neuropathy that primarily affects the distal regions of the limb. Recent preclinical studies have identified encoding dysfunction of muscle proprioceptors as an alternative mechanism. Unlike the dying-back sensory neuropathy affecting distal limbs, dysfunction of muscle proprioceptors could have more widespread effects. Most investigations of chemotherapy-induced sensorimotor impairments have considered only the effects of distal changes in sensory processing; none have evaluated proximal changes or their influence on function. Our study fills this gap by evaluating the functional use of proprioception in the shoulder and elbow joints of cancer survivors post OX chemotherapy. We implemented three multidirectional sensorimotor tasks: force matching, target reaching, and postural stability tasks to evaluate various aspects of proprioception and their use. Force and kinematic data of the sensorimotor tasks were collected in 13 cancer survivors treated with OX and 13 age-matched healthy controls.
Cancer survivors exhibited less accuracy and precision than an age-matched control group when they had to rely only on proprioceptive information to match force, even for forces that required only torques about the shoulder. There were also small differences in the ability to maintain arm posture but no significant differences in reaching. The force deficits in cancer survivors were significantly correlated with self-reported motor dysfunction.
These results suggest that cancer survivors post OX chemotherapy exhibit proximal proprioceptive deficits, and that the deficits in producing accurate and precise forces are larger than those for producing unloaded movements. Current clinical assessments of chemotherapy-related sensorimotor dysfunction are largely limited to distal symptoms. Our study suggests that we also need to consider changes in proximal function. Force matching tasks similar to those used here could provide a clinically meaningful approach to quantifying OX-related movement dysfunction during and after chemotherapy.
结直肠癌的奥沙利铂（OX）化疗会引起不良的神经毒性作用，这可能导致癌症幸存者长期出现感觉运动障碍。通常认为，这些感觉运动障碍主要是 OX 诱导的感觉神经退行性病变引起的，主要影响肢体的远端区域。最近的临床前研究已经确定肌肉本体感受器的编码功能障碍是一种替代机制。与影响远端肢体的感觉神经退行性病变不同，肌肉本体感受器功能障碍可能会产生更广泛的影响。大多数关于化疗引起的感觉运动障碍的研究仅考虑了远端感觉处理变化的影响；没有评估近端变化或它们对功能的影响。我们的研究通过评估 OX 化疗后癌症幸存者肩部和肘部的本体感觉功能的实际使用情况来填补这一空白。我们实施了三个多向感觉运动任务：力量匹配、目标到达和姿势稳定性任务，以评估本体感觉的各个方面及其用途。在 13 名接受 OX 治疗的癌症幸存者和 13 名年龄匹配的健康对照者中收集了传感器任务的力和运动学数据。
癌症幸存者仅依靠本体感觉信息来匹配力时，准确性和精密度低于年龄匹配的对照组，即使是只需要肩部扭矩的力也如此。维持手臂姿势的能力也存在微小差异，但在到达方面没有显著差异。癌症幸存者的力量缺陷与自我报告的运动功能障碍显著相关。
这些结果表明，OX 化疗后的癌症幸存者表现出近端本体感觉缺陷，并且产生准确和精确力量的缺陷大于产生无负荷运动的缺陷。目前对化疗相关感觉运动功能障碍的临床评估主要局限于远端症状。我们的研究表明，我们还需要考虑近端功能的变化。类似于这里使用的力量匹配任务可以为量化化疗期间和之后与 OX 相关的运动功能障碍提供一种有临床意义的方法。
