Motor and Basic Cognitive Functions in Children with Acute Lymphoblastic Leukemia Undergoing Induction or Consolidation Chemotherapy

Identifying causes of balance impairment and exploring sensory contributions to balance in pediatric oncology: A scoping review

PURPOSE

To identify causes of balance impairment in children undergoing treatment for cancer and childhood cancer survivors.

METHODS

A systematic search was performed according to PRISMA guidelines. Studies were included if participants were 0-19 years of age with a current/past diagnosis of cancer, an objective balance measure was reported, and a cause of balance impairment was either stated or implied.

RESULTS

The 64 full text studies included identified balance impairments as sequelae secondary to CNS tumors, and/or as an effect of medical treatment including chemotherapy, radiation, and/or surgery. Cancer treatment can result in damage to the visual, vestibular and/or somatosensory systems which in turn can contribute to balance dysfunction.

CONCLUSIONS

Balance impairments were caused by the cancer itself or the result of medical treatment. Oncology professionals are integral in recognition and treatment of factors affecting balance impairments in childhood cancer; however, further research is needed to identify interventions targeting specific causes of balance impairment.

Identifying fine motor difficulties in children with acute lymphoblastic leukemia: a scoping review

PURPOSE

Survival rates for children diagnosed with acute lymphoblastic leukemia (ALL) have increased significantly over recent decades, and thus attention shifted toward understanding the adverse effects of cancer treatment. Chemotherapy has side effects that could affect muscle state and diminish motor performance. This scoping review was conducted to map the breadth of evidence for different tools used in fine motor skills assessment, the extent of upper extremity strength, and fine motor performance, highlighting the potential risk factors that may influence these skills.

METHODS

In March 2023, full-text studies that examined fine motor performance and/or upper extremity strength were identified via searches in PubMed, Science Direct, Scopus, Web of Science, and PEDro databases. The titles and abstracts of selected studies were screened according to the inclusion and exclusion criteria.

RESULTS

The search yielded initial 418 citations and 26 peer-reviewed articles were finally included in the review. Considerable heterogeneity was observed regarding the methods of evaluating fine motor skills. The results of this review indicate that children and adolescents with ALL experienced fine motor limitations and upper extremity weakness either during or after cessation of treatment.

CONCLUSION

This scoping review presents a broad overview of the literature addressing fine motor difficulties in the pediatric population with ALL. Results accentuate the need to incorporate strengthening and occupational therapy training to preserve muscle strength and minimize future fine motor problems along the course of chemotherapeutic treatment. Little evidence was reported regarding the risk factors that may impair muscle strength and motor performance.

The association of environmental factors with neurocognitive outcomes in survivors of childhood acute lymphoblastic leukemia (ALL)

PURPOSE

To investigate the association of environmental factors, rehabilitation services during therapy and socioeconomic status (SES - insurance type), with neurocognitive outcomes at the end of therapy for survivors of childhood acute lymphoblastic leukemia (ALL).

METHODS

Survivors (n = 236) treated on the St. Jude Total Therapy Study 16 completed end of therapy testing with performance measures (IQ, attention, processing speed, fine motor skills, academics) and caregiver ratings (attention, executive function, adaptive skills). Environmental factors were abstracted from the medical record.

RESULTS

Distribution of sex (47.3% female, p = 0.399), treatment arm (45.5% low risk, 54.5% standard/high risk p = 0.929), insurance type (47.7% private, 52.3% public/none, p = 0.117), and mean age at diagnosis (7.7 vs. 6.8 years, p = 0.143) were similar for groups with (n = 110; 46.6%) and without (n = 126; 53.6%) rehabilitation services during therapy. Compared to those without rehabilitation, the rehabilitation group (n = 110; 46.4%) had more caregiver reported problems with attention (Z = -0.28 vs. 0.43, p = 0.022), executive function (Z = -0.50 vs. -0.08, p = 0.003), and adaptive skills (Z = -0.41 vs.-0.13, p = 0.031). Among the rehabilitation group, there was no difference in outcomes by insurance status. Among those without rehabilitation, those with public insurance had worse neurocognitive outcomes than those with private insurance in IQ (Z = -0.04 vs. -0.45, p = 0.0115), processing speed (Z = -0.10 vs. -0.75, p = 0.0030), reading (Z = 0.18 vs. -0.59, p < 0.0001), and math (Z = -0.04 vs. -0.50, p = 0.0021).

