Longitudinal evaluation of fine motor deficits in children with leukemia

Abstract

8559 Background: Fine motor assessments are important tools to use in screening children undergoing treatment for acute lymphoblastic leukemia (ALL) that may provide decisive data that can reveal subtle changes in neurodevelopment over time. Methods: Fine motor and visual-motor skills were assessed longitudinally in a group of 83 children receiving treatment for ALL. Children in this study had the first fine motor assessment at an average of 8 weeks into treatment and had already received several doses of Vincristine. Fine motor and visual-motor skills assessments were repeated at years 1 and 2 into therapy. The mean age at time of first assessment was 7.2 years and 58% were female. Results: Fine motor speed deficits were evident at the first assessment, and for many, continued to be problematic at Years 1 and 2. In addition to fine motor speed deficits, a significant decline in visual motor integration skills was noted from the baseline level (p = 0.019). Visual motor integration skills observed at Years 1 and 2 were predicted by the baseline performance on the Purdue Pegboard test. Our results indicate that the factors underlying these declines in higher-level skills begin within six months of the onset of chemotherapy. Conclusions: Early reductions in fine motor speed, possibly due to Vincristine, steroids and/or acute Methotrexate toxicity, may lead to reduced visual motor integration and construction abilities. The reduced fine motor skills, which predict eventual declines in visual motor integration, may be part of the underlying process for reduced perceptual abilities and nonverbal intellect often reported in long-term follow-up studies. For children with ALL, motor and sensory-perceptual examinations during treatment may identify those most at risk for significant long-term effects interfering with integration of visual spatial construction. These basic processing skills are necessary elements to the development of higher-level cognitive abilities, including nonverbal intelligence and academic achievement, particularly in arithmetic and written language. Early identification of reduced processing skills can provide an opportunity to identify at risk patients and intervene prior to reduction in these higher-level skills. Supported by NIH/NICHD RO-1 Funding: Grant number HD 37816 No significant financial relationships to disclose.