ISSN 1866-8836
Клеточная терапия и трансплантация
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Introduction

At the present time, a sufficient attention is paid to changing quality of life (QoL) during rehabilitation programs in young patients with tuberculosis and other chronic conditions [1, 2]. Life quality aspects in children and adults after hematopoietic stem cell transplantation is also in focus of current studies [3-7]. In this view, the effects of physical rehabilitation seems to exert positive effects upon quality of life in early posttransplant period.

QoL is a common category meaning an integrity of physical, psychological, emotional and social functioning. Determination of the QoL indexes is included into evaluation scoring of rehabilitation programs [8].

Over last years, a distinct trend for increased cancer morbidity worldwide, including children and adolescents [9]. 300,000 cases of cancer are registered yearly in children from 0 to 18 years old. In 2016, 24207 children were registered at oncological dispensaries in Russia, thus requiring appropriate rehabilitation programs following cancer therapy.

The effects of physical rehabilitation upon QoL of adolescents with cancer following HSCT is poorly studied so far. Our aim was to propose an original system of post-transplant physical rehabilitation and tools of appropriate QoL control.

Patients and methods

The study included twenty patients at the age of 12 to 17 years old. The study was performed at the base of R. Gorbacheva Research Institute of Children Onclogy, Hematology and Transplantology over a period of April 2017 to November 2018. Ten patients were in experimental group 1, and 10, in experimental group 2. The 1st group received a standard program of physical exercises, whereas 2nd group was subject to additional program of physical rehabilitation.

To resolve our clinical tasks, we have developed and tested a program of physical rehabilitation for adolescents with cancer diseases after HSCT procedure. This method is aimed for effective recovery of functional state, prevention of complications, QoL increase, psychophysical development of the patients subjected to HSCT at different rehabilitation stages.

This purpose was achieved by resolution of some educational and health-sparing health-promoting tasks at the 3 time stages of the program:
1. Pre-transplant;
2. During the early posttransplant period (over 30-40 days);
3. At the later posttransplant period (over D+100).

Educational tasks are obligatory for each phase of the physical rehabilitation. They include: developing positive attitude for physical exercises; development of physical abilities during the studies; education of aesthetic and moral personal properties (honesty, discipline, responsibility etc.). Posing the health-promoting tasks depends on the disease severity, secondary disturbances of different organs and systems as well as existing comorbidities.

At each stage of the program, certain specific tasks were perform, as follows:
1. Before transplantation:
- to prepare the organism for the ongoing therapeutic procedure;
- to promote sufficient levels of adaptational abilities in the patient;
- to educate positive attitude for the motor activity exercises.
2. Early posttransplant period:
- to promote recovery of the functional systems of the organism;
- to develop and restore motor abilities;
- to perform prevention of complications and concomitant diseases;
- to optimize psycho-emotional state of the patient.
3. Late posttransplant period:
- further promotion of physical abilities;
- development of functional systems in the patient;
- to foster volitional powers in the subjects’ personality;
- to increase the level of emotional state.

Design of the program was based on the following pedagogical principles: availability and individualization, gradually increasing duration and intensity of exercises, activity and consciousness of the subjects involved; continuity of pedagogical activity in the course of rehabilitation, differential approach to application of physical exercises. Organizational and methodical features of physical rehabilitation for adolescents with cancer diseases: keeping the treatment and general regimen at the clinical facility; taking into account the types and forms of physical exercises; engraftment degree; education and preparation for the next rehabilitation step, high-quality self-consistent performance of the physical exercises; prophylaxis of the complications caused by low motor activities.

The developed program of physical rehabilitation consists of the following components:
1) Active games, aimed for correction and development of sensory, perceptive, psychomotor, emotional and volitional properties, voluntary attention and memory, communicative skills, e.g., Just a Minute, Nose-Year, Mirror etc.
2) Active games aimed for development of fine motor skills, respiratory functions, restoration of motor skills, after long-term hypodynamy when staying in bed, games in order to improve physical characteristics of the patients, i.e., Balls in the basket, Rope-walker, Spinner.
3) Physical exercises should be health-promoting, with elements of extension and static tension, respiratory and corrective exercises with adaptive sport elements. Hockey on the floor, sitting volleyball.

