A new approach to characterize postural deficits in chemotherapy-induced peripheral neuropathy and to analyze postural adaptions after an exercise intervention

Sarah Kneis,Hartmut Bertz,Isabella Katharina Wiesmeier,Albert Gollhofer,Christoph Maurer,Johann Lambeck,Daniela Dalin,Anja Wehrle

doi:10.1186/s12883-019-1589-7

Sarah Kneis, Hartmut Bertz + Show 6 more

Open Access

https://doi.org/10.1186/s12883-019-1589-7

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Journal: BMC Neurology	Publication Date: Jan 16, 2020
Citations: 11	License type: open-access

Affiliation: University of Freiburg

Abstract

BackgroundPostural instability presents a common and disabling consequence of chemotherapy-induced peripheral neuropathy (CIPN). However, knowledge about postural behavior of CIPN patients is sparse. With this pilot study, we used a new approach to i) characterize postural impairments as compared to healthy subjects, ii) allocate possible abnormalities to a set of parameters describing sensorimotor function, and iii) evaluate the effects of a balance-based exercise intervention.MethodsWe analyzed spontaneous and externally perturbed postural control in eight CIPN patients before and after a balance-based exercise intervention by using a modification of an established postural control model. These findings were compared to 15 matched healthy subjects.ResultsSpontaneous sway amplitude and velocity were larger in CIPN patients compared to healthy subjects. CIPN patients’ reactions to external perturbations were smaller compared to healthy subjects, indicating that patients favor vestibular over proprioceptive sensory information. The balance-based exercise intervention up-weighted proprioceptive information in patients.ConclusionsCIPN patients’ major postural deficit may relate to underuse of proprioceptive information that results in a less accurate posture control as spontaneous sway results indicate. The balance-based exercise intervention is able to partially correct for this abnormality. Our study contributes to a better understanding of postural impairments in CIPN patients and suggests an effective treatment strategy.Trial registrationGerman Clinical Trials Register: DRKS00004340, retrospectively registered 04 January 2013.

Highlights

Postural instability presents a common and disabling consequence of chemotherapy-induced peripheral neuropathy (CIPN)
Group designation significantly interacted with sway direction, ie the difference between control subjects and Chemotherapy-induced peripheral neuropathy (CIPN) patients is larger in anteriorposterior direction
As postural instability is a momentous symptom of CIPN [9,10,11,12,13,14,15,16], the first aim of this study was to assess the specific set of postural control deficits associated with CIPN compared to healthy subjects

Summary

Introduction

Postural instability presents a common and disabling consequence of chemotherapy-induced peripheral neuropathy (CIPN). CIPN patients often suffer from postural instability [9,10,11,12,13,14,15,16,17], contributing to a lower quality of life [5, 18], a higher risk of mortality [19,20,21,22] and increased healthcare costs [23, 24]. Underlying mechanisms are sparsely described [10, 25]: Wampler et al [10] assumed that besides somatosensory impairments diminished vestibular function causes increased postural sway in CIPN patients. Our first aim here is to characterize the postural deficits in CIPN and to extract the sensorimotor abnormalities using a well-established model of postural control [36,37,38]

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