Lynn Tanner

Use of a Fitness Tracker to Promote Physical Activity in Children With Acute Lymphoblastic Leukemia: Fitness Tracker to Promote Physical Activity

Children with cancer identify fatigue as a pervasive symptom, which increases during the corticosteroid pulse in acute lymphoblastic leukemia (ALL) maintenance. The FitBit® is a fitness tracker that downloads activity measurements to the Internet in real time. In this feasibility study, we explored if children who received daily FitBit® coaching for 2 weeks before a maintenance steroid pulse had an increase in steps per day and determined the relationship between steps per day prepulse and fatigue postpulse.

Comment on: Use of a Fitness Tracker to Promote Physical Activity in Children with Acute Lymphoblastic Leukemia

Background Children with cancer identify fatigue as a pervasive symptom, which increases during the corticosteroid pulse in acute lymphoblastic leukemia (ALL) maintenance. The FitBit® is a fitness tracker that downloads activity measurements to the Internet in real time. In this feasibility study, we explored if children who received daily FitBit® coaching for 2 weeks before a maintenance steroid pulse had an increase in steps per day and determined the relationship between steps per day prepulse and fatigue postpulse. Procedure Seventeen children in ALL maintenance, aged 6–15, wore the FitBit® for 3 days to establish a baseline. A tailored weekly step goal was then set with the child and parent. Daily emails with feedback and FitBit® screenshots were sent over the 2-week intervention. Self-report of fatigue was measured at baseline, after 2 weeks (i.e. before the steroid pulse), and after 5 days of steroids. Results There was a trend toward increased steps per day from weeks 1–2 (P = 0.079); fatigue was low and did not increase during the corticosteroid pulse. A significant correlation (r = −0.66, P = 0.005) was found between the steps per day during week 2 and fatigue after the steroid pulse with higher steps associated with lower fatigue. Conclusions The intervention was feasible in this small sample. The average steps each time period (week 1, week 2, and during steroids) was over 10,000, demonstrating that children with ALL can be active during treatment. Physical activity may be protective of fatigue during a corticosteroid pulse.

Measuring chemotherapy-induced peripheral neuropathy in children: Development of the Ped-mTNS and pilot study results

&NA; The aim of this study was to develop and test the feasibility of a chemotherapy‐induced peripheral neuropathy (CIPN) measurement, the ped‐mTNS, for use in school‐aged children. After adapting an established adult measure (modified‐Total Neuropathy Scale), the ped‐mTNS was administered one time to 20 children ages 5 ‐ 18 who were undergoing, or had recently completed, chemotherapy. The ability to complete the measurements, to be understood by school‐aged children and represent their symptoms, and the frequency of signs and symptoms was assessed. The ped‐mTNS was successfully completed in all children in under 10 minutes. Three children reported symptoms not covered by test items. Sixty percent (12/20) reported sensory symptoms and 55% (11/20) reported motor symptoms. On clinical examination, impairments were found in pin sensibility (30%), vibration (50%), distal muscle strength (90%), and deep tendon reflexes (95%). The mean score was 6.1 ± 3.8 out of possible 24. The ped‐mTNS is a feasible measure of CIPN and further research is warranted.

Short-term recovery of chemotherapy-induced peripheral neuropathy after treatment for pediatric non-CNS cancer

Chemotherapy‐induced peripheral neuropathy (CIPN) is a frequent side effect of pediatric cancer treatment. The presentation of CIPN, trajectory and completeness of recovery over the first 6 months postchemotherapy, and the influence of patient and treatment characteristics on recovery are described.

Gait Patterns in Children With Cancer and Vincristine Neuropathy.

Purpose: Children treated with vincristine often develop chemotherapy-induced peripheral neuropathy (CIPN), but effects of CIPN on gait have not been reported. Methods: Gait variables of 52 children/adolescents treated for non-central nervous system cancers with CIPN were compared with an age- and sex-matched control group. Gait data were collected via GaitRite walkway before and after completing a 6-minute walk test (6MWT). Ankle range-of-motion (ROM) measures, balance, and strength tests were also completed. Results: Participants with CIPN had decreased velocity and step length. Ankle ROM and balance explained variability in step length. Both groups increased self-selected velocity after the 6MWT, but participants with cancer walked with slower velocity, shorter step length, and decreased cadence. Strength, neuropathy, and self-selected velocity measured before the 6MWT explained variability in 6MWT scores. Conclusions: Ankle ROM and balance are important factors when treating step length deficits, whereas strength is also an important consideration for walking capacity.

Effect of an Ankle Foot Orthosis Intervention for Children With Non-Central Nervous System Cancers: A Pilot Study.

Purpose: Children with cancer are at risk for physical performance limitations. In this pilot study we investigated the feasibility and initial efficacy of an ankle foot orthosis (AFO) in children with non–central nervous system cancer with peripheral weakness. Methods: Participants included children aged 5 to 11 years diagnosed with cancer. Children wore AFOs for 1 cycle of chemotherapy. Pre- and postintervention adverse events, adherence, gait, strength, range of motion, activity, and fatigue were measured. Results: Six of 7 children completed the study; none of the 7 reported adverse events. Positive trends were observed in step length (46.23-49.25 cm), dorsiflexion strength (19.25-24.50 lb), ankle dorsiflexion range of motion (0.5-8°), and activity (7850-9857 epochs). Negative trends observed included cadence and fatigue ratings. No change was observed in the 6-minute walk or parent-reported fatigue. Conclusions: An AFO intervention is feasible in children with cancer. Initial efficacy results warrant further study.

Improving Functional Mobility in Children and Adolescents Undergoing Treatment for Non–Central Nervous System Cancers: A Systematic Review

Childhood cancers and subsequent treatments can leave survivors with impairments that may lead to decreased physical performance. Rehabilitation can be an important component of promoting improved physical function in children and adolescents undergoing treatment for cancer.

The Stoplight Program: A Proactive Physical Therapy Intervention for Children With Acute Lymphoblastic Leukemia:

Chemotherapy may cause neuromuscular impairments that can have life-long effects. The Stoplight Program (SLP) was developed as a proactive physical therapy (PT) intervention directed at impairments in children with acute lymphoblastic leukemia (ALL). In this program evaluation, we assessed the feasibility of the SLP delivered as part of standard care and identified body function and activity patterns in patients who received the intervention. Children ages 1 to 22 years, diagnosed with ALL, received an assessment by a physical therapist as part of usual care. The SLP intervention used 3 levels to categorize the impairment levels and intensity of PT. Of the children (n = 135) screened, 46% completed 5 intervention visits and 32% completed the program and met discharge criteria. At initial assessment, 46% of children ages 1 to 5 years and 67% of children ages 6 to 22 years had abnormal motor function. Those completing the program tested within the healthy norms. Research is needed on variables that influence adherence to a PT program and the range of functional impairment and activity limitations in this population.

Reply: Interplay Between Physical Activity and Sleep in Fatigue Modulation of Cancer Patients

To the Editor: We would like to thank de-Paula-Oliveira, Hirotsu, Tukif, and Anderson for their letter regarding our study, “Use of a Fitness Tracker to Promote Physical Activity in Children with Acute Lymphoblastic Leukemia.”[1,2] We concur with the authors’ recommendations of the inclusion of sleep measurements when considering the relationship between physical activity and fatigue. As noted in Orsey and colleagues’ research on children with cancer aged 8–18, those who had higher levels of physical activity had less impaired sleep as measured by actigraphy.[3] Self-report instruments for sleep have been established for the pediatric population.[4] In our pilot study, our focus was on evaluating the feasibility of using the FitBit R