The program includes 9 sets which were dependent on the rehabilitation stage and age of the patient. The exercise sets consisted of basic and variative parts. The basic part included obligatory exercises, whereas variative part consisted of games that could be chosen of a certain list, aiming for solution of distinct tasks for the given rehabilitation phase, as shown in Table 1.

Table 1. Variable exercise sets included into the physical rehabilitation program

Potapchuk-tab01.jpg

Contents of the exercise sets were variable, depending on age and rehabilitation period. I.e., exercises for the children of 12-13 years are more simple and require less repeats that those for adolescents in the age of 14-15 or 16-17 years.

Short description of the physical exercises applied includes the movement regimens, initial positions, amplitude and pace of the exercises, ratio of fitness gym and special exercises (respiratory, correcting exercises with adaptive sport elements). Short characteristics of their contents are presented in Table 2.

Table 2. Brief description of exercise sets for different posttransplant patients

Potapchuk-tab02.jpg

Recent publications on dosage of loads for physical rehabilitation of children after HSCT are controversial and methodologically different [10, 11, 12].

The authors propose individual dosage, depending on physical potential of the patients and terms posttransplant. E.g., Yildiz Kabak et al. suggest usage of the Borg scale despite its subjectivity based on pulse rates of adult persons [13]. To perform dosage for physical loads, some special devices are applied, e.g., Actiwatch-Score-type pulsometers, or a portable monitor for the pulse rate measurements. However, they are intended for routine screening, and it is difficult to perform effective scheduling of long-term programs [11, 14].

Some reports present dosage variants for physical loadings with its gradual increment, variability and adaptation, depending on the patients’ condition. Meanwhile, we did not find any data on dosage of physical loads for adolescents during the pre-transplant period. Therefore, we planned loadings based on the developed original regimens, general principles and requirements for age-adapted physical exercises [15, 16].

The physical load was optimal and corresponded to functional abilities for adolescents. A number of factors was considered when planning the dosage of physical load, aiming for its increase or reduction: initial laying or sitting caused reduced load; staying posture was associated with increased load; switching of small muscular groups (foot, hand) were connected with decreased loadings. Increased amplitude of the movements and repeat numbers did also increase physical loads. The exercises were performed slowly, at moderate rates, or rapidly; rhythmic exercises alleviated the loads. A demand for exact performance caused initial increase of physical load, while decreasing later, upon automation of movements. Complex exercises with motor coordination did enhance the load, thus having been excluded from initial first-stage classes, and were introduced gradually; the exercises for relaxation and static respiratory exercises caused a decreased load (the load became lesser, the more this exercise was repeated. The ratios between health-promoting and special exercises were 1:1; 1:2; 1:3; 1:4; 1:5, and positive emotions during the classes in the form of games helped to better tolerate physical loads. Different grade of the patient’s efforts when performing the exercises proved to promote variation of loadings. In order to manage physical loadings, we used a principle of the load spreading with alternative involvement of different muscle groups; usage of different apparatus influenced the intensity of physical load.

When performing this program of physical exercises, their general load depended on their intensity, duration, density and volume. The intensity corresponded to certain threshold level for given step of the program. Duration of the load was adequate to performance time for each distinct task. The total volume of loads and their density was distributed uniformly, with their intensity determined by individual features of the patient and stage of the program. The motion regimen, dosage, density and total volume of the loads depended on the patient’s age and stage of the given rehabilitation program.

When arranging content of the game complexes and physical exercise sets we followed the principle "from a simple to more complex", i.e., from minor muscular groups to major ones, depending on the patient’s age. The games were classified into four groups with increasing loads: 1) On-site passive games; 2) Less active games; 3) Active games; 4) Elements of sports games. The games allowed usage of selective effects, exact intensity dosage for differently directed game exercises.

To evaluate efficiency of the the program, we used the QoL assessment using the special questionnaire (PedsQL Stem Cell Transplant Module Version 1.0) [14, 17].

Statistical evaluation of the results was performed by the STATISTICA 7.0 (StatSoft, USA). At initial stage, we evaluated the type of distribution by means of Shapiro-Wilkes criterion. Since most indexes did not show a standard distribution, the non-parametric methods were used. Significance of appropriate differences between the median values was evaluated by the Mann-Whitney test, with p<0.05 taken as a value of significance.

