Balance impairment is associated with neuromuscular dysfunction in breast cancer patients with chemotherapy-induced peripheral neuropathy
Ritzmann Ramona1, Kneis Sarah1,2, Wehrle Anja1,3, Freyler Kathrin1, Lehmann Katrin1, Rudolphi Britta4, Hildenbrand Bernd4, Bartsch Hans Helge4, Bertz Hartmut2, Gollhofer Albert1
1Institute of Sport and Sport Science, University of Freiburg, Germany
2Department Medicine I, Haematology, Oncology and Stem Cell Transplantation, University
Medical Centre Freiburg, Germany
3Department of Exercise Medicine and Sport, University Medical Centre Freiburg, Germany
4Tumor Biology Centre Freiburg, Germany
HISTORY: A clinically relevant side-effect of chemotherapy in cancer treatment is peripheral neuropathy. Peripheral neuropathy causes balance and gait problems limiting the patient’s daily life. The neuromuscular mechanisms underlying these impairments are poorly understood.
PHYSICAL EXAMINATION: This study aimed to assess balance performance of patients with chemotherapy-induced peripheral neuropathy (CIPN) vs. healthy controls (CON) and to determine differences in the underlying neuromuscular mechanisms.
DIFFERENTIAL DIAGNOSIS: 20 breast cancer patients with CIPN (PAT) were compared to 16 matched CON: in a cross-sectional study design, center of pressure displacement (COP) and electromyographic (EMG) activity of M. tibialis anterior (TA), soleus (SOL), gastrocnemius (GM), rectus femoris (RF) and biceps femoris (BF) were recorded in a single leg balance task. Co-contraction index (CCI) of TA/SOL, TA/GM and RF/BF was calculated. To evaluate changes in the excitability of spinal reflex circuitry SOL H-reflexes were elicited.
TEST AND RESULTS: In PAT, COP displacement was greater than in CON (+12%, p=0.013) and correlated significantly with an increased level of CCI for TA/SOL (+ +33%, p=0.047). Moreover, PAT revealed a prolonged H-reflex latency (+5%, p=0.021) and a decreased H-reflex sensitivity (-71%, p=0.001).
FINAL WORKING DIAGNOSIS: CIPN is associated with decreased spinal excitability, prolonged nerve conduction velocity and impaired ability to modulate spinal reflex activity, resulting in an extensively diminished ability to keep postural equilibrium. As a consequence, to compensate for the neuromuscular degradation and secure postural stability, increased simultaneous antagonistic muscle activation is used.
TREATMENT AND OUTCOMES: To counteract these postural degradation sensorimotor training could serve as a training modality and thus should be considered when treating CIPN patients to improve their balance.