Abstract
Chemotherapy-induced polyneuropathy (CIPN), one of the most severe and incapacitating side effects of chemotherapeutic drugs, is a serious concern in breast cancer therapy leading to dose diminution, delay, or cessation. The reversibility of CIPN is of increasing importance since active chemotherapies prolong survival. Clinical assessment tools show that patients experiencing sensorimotor CIPN symptoms not only do they have to cope with loss in autonomy and life quality, but CIPN has become a key restricting factor in treatment. CIPN incidence poses a clinical challenge and has lacked established and efficient therapeutic options up to now. Complementary, non-opioid therapies are sought for both prevention and management of CIPN. In this perspective, we explore the potential that digital interventions have for sensorimotor CIPN rehabilitation in breast cancer patients. Our primary goal is to emphasize the benefits and impact that Virtual Reality (VR) avatars and Machine Learning have in combination in a digital intervention aiming at (1) assessing the complete kinematics of deficits through learning underlying patient sensorimotor parameters, and (2) parameterize a multimodal VR simulation to drive personalized deficit compensation. We support our perspective by evaluating sensorimotor effects of chemotherapy, the metrics to assess sensorimotor deficits, and relevant clinical studies. We subsequently analyse the neurological substrate of VR sensorimotor rehabilitation, with multisensory integration acting as a key element. Finally, we propose a closed-loop patient-centered design recommendation for CIPN sensorimotor rehabilitation. Our aim is to provoke the scientific community toward the development and use of such digital interventions for more efficient and targeted rehabilitation.
Highlights
Breast cancer remains the most prevalent chronic disease in women, with a predicted 5 million new cases reported annually and among those with higher survival rates (i.e., 5years median survival in most developed countries is more than 80%)
Wearable sensors Sensorimotor balance training Specialized physical exercise training Physiotherapy Joint stabilizers and orthotics Impact and vibration training Closed kinematic chain exercise Visual computer-feedback balance training Transcutaneous electrical stimulation. These studies have laid the foundation for using technology in assessing, monitoring and controlling sensorimotor deficits associated with Chemotherapy-induced polyneuropathy (CIPN)
Our perspective sheds the light on the possibility to use commodity digital technologies, such as Virtual Reality (VR) and Machine Learning (ML), in combination, for personalized CIPN sensorimotor rehabilitation
Summary
Breast cancer remains the most prevalent chronic disease in women, with a predicted 5 million new cases reported annually and among those with higher survival rates (i.e., 5years median survival in most developed countries is more than 80%). Chemotherapy-induced polyneuropathy(CIPN) is among the most severe side effects of many regularly used chemotherapy drugs with a direct impact on the autonomy and quality of life of patients [1,2,3] with incidence varying between 12 and 96% in the case of taxane- and platinum-based chemotherapy [4,5,6]. The current landscape of solutions is broad and diverse comprising: Intervention These studies have laid the foundation for using technology in assessing, monitoring and controlling sensorimotor deficits associated with CIPN. We consolidate this thesis and propose a patient-centered design recommendation for CIPN sensorimotor rehabilitation
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