Results

Potapchuk-fig01.jpg

Figure 1. Quality of life indexes at the 3 stages of study in the 2 experimental groups

The analysis of QoL in the children following HSCT has shown statistically significant differences between the groups 1 and 2 (p<0.05) by all the scales of Questionnaire. The indexes were registered at all 3 stages of the program. The PedsQL Stem Cell Transplant Module data are shown in Table 3 and Fig. 1.

Evaluation of QoL indexes in adolescents subjected to HSCT allowed us to assess a statistically significant improvement of QoL by all the questionnaire scales. The indexes regularly decreased at the 2nd rehabilitation stage after HSCT, and increased at the 3rd rehabilitation stage, showing improved QoL for most indexes in experimental group 2, as compared to the 1st group.

Table 3. Quality of life scores in posttransplant adolescents at different stages of rehabilitation program

Potapchuk-tab03.jpg

Note: The data are expressed as points of the QoL questionnaire scores *, p<0.05 means a statistically significant difference between group 1 and group 2.

When summarizing the data obtained, one may see that all the life quality indexes were substantially decreased after HSCT in both experimental groups. However, during the rehabilitation measures, implementing the proposed program, a normalization and increase of parameters were revealed in experimental groups, especially by the indexes of physical functioning (+14%), emotional functioning (+11%), and communication abilities (+33%), thus confirming efficiency of the proposed physical rehabilitation program with respect to quality of life in the patients.

The data obtained confirm a positive effect of motor activities upon quality of life in adolescents subjected to hematopoietic stem cell transplantation reported elsewhere [13, 16].

Conclusion

1. At the present time, a number of children with cancer is registered worldwide, thus often requiring severe chemotherapy and hematopoietic stem cell transplantation (HSCT).

2. We have proposed a program of physical rehabilitation in children with cancer diseases, including nine variative sets of exercises. The technique consists of game exercises, fitness, respiratory and corrective exercises as well elements of adaptive sport.

3. The quality of life was evaluated by means of a PedsQL Stem Cell Transplant Questionnaire. Following HSCT, all the QoL indexes were decreased in both groups, i.e., with standard program of physical exercises (Group 1), and group 2 subjected to additional physical programs.

4. The course of rehabilitation in the patients from group 2 who used the proposed additional program has resulted into physical normalization and more pronounced increase in QoL, when compared to the children receiving standard physical exercises.

