ABSTRACT
BACKGROUND: Cancer patients with chemotherapy-induced peripheral neuropathy (CIPN) have sensory and motor deficits leading to inappropriate proprioceptive feedback, impaired postural control, and fall risk. Balance training with computerized force platforms has been successfully used in rehabilitation of balance disturbances, but programs specifically developed for CIPN patients are lacking. AIM: This pilot study evaluated a rehabilitation protocol exclusively based on visual computer-feedback balance training (VCFBT) to improve balance in patients with CIPN. DESIGN: Open-label, non-randomized pilot study, 4-week intervention with pre- vs. post-treatment evaluation. SETTING: Outpatients of the Rehabilitation Institute of the Salvatore Maugeri Foundation, in Genoa, Italy. POPULATION: Seven out-patients with clinical-instrumental diagnosis of CIPN. METHODS: At admission, patients were administered the Berg Balance Scale (BBS) and underwent static-dynamic posturography using a computerized force platform to objectively quantify their balance impairment. Their performance was compared to values of a normal age-matched population. Patients then underwent 4 weeks of VCFBT (three 60-minute sessions/week). At discharge, BBS and posturography were repeated and the results compared with those at admission. RESULTS: A significant pre- vs. post-treatment improvement was found in balance as measured by static-dynamic posturography (P=0.004) and BBS (P<0.002). CONCLUSIONS: Despite caution needed for the low sample size, this pilot study has shown preliminary evidence that intensive rehabilitation, based on VCFBT can produce a significant improvement in balance outcomes. CLINICAL REHABILITATION IMPACT: To our knowledge, this is the first report in CIPN patients of a rehabilitation program based exclusively on VCFBT.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/adverse effects , Exercise Therapy/methods , Peripheral Nervous System Diseases/chemically induced , Peripheral Nervous System Diseases/rehabilitation , Sensation Disorders/rehabilitation , Therapy, Computer-Assisted/methods , Aged , Cohort Studies , Female , Follow-Up Studies , Humans , Male , Middle Aged , Neoplasms/drug therapy , Neoplasms/surgery , Patient Selection , Peripheral Nervous System Diseases/diagnosis , Pilot Projects , Postural Balance , Risk Assessment , Sensation Disorders/chemically induced , Sensation Disorders/diagnosis , Severity of Illness Index , Statistics, Nonparametric , Survivors , Treatment OutcomeABSTRACT
It is not known whether postsurgery systemic inflammation and plasma amino acid abnormalities are still present during rehabilitation of individuals after elective hip arthroplasty (EHA). Sixty subjects (36 females; age 66.58 ± 8.37 years) were randomized to receive 14-day oral EAAs (8 g/day) or a placebo (maltodextrin). At admission to and discharge from the rehabilitation center, serum C-reactive protein (CRP) and venous plasma amino acid concentrations were determined. Post-EHA hip function was evaluated by Harris hip score (HHS) test. Ten matched healthy subjects served as controls. At baseline, all patients had high CRP levels, considerable reduction in several amino acids, and severely reduced hip function (HHS 40.78 ± 2.70 scores). After treatment, inflammation decreased both in the EAA group and in the placebo group. Only EAA patients significantly improved their levels of glycine, alanine, tyrosine, and total amino acids. In addition, they enhanced the rate of hip function recovery (HHS) (from baseline 41.8 ± 1.15 to 76.37 ± 6.6 versus baseline 39.78 ± 4.89 to 70.0 ± 7.1 in placebo one; p = 0.006). The study documents the persistence of inflammation and plasma amino acid abnormalities in post-EHA rehabilitation phase. EAAs enhance hip function retrieval and improve plasma amino acid abnormalities.
Subject(s)
Amino Acids, Essential/administration & dosage , Arthroplasty, Replacement, Hip/adverse effects , Inflammation/diet therapy , Postoperative Complications/diet therapy , Aged , Dietary Supplements , Elective Surgical Procedures , Female , Humans , Inflammation/rehabilitation , Male , Middle Aged , Postoperative Complications/rehabilitation , Recovery of FunctionABSTRACT
We evaluated alterations of balance by stabilometry in patients with amnestic mild cognitive impairment (aMCI) and with mild-moderate Alzheimer's disease (AD). Fifteen patients with aMCI and 15 with mild AD were recruited according to the current diagnostic criteria. Fifteen healthy subjects of the same age range were recruited as controls. Stabilometry was carried out using a commercial 4 load cell platform. Statistical analysis of between group differences was performed using one-way analysis of variance for parametric data and Kruskal-Wallis tests for non-parametric data. Spearman correlation coefficients were used to investigate the association between cognitive test scores and stabilometric data. All stabilometry measures were significantly altered in mild AD patients compared to normal controls. Antero-posterior sway was found to be the most sensitive parameter, since it correlated with the ADAS-cog orientation subscale in AD patients, and also discriminated between aMCI and normal controls. Our study shows that impairment in balance is a feature not only of AD, but also of aMCI. The alterations found suggest that a progressive failure of the vestibular system, possibly linked to reduced hippocampal performance, may be responsible for such a feature. Further research must be focused on studying the predictive value of stabilometry in the conversion of aMCI.