CONCLUSION

Participation in rehabilitation services during early intensive therapy is associated with end of therapy caregiver-reported neurocognitive outcomes in daily life.

Clinical applicability of short form of Bruininks-Oseretsky Test of Motor Proficiency Second Edition in patients after treatment of acute lymphoblastic leukemia

Introduction

Acute lymphoblastic leukaemia (ALL) ranks among paediatrics' most common oncological malignancies. Monitoring motor performance levels associated with self-sufficiency in the everyday activities of ALL patients is extremely important during treatment. The motor development of children and adolescents with ALL is most often assessed using the Bruininks-Oseretsky Test of Motor Proficiency Second Edition (BOT-2) complete form (CF) with 53 items or the short form (SF) with 14 items. However, there is no evidence in research that BOT-2 CF and SF give comparable results in the population of patients with ALL.

Objective

This study aimed to determine the compatibility of motor proficiency levels achieved from BOT-2 SF and BOT-2 CF in ALL survivors.

Materials and Method

The research sample consists of n = 37 participants (18 girls, 19 boys) aged 4-21 years (10.26, ± SD 3.9) after treatment for ALL. All participants passed BOT-2 CF and were at least 6 months and a maximum of 6 years from the last dose of vincristine (VCR). We used ANOVA with repeated measures, considering the sex, intra-class correlation (ICC) for uniformity between BOT-2 SF and BOT-2 CF scores and Receiving Operating Characteristic.

Results

BOT-2 SF and BOT-2 CF assess the same underlying construct, and BOT-2 SF and CF standard scores have good uniformity: ICC = 0.78 for boys and ICC = 0.76 for girls. However, results from ANOVA showed that the participants achieved a significantly lower standard score in SF (45.1 ± 7.9) compared to CF (49.1 ± 9.4) (p < 0.001; Hays ω ² = 0.41). ALL patients performed the worst in Strength and Agility. According to the ROC analysis, BOT-2 SF obtains acceptable sensitivity (72.3%) and high specificity (91.9%) with high accuracy of 86.1%, and the fair value of the Area Under the Curve (AUC) = 0.734 CI95% (0.47-0.88) in comparison to BOT-2 CF.

Conclusions

To reduce the burden on ALL patients and their families, we recommend using BOT-2 SF instead of BOT-2 CF as a useful screening tool. BOT-SF can replicate motor proficiency with as high probability as BOT-2 CF but systematically underestimates motor proficiency.

Effects of strength exercise interventions on activities of daily living, motor performance, and physical activity in children and adolescents with leukemia or non-Hodgkin lymphoma: Results from the randomized controlled ActiveADL Study

OBJECTIVES

Pediatric patients with cancer experience impairments in muscle strength and physical activity (PA) that may reduce autonomy during hospitalization. To determine the effects of strength exercise interventions on the accomplishment of activities of daily living (ADLs), motor performance, and PA in children with leukemia or non-Hodgkin lymphoma, we randomly allocated patients (4-18 years) immediately after diagnosis into two exercise groups.

METHODS

The intervention group (IG; n = 21) received a specific strength training combined with a standard care exercise program, whereas the control group (CG; n = 20) was provided standard care exercise program without any targeted muscle strengthening. After the baseline visit, participants were followed-up three times until intensive treatment cessation. We assessed physical function limitations using the Activities Scale for Kids© (ASK) and Functional ADL Screen. Secondary outcomes were PA levels using accelerometer and motor performance as measured by MOON-test (motor performance in pediatric oncology-test).

RESULTS

In both groups, ADL accomplishment had significantly increased (p < 0.05). However, no significant between-group differences for ASK outcome were noted. Motor performance was reduced in all motor abilities.

CONCLUSIONS

Both exercise interventions were effective to maintain ADLs and motor performance during intensive treatment. In comparison, regular strength exercise interventions in the course of therapy tended to be more beneficial with regards to muscular explosive and endurance strength.