References

  1. Solokhina LV, Dyachenko EI, Yarinchuk EI. Studies on quality of life in tuberculosis-affected children. Far-Eastern Medical Journal. 2010; No.1: 134-137 (In Russian).
  2. Romanova LA, Kulishova TV, Nesina IA. Time dynamics of life quality in the children of school age with innate cervical spinal trauma following combined sanatory treatment, including manual therapy. Journal of Siberian Medical Sciences. 2014; No.4:180-187 (In Russian).
  3. Takken T, van der Torre P, Zwerink M, Hulzebos EH, Bierings M, Helders PJ, van der Net J. Development, feasibility and efficacy of a community-based exercise training program in pediatric cancer survivors. Psychooncology. 2009; 18(4):440-448.
  4. Parsons SK, Tighiouart H, Terrin N. Assessment of health-related quality of life in pediatric hematopoietic stem cell transplant recipients: progress, challenges and future directions. Expert Rev Pharmacoecon Outcomes Res. 2013; 13: 217-225.
  5. Lawitschka A, Güclü ED, Varni JW, Putz M, Wolff D, Pavletic S, Greinix H, Peters C, Felder-Puig R. Health-related quality of life in pediatric patients after allogeneic SCT: development of the PedsQL Stem Cell Transplant module and results of a pilot study. Bone Marrow Transplant. 2014; 49: 1093-1097.
  6. Hastings B, Patil C, Gallo AM. The experience and health-related quality of life after haploidentical stem cell transplantation for adults with sickle cell disease. West J Nurs Res. 2019;18:193945919870828. doi: 10.1177/0193945919870828.
  7. Zając-Spychała O, Pieczonka A, Barańska M, Wachowiak J. Long-term recipient health-related quality of life and donor-recipient relationship following sibling pediatric hematopoietic stem cell transplantation. Biol Blood Marrow Transplant. 2019 pii: S1083-8791(19)30665-2/ doi: 10.1016/j.bbmt.2019.10.009.
  8. Ivannikova AS, Pochivalov AV. Quality of life in children with respiratory diseases associated with non-differentiated dysplasia of connective tissue. The BelGU Research Notes (Medical and Pharmaceutic Series). 2012; No.16(135):47-49 (In Russian).
  9. Kaprina AD, Starinsky VV, Petrova GV. State of oncological care for the population of Russia in 2016. P.Gerzen Research Institute of Oncology: Moscow, 2017, pp. 18-19 (In Russian).
  10. van Brussel M, Takken T, van der Net J, Engelbert RH, Bierings M, Schoenmakers MA, Helders PJ. Physical function and fitness in long-term survivors of childhood leukaemia. Pediatr Rehabil. 2006; 9(3):267-274.
  11. San Juan AF, Chamorro-Viña C, Moral S, Fernández del Valle M, Madero L, Ramírez M, Pérez M, Lucia A. Benefits of intrahospital exercise training after pediatric bone marrow transplantation. Int J Sports Med. 2008;29(5): 439-446.
  12. Norris JM, Moules NJ, Pelletier G, Culos-Reed SN. Families of young pediatric cancer survivors: a cross-sectional survey examining physical activity behavior and health-related quality of life. J Pediatr Oncol Nurs. 2010; 27(4):196-208.
  13. Yildiz Kabak V, Cetinkaya DU, Kuskonmaz B, Cetin N, Duger T. Effects of multimodal exercise on clinical status and patient-reported outcomes in children undergoing hematopoietic stem cell transplantation. Pediatr Hematol Oncol. (2019) 36(7):410-421.
  14. Danaher EH, Ferrans C, Verlen E, Ravandi F, van Besien K, Gelms J, Dieterle N. Fatigue and physical activity in patients undergoing hematopoietic stem cell transplant. Oncol Nurs Forum. 2006; 33:614-624.
  15. Rosenhagen A, Bernhörster M, Vogt L, Weiss B, Senn A, Arndt S, Siegler K, Jung M, Bader P, Banzer W. Implementation of structured physical activity in the pediatric stem cell transplantation. Klin Pädiatr. 2011;223(3):147-151.
  16. Yildiz Kabak V, Duger T, Cetinkaya D. Investigation of the effects of an exercise program on physical functions and activities of daily life in pediatric hematopoietic stem cell transplantation. Pediatr Blood Cancer. 2016;63 (9):1643-1648.
  17. Brice L, Weiss R, Wei Y, Satwani P, Bhatia M, George D, Garvin J, Morris E, Harrison L, Cairo MS, Sands SA. Health-related quality of life (HRQoL): the impact of medical and demographic variables upon pediatric recipients of hematopoietic stem cell transplantation. Pediatr Blood Cancer. 2011;57(7):1179-1185.
" ["~DETAIL_TEXT"]=> string(20172) "

Introduction

At the present time, a sufficient attention is paid to changing quality of life (QoL) during rehabilitation programs in young patients with tuberculosis and other chronic conditions [1, 2]. Life quality aspects in children and adults after hematopoietic stem cell transplantation is also in focus of current studies [3-7]. In this view, the effects of physical rehabilitation seems to exert positive effects upon quality of life in early posttransplant period.

QoL is a common category meaning an integrity of physical, psychological, emotional and social functioning. Determination of the QoL indexes is included into evaluation scoring of rehabilitation programs [8].

Over last years, a distinct trend for increased cancer morbidity worldwide, including children and adolescents [9]. 300,000 cases of cancer are registered yearly in children from 0 to 18 years old. In 2016, 24207 children were registered at oncological dispensaries in Russia, thus requiring appropriate rehabilitation programs following cancer therapy.

The effects of physical rehabilitation upon QoL of adolescents with cancer following HSCT is poorly studied so far. Our aim was to propose an original system of post-transplant physical rehabilitation and tools of appropriate QoL control.

Patients and methods

The study included twenty patients at the age of 12 to 17 years old. The study was performed at the base of R. Gorbacheva Research Institute of Children Onclogy, Hematology and Transplantology over a period of April 2017 to November 2018. Ten patients were in experimental group 1, and 10, in experimental group 2. The 1st group received a standard program of physical exercises, whereas 2nd group was subject to additional program of physical rehabilitation.

