Using wearables to screen motor performance deterioration because of cancer and chemotherapy-induced peripheral neuropathy (CIPN) in adults - Toward an early diagnosis of CIPN

Abstract

Objective: An essential component for optimizing quality of life in adults with cancer is determining the degree to which therapy may negatively impact motor-performance, so that patients can maintain their quality of life and independence. This study examined whether instrumented gait and balance could determine the magnitude of deterioration in motor-performance from chemotherapy-induced peripheral neuropathy (CIPN). Methods: We recruited 84 adults with cancer (age = 71.1 ± 9.7 years old, BMI = 26.8 ± 6.2 kg/m 2 , gender = 56%female) and 57 age-matched non-cancer patients (age = 69.5 ± 9.8 years old, BMI = 27.1 ± 6.0 kg/m 2 , gender = 79%female). Based on clinical screening, the group with cancer was classified into two groups: participants with CIPN (CIPN+) and without CIPN (CIPN-). Gait and balance were quantified using validated wearables. The Vibration Perception Threshold (VPT) test was used to stratify the CIPN+ group into mild (Mild-CIPN) and severe (Severe-CIPN) subgroups. Results: All gait and balance parameters were deteriorated in the group with cancer compared to noncancer group with the largest effects observed for stride-time (11%, Cohen's effect size d = 1.00, p < 0.001) and eyes-closed ankle sway (94%, d = 0.49, p = 0.001). The same trend was observed when the Severe-CIPN subgroup was compared to the Mild-CIPN. VPT correlates significantly with motor deterioration, with the largest correlation found in stride-time (Rho = 0.37, p = 0.007). Severe-CIPN subjects were significantly older and overall had more deterioration in the majority of motor-performance parameters after adjusting for age (p < 0.050). Conclusion: These results confirmed the negative impact of CIPN on motor-performance with the largest effects on ankle stability and stride-time. VPT is a predictor of motor deterioration and may be used to determine the severity of CIPN symptom.

A review of movement disorders in chemotherapy-induced neurotoxicity

“…The peripheral sensory system constitutes different perceptual subsystems involving mechanoreceptors in skin, muscles, tendons, and ligaments, but the precise determination of the diminished peripheral sensory capability associated with CIN is not straightforward. Researchers investigating the relationship between increased postural sway and peripheral sensory neuropathy relied on various measures to assess the state of the peripheral sensory system, including subjective reports of sensory symptoms (e.g., severity of numbness/tingling, Functional Assessment of Cancer Therapy-Gynecologic Oncology Group-neurotoxicity (FACT&GOG-Ntx), and CIPN 20-item quality of life questionnaire (CIPN20)) [ 21 , 29 , 32 , 33 , 40 ], vibration perception threshold [ 29 , 40 ], and conduction studies of peripheral nerves [ 33 ]. Composite scores that combine subjective symptoms and objective measures of sensory signs and reflexes (e.g., modified Total Neuropathy Score (mTNS)) [ 24 , 41 ] were also used [ 33 ].…”

“…PAT’s reactions to perturbations were smaller than CT’s. Zahiri 2019 [ 29 ] Cancer survivors: N = 82 (CIPN+: N = 58 and CIPN−: N = 24) Age-matched controls: N = 57 IMU on the shins, thighs, and low back measured CoM sway during bipedal stance EO, EC Area of ankle and hip sway, area of CoM sway, and ML CoM sway Vibration perception threshold FES-I PAT had greater sway compared to CT with the largest effect observed in ankle sway during EC. The same trend held comparing CIPN+ to CIPN−.…”

Sensor-Based Daily Physical Activity: Towards Prediction of the Level of Concern about Falling in Peripheral Neuropathy

“…In order to assess the severity of PN, we measured vibration perception threshold (VPT) in the plantar surface of the foot (the first and fifth metatarsal heads, and the heel) using a standard biothesiometer (Bio-Medical Instrument, Newbury, Ohio, United States) as performed in previous studies [23][24][25][26][27]. Briefly, the probe of the biothesiometer was placed on the plantar surface of the foot, and electrical vibration was gradually increased from 0 volts until participants felt the electrical vibration.…”

Role of Kinematics Assessment and Multimodal Sensorimotor Training for Motion Deficits in Breast Cancer Chemotherapy-Induced Polyneuropathy: A Perspective on Virtual Reality Avatars

“…Providing a richer depiction of patient's motion parameters, the next level in CIPN sensorimotor rehabilitation focuses on the use of wearable sensors in physical training (8,17,19). Such an approach is an inexpensive, robust, and efficient method to screen motor performance deterioration by assessing spatio-temporal parameters of gait and balance [as shown by (8,18)]. Extending the range of wearable rehabilitation modalities, whole-body vibration (WBV) training, has proven to attenuate sensorimotor deficits by de-conditioning skeletal muscles in order to reduce fall frequency (9).…”

“…Wearable sensors (8) Sensorimotor balance training (9) Specialized physical exercise training (10-13) Physiotherapy (14,15) Joint stabilizers and orthotics (16) Impact and vibration training (17,18) Closed kinematic chain exercise (19) Visual computer-feedback balance training (20,21) Transcutaneous electrical stimulation (22) These studies have laid the foundation for using technology in assessing, monitoring and controlling sensorimotor deficits associated with CIPN. Yet, none of them considered wholebody kinematic assessment of deficits and closed-loop deficit compensation.…”