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Table 2 Movement studies on gait

From: A review of movement disorders in chemotherapy-induced neurotoxicity

Authors

Population

Procedures

Examined variables

Results/Conclusions

PAT

CT

Zahiri 2019 [29]

Cancer survivors: N = 82 (CIPN+ : N = 58 and CIPN−: N = 24)

Age-matched controls: N = 57

LEGSys assessed spatiotemporal gait parameters during 15-m walk using self-paced speed

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−.

Vibration perception threshold was correlated with balance (ML CoM sway EO, area of CoM sway EC) and gait (stride time) parameters, and FES-I.

Vallabha-josula 2019 [54]

Postmenopausal breast cancer survivors: N = 17

Age-matched controls: N = 17

Zeno walkway assessed self-paced and fast-paced forward walking, and self-paced backward walking on 16-ft walkaway

Speed, step length, step width, stance time, swing time, single support time, and double support time

Strength: hand grip, chest press and leg press

PAT had 7% shorter step length, 8% slower gait speed compared to CT while walking both forward and backward.

PAT had greater stance time variability during forward and fast forward conditions, but less during backward condition.

Hsieh 2019 [53]

CIPN+ : N = 9

CIPN−: N = 8

Age and sex-matched controls: N = 12

Zeno walkaway assessed spatiotemporal gait parameters during self-paced forward walking

FACT&GOG-Ntx

Activities-specific Balance Confidence Scale

Physiological Profile Assessment to assess overall fall risk

There were no group differences in gait speed, step length, or step width, but CIPN+ had greater step width variability and less step length variability than control.

Monfort 2019 [64]

Cancer patients within 6 weeks of completing chemotherapy

CIPN− (mild to no symptoms): N = 9

CIPN+ (severe symptoms): N = 6

Cancer patient has not received chemotherapy: N = 6

An instrumented split belt treadmill assessed orbital gait stability during single-task and dual-task walking

Bilateral lower extremity kinematics (motion capture)

Orbital stability

Groton Max Learning Test to assess executive function

CIPN20

CIPN+ group had worse executive function and was associated with decreased orbital stability during the dual-task condition.

Chemotherapy maybe associated with impaired gait stability, but there was no evidence for an isolated association between CIPN and orbital stability.

Winters-Stone 2017 [49]

Women cancer survivors (average 6 years post treatment): N = 512

CIPN+ : N = 238

CIPN−: N = 274

NA

GAITRite system assessed spatiotemporal gait pattern during self-paced 4-m walk

Rep max leg press

Short physical performance battery (5×STS, standing balance, 4-m walk speed)

PRO: physical function and mobility disability; falls; severity of CIPN symptoms 1–4

Gait speed, step number, rate and length, stride length, base of support and % time in single support and double support

CIPN+ group took significantly more step, shorter step length, slower step time, shorter strides, and more time in double limb support compared to CIPN− group.

Increased CIPN symptom severity was linearly associated with slower walking speed, slower chair stand time, and worse short physical performance battery score.

Monfort 2017 [32]

Patients with breast cancer prior to, during and 1–3 months after taxane chemotherapy: N = 33

NA

A custom-built timing gate assessed gait speed and step length during fast forward 10-m walking

CoP: ML RMS

mTNS

CIPN20

C30

Brief Pain Inventory

Gait: step length, walking speed

All parameters progressively worsen over time; CIPN20 sensory subscale was significantly correlated with ML RMS.

Gait speed and step length worsen during chemotherapy compared to baseline, but no difference was observed 1–3 months post chemotherapy.

Marshall 2017 [52]

Breast and colorectal cancer survivors with CIPN diagnosed by CTCAT: N = 8

Age- and morphologically-matched controls: N = 8

GAITRite system assessed spatiotemporal gait pattern during self-paced 8.2 m-walk

Gait: speed, step length, step time, swing time, single support time, base of support

TUG

PAT had significant slower gait speed, shorter step length, and greater TUG score compared to CT.

Gilchrist 2016 [51]

Pediatric cancer patients with mTNS > 5 (average 6 months after treatment begins): N = 52

Age- and sex-matched healthy controls: N = 52

GAITRITE system measured spatiotemporal gait pattern during self-paced 14-ft walk (2 trials before and 2 trials after 6MWT-fatigue)

Gait speed, cadence, step length, base of support, time in single and double limb support

Ped-mTNS

Ankle ROM

Strength and balance subscale of the Bruininks-Oseretsky Test of Motor Proficiency Ed 2

Before 6MWT, PAT had significantly slower speed and wider base of support; the decreased gait speed was related to decreased step length rather than cadence.

After 6MWT, all parameters were significantly different between groups except double support time. PAT group had increased forefoot contact that reflects decreased eccentric control and fatigue of dorsiflexors.

Decreased DF AROM and balance score explained the variance in step length the most for PAT group.

Beulertz 2016 [55]

Childhood cancer survivors who completed cancer treatment and < 5 years from diagnosis (85% received chemotherapy): N = 13

Age and gender-matched healthy controls: N = 13

Microgate Optogait 2D Gait Analysis System assessed spatiotemporal gait pattern during self-paced 2-m walk

Gait: step time, length and width, stride time and length, and gait cycle percentage

DF AROM

6MWT to assess walking efficiency

German Motor Test 6–18 to assess motor performance

DF AROM, gait (stance, swing and pre-sway phase) and walking efficiency were significantly impaired in PAT group compared to CT group. There was no group difference found in motor performance.

Wright 2017 [63]

Pediatric cancer patients who are receiving or have completed vincristine treatment and presented with CIPN: N = 17

Age-matched healthy controls: N = 10

3D motion capture and force plate analyzed kinematic and kinetic of gait during self-paced 8-m walk while surface EMG sensors recorded muscle activities on tibialis anterior and medial gastrocnemius muscles

Gait Deviation Index quantified the magnitude of gait deviation

Kinematic, kinetic and spatiotemporal gait variables

PROM DF

Strength: DF and PF

Gait deviation was heterogenous in PAT group.

PAT group had significantly less peak hip extension, knee flexion in loading, dorsiflexion at initial contact, plantarflexion at pre-swing, and dorsiflexion in swing, shorter step lengths, and lower ankle moments and powers compared to CT.

PAT group also exhibited out of phase firing of MG and TA and high proportion of MG-TA co-activation compared to CT.

  1. PAT patients, CT controls, CoP center of pressure, CoM center of mass, AP anteroposterior, ML mediolateral, mTNS modified total neuropathy score, Ped-mTNS pediatric version of the modified total neuropathy score, CIPN chemotherapy-induced peripheral neuropathy, FES-I Fall efficacy scale international version, FACT&GOG-Ntx Functional assessment of cancer therapy-gynecologic oncology group-neurotoxicity, CIPN20 chemotherapy-induced peripheral neuropathy 20-item quality of life questionnaire, C30 quality of life core questionnaire, 6MWT six-minute walk test, DF dorsiflexion, PF plantarflexion, AROM active range of motion, PROM passive range of motion, 5 × STS five times sit to stand, PRO patient-reported outcome, TA tibialis anterior muscle, MG medial gastrocnemius muscle