To resolve our clinical tasks, we have developed and tested a program of physical rehabilitation for adolescents with cancer diseases after HSCT procedure. This method is aimed for effective recovery of functional state, prevention of complications, QoL increase, psychophysical development of the patients subjected to HSCT at different rehabilitation stages.

This purpose was achieved by resolution of some educational and health-sparing health-promoting tasks at the 3 time stages of the program:
1. Pre-transplant;
2. During the early posttransplant period (over 30-40 days);
3. At the later posttransplant period (over D+100).

Educational tasks are obligatory for each phase of the physical rehabilitation. They include: developing positive attitude for physical exercises; development of physical abilities during the studies; education of aesthetic and moral personal properties (honesty, discipline, responsibility etc.). Posing the health-promoting tasks depends on the disease severity, secondary disturbances of different organs and systems as well as existing comorbidities.

At each stage of the program, certain specific tasks were perform, as follows:
1. Before transplantation:
- to prepare the organism for the ongoing therapeutic procedure;
- to promote sufficient levels of adaptational abilities in the patient;
- to educate positive attitude for the motor activity exercises.
2. Early posttransplant period:
- to promote recovery of the functional systems of the organism;
- to develop and restore motor abilities;
- to perform prevention of complications and concomitant diseases;
- to optimize psycho-emotional state of the patient.
3. Late posttransplant period:
- further promotion of physical abilities;
- development of functional systems in the patient;
- to foster volitional powers in the subjects’ personality;
- to increase the level of emotional state.

Design of the program was based on the following pedagogical principles: availability and individualization, gradually increasing duration and intensity of exercises, activity and consciousness of the subjects involved; continuity of pedagogical activity in the course of rehabilitation, differential approach to application of physical exercises. Organizational and methodical features of physical rehabilitation for adolescents with cancer diseases: keeping the treatment and general regimen at the clinical facility; taking into account the types and forms of physical exercises; engraftment degree; education and preparation for the next rehabilitation step, high-quality self-consistent performance of the physical exercises; prophylaxis of the complications caused by low motor activities.

The developed program of physical rehabilitation consists of the following components:
1) Active games, aimed for correction and development of sensory, perceptive, psychomotor, emotional and volitional properties, voluntary attention and memory, communicative skills, e.g., Just a Minute, Nose-Year, Mirror etc.
2) Active games aimed for development of fine motor skills, respiratory functions, restoration of motor skills, after long-term hypodynamy when staying in bed, games in order to improve physical characteristics of the patients, i.e., Balls in the basket, Rope-walker, Spinner.
3) Physical exercises should be health-promoting, with elements of extension and static tension, respiratory and corrective exercises with adaptive sport elements. Hockey on the floor, sitting volleyball.

The program includes 9 sets which were dependent on the rehabilitation stage and age of the patient. The exercise sets consisted of basic and variative parts. The basic part included obligatory exercises, whereas variative part consisted of games that could be chosen of a certain list, aiming for solution of distinct tasks for the given rehabilitation phase, as shown in Table 1.

Table 1. Variable exercise sets included into the physical rehabilitation program

Potapchuk-tab01.jpg

Contents of the exercise sets were variable, depending on age and rehabilitation period. I.e., exercises for the children of 12-13 years are more simple and require less repeats that those for adolescents in the age of 14-15 or 16-17 years.

Short description of the physical exercises applied includes the movement regimens, initial positions, amplitude and pace of the exercises, ratio of fitness gym and special exercises (respiratory, correcting exercises with adaptive sport elements). Short characteristics of their contents are presented in Table 2.

Table 2. Brief description of exercise sets for different posttransplant patients

Potapchuk-tab02.jpg

Recent publications on dosage of loads for physical rehabilitation of children after HSCT are controversial and methodologically different [10, 11, 12].

The authors propose individual dosage, depending on physical potential of the patients and terms posttransplant. E.g., Yildiz Kabak et al. suggest usage of the Borg scale despite its subjectivity based on pulse rates of adult persons [13]. To perform dosage for physical loads, some special devices are applied, e.g., Actiwatch-Score-type pulsometers, or a portable monitor for the pulse rate measurements. However, they are intended for routine screening, and it is difficult to perform effective scheduling of long-term programs [11, 14].

Some reports present dosage variants for physical loadings with its gradual increment, variability and adaptation, depending on the patients’ condition. Meanwhile, we did not find any data on dosage of physical loads for adolescents during the pre-transplant period. Therefore, we planned loadings based on the developed original regimens, general principles and requirements for age-adapted physical exercises [15, 16].

The physical load was optimal and corresponded to functional abilities for adolescents. A number of factors was considered when planning the dosage of physical load, aiming for its increase or reduction: initial laying or sitting caused reduced load; staying posture was associated with increased load; switching of small muscular groups (foot, hand) were connected with decreased loadings. Increased amplitude of the movements and repeat numbers did also increase physical loads. The exercises were performed slowly, at moderate rates, or rapidly; rhythmic exercises alleviated the loads. A demand for exact performance caused initial increase of physical load, while decreasing later, upon automation of movements. Complex exercises with motor coordination did enhance the load, thus having been excluded from initial first-stage classes, and were introduced gradually; the exercises for relaxation and static respiratory exercises caused a decreased load (the load became lesser, the more this exercise was repeated. The ratios between health-promoting and special exercises were 1:1; 1:2; 1:3; 1:4; 1:5, and positive emotions during the classes in the form of games helped to better tolerate physical loads. Different grade of the patient’s efforts when performing the exercises proved to promote variation of loadings. In order to manage physical loadings, we used a principle of the load spreading with alternative involvement of different muscle groups; usage of different apparatus influenced the intensity of physical load.

When performing this program of physical exercises, their general load depended on their intensity, duration, density and volume. The intensity corresponded to certain threshold level for given step of the program. Duration of the load was adequate to performance time for each distinct task. The total volume of loads and their density was distributed uniformly, with their intensity determined by individual features of the patient and stage of the program. The motion regimen, dosage, density and total volume of the loads depended on the patient’s age and stage of the given rehabilitation program.

When arranging content of the game complexes and physical exercise sets we followed the principle "from a simple to more complex", i.e., from minor muscular groups to major ones, depending on the patient’s age. The games were classified into four groups with increasing loads: 1) On-site passive games; 2) Less active games; 3) Active games; 4) Elements of sports games. The games allowed usage of selective effects, exact intensity dosage for differently directed game exercises.

To evaluate efficiency of the the program, we used the QoL assessment using the special questionnaire (PedsQL Stem Cell Transplant Module Version 1.0) [14, 17].

Statistical evaluation of the results was performed by the STATISTICA 7.0 (StatSoft, USA). At initial stage, we evaluated the type of distribution by means of Shapiro-Wilkes criterion. Since most indexes did not show a standard distribution, the non-parametric methods were used. Significance of appropriate differences between the median values was evaluated by the Mann-Whitney test, with p<0.05 taken as a value of significance.

Results

Potapchuk-fig01.jpg

Figure 1. Quality of life indexes at the 3 stages of study in the 2 experimental groups

The analysis of QoL in the children following HSCT has shown statistically significant differences between the groups 1 and 2 (p<0.05) by all the scales of Questionnaire. The indexes were registered at all 3 stages of the program. The PedsQL Stem Cell Transplant Module data are shown in Table 3 and Fig. 1.

Evaluation of QoL indexes in adolescents subjected to HSCT allowed us to assess a statistically significant improvement of QoL by all the questionnaire scales. The indexes regularly decreased at the 2nd rehabilitation stage after HSCT, and increased at the 3rd rehabilitation stage, showing improved QoL for most indexes in experimental group 2, as compared to the 1st group.

Table 3. Quality of life scores in posttransplant adolescents at different stages of rehabilitation program

Potapchuk-tab03.jpg

Note: The data are expressed as points of the QoL questionnaire scores *, p<0.05 means a statistically significant difference between group 1 and group 2.

When summarizing the data obtained, one may see that all the life quality indexes were substantially decreased after HSCT in both experimental groups. However, during the rehabilitation measures, implementing the proposed program, a normalization and increase of parameters were revealed in experimental groups, especially by the indexes of physical functioning (+14%), emotional functioning (+11%), and communication abilities (+33%), thus confirming efficiency of the proposed physical rehabilitation program with respect to quality of life in the patients.

The data obtained confirm a positive effect of motor activities upon quality of life in adolescents subjected to hematopoietic stem cell transplantation reported elsewhere [13, 16].

Conclusion

1. At the present time, a number of children with cancer is registered worldwide, thus often requiring severe chemotherapy and hematopoietic stem cell transplantation (HSCT).

2. We have proposed a program of physical rehabilitation in children with cancer diseases, including nine variative sets of exercises. The technique consists of game exercises, fitness, respiratory and corrective exercises as well elements of adaptive sport.

3. The quality of life was evaluated by means of a PedsQL Stem Cell Transplant Questionnaire. Following HSCT, all the QoL indexes were decreased in both groups, i.e., with standard program of physical exercises (Group 1), and group 2 subjected to additional physical programs.

4. The course of rehabilitation in the patients from group 2 who used the proposed additional program has resulted into physical normalization and more pronounced increase in QoL, when compared to the children receiving standard physical exercises.

References

  1. Solokhina LV, Dyachenko EI, Yarinchuk EI. Studies on quality of life in tuberculosis-affected children. Far-Eastern Medical Journal. 2010; No.1: 134-137 (In Russian).
  2. Romanova LA, Kulishova TV, Nesina IA. Time dynamics of life quality in the children of school age with innate cervical spinal trauma following combined sanatory treatment, including manual therapy. Journal of Siberian Medical Sciences. 2014; No.4:180-187 (In Russian).
  3. Takken T, van der Torre P, Zwerink M, Hulzebos EH, Bierings M, Helders PJ, van der Net J. Development, feasibility and efficacy of a community-based exercise training program in pediatric cancer survivors. Psychooncology. 2009; 18(4):440-448.
  4. Parsons SK, Tighiouart H, Terrin N. Assessment of health-related quality of life in pediatric hematopoietic stem cell transplant recipients: progress, challenges and future directions. Expert Rev Pharmacoecon Outcomes Res. 2013; 13: 217-225.
  5. Lawitschka A, Güclü ED, Varni JW, Putz M, Wolff D, Pavletic S, Greinix H, Peters C, Felder-Puig R. Health-related quality of life in pediatric patients after allogeneic SCT: development of the PedsQL Stem Cell Transplant module and results of a pilot study. Bone Marrow Transplant. 2014; 49: 1093-1097.
  6. Hastings B, Patil C, Gallo AM. The experience and health-related quality of life after haploidentical stem cell transplantation for adults with sickle cell disease. West J Nurs Res. 2019;18:193945919870828. doi: 10.1177/0193945919870828.
  7. Zając-Spychała O, Pieczonka A, Barańska M, Wachowiak J. Long-term recipient health-related quality of life and donor-recipient relationship following sibling pediatric hematopoietic stem cell transplantation. Biol Blood Marrow Transplant. 2019 pii: S1083-8791(19)30665-2/ doi: 10.1016/j.bbmt.2019.10.009.
  8. Ivannikova AS, Pochivalov AV. Quality of life in children with respiratory diseases associated with non-differentiated dysplasia of connective tissue. The BelGU Research Notes (Medical and Pharmaceutic Series). 2012; No.16(135):47-49 (In Russian).
  9. Kaprina AD, Starinsky VV, Petrova GV. State of oncological care for the population of Russia in 2016. P.Gerzen Research Institute of Oncology: Moscow, 2017, pp. 18-19 (In Russian).
  10. van Brussel M, Takken T, van der Net J, Engelbert RH, Bierings M, Schoenmakers MA, Helders PJ. Physical function and fitness in long-term survivors of childhood leukaemia. Pediatr Rehabil. 2006; 9(3):267-274.
  11. San Juan AF, Chamorro-Viña C, Moral S, Fernández del Valle M, Madero L, Ramírez M, Pérez M, Lucia A. Benefits of intrahospital exercise training after pediatric bone marrow transplantation. Int J Sports Med. 2008;29(5): 439-446.
  12. Norris JM, Moules NJ, Pelletier G, Culos-Reed SN. Families of young pediatric cancer survivors: a cross-sectional survey examining physical activity behavior and health-related quality of life. J Pediatr Oncol Nurs. 2010; 27(4):196-208.
  13. Yildiz Kabak V, Cetinkaya DU, Kuskonmaz B, Cetin N, Duger T. Effects of multimodal exercise on clinical status and patient-reported outcomes in children undergoing hematopoietic stem cell transplantation. Pediatr Hematol Oncol. (2019) 36(7):410-421.
  14. Danaher EH, Ferrans C, Verlen E, Ravandi F, van Besien K, Gelms J, Dieterle N. Fatigue and physical activity in patients undergoing hematopoietic stem cell transplant. Oncol Nurs Forum. 2006; 33:614-624.
  15. Rosenhagen A, Bernhörster M, Vogt L, Weiss B, Senn A, Arndt S, Siegler K, Jung M, Bader P, Banzer W. Implementation of structured physical activity in the pediatric stem cell transplantation. Klin Pädiatr. 2011;223(3):147-151.
  16. Yildiz Kabak V, Duger T, Cetinkaya D. Investigation of the effects of an exercise program on physical functions and activities of daily life in pediatric hematopoietic stem cell transplantation. Pediatr Blood Cancer. 2016;63 (9):1643-1648.
  17. Brice L, Weiss R, Wei Y, Satwani P, Bhatia M, George D, Garvin J, Morris E, Harrison L, Cairo MS, Sands SA. Health-related quality of life (HRQoL): the impact of medical and demographic variables upon pediatric recipients of hematopoietic stem cell transplantation. Pediatr Blood Cancer. 2011;57(7):1179-1185.
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Потапчук<sup>1</sup>, Алиса Г. Волкова<sup>1</sup>, Федор В. Терентьев<sup>2</sup>, Ирина Г. Терентьева<sup>2</sup>, Людмила С. Зубаровская<sup>1</sup>, Борис В. Афанасьев<sup>1</sup> </p>" ["TYPE"]=> string(4) "HTML" } ["DESCRIPTION"]=> string(0) "" ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> array(2) { ["TEXT"]=> string(290) "

Алла А. Потапчук1, Алиса Г. Волкова1, Федор В. Терентьев2, Ирина Г. Терентьева2, Людмила С. Зубаровская1, Борис В. Афанасьев1

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1 НИИ детской онкологии, гематологии и трансплантологии им. Р. М. Горбачевой, Первый Санкт-Петербургский государственный медицинский университет им. акад. И. П. Павлова, Санкт-Петербург, Россия
2 Национальный государственный университет физической культуры, спорта и здоровья им. П. Ф. Лесгафта, Санкт-Петербург, Россия

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Данная статья посвящена анализу влияния физической реабилитации на показатели качества жизни подростков 12-17 лет с онкопатологией после трансплантации гемопоэтических стволовых клеток (ТГСК). Авторская методика физической реабилитации включает три этапа, включающие девять комплексов физических упражнений в зависимости от возраста и режима двигательной активности. Проводилась оценка качества жизни, оценивался уровень тревожно-депрессивных состояний подростков на трех этапах исследования: до проведения трансплантации, после трансплантации, после реабилитации. Полученные данные свидетельствуют о положительном влиянии физической реабилитации на качество жизни подростков с онкопатологией, перенесших трансплантацию гемопоэтических стволовых клеток.

Ключевые слова

Физическая реабилитация, онкология, дети, трансплантация гемопоэтических стволовых клеток, депрессия, тревога, эмоциональное состояние.

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Alla A. Potapchuk1, Alisa G. Volkova1, Fedor V. Terentiev2, Irina G. Terentieva2, Ludmila S. Zubarovskaya1, Boris V. Afanasyev1

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1 Raisa Gorbacheva Memorial Research Institute of Pediatric Oncology, Hematology and Transplantation, Pavlov University,
St. Petersburg, Russia
2 National State P. F. Lesgaft University of Physical Culture, Sports and Health, St. Petersburg, Russia

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The present article is evaluating the effects of physical rehabilitation upon the quality of life (QoL) indexes in adolescents (12 to 17 y.o.) with oncological diseases following hematopoietic stem cell transplantation (HSCT). The proprietary technique of physical rehabilitation includes 3 stages with nine complexes of physical exercises, dependent on their age and regimen of motor activities. We have evaluated QoL, and anxiety/depressive conditions in adolescents at three stages of the study: HSCT, after it, and following rehabilitation. The data obtained confirm a positive effect of the physical rehabilitation upon QoL in the adolescents with cancer subjected to hematopoietic stem cell transplantation.

Keywords

Physical rehabilitation, oncology, children, hematopoietic stem cell transplantation, depression, anxiety, emotional state.

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Potapchuk<sup>1</sup>, Alisa G. Volkova<sup>1</sup>, Fedor V. Terentiev<sup>2</sup>, Irina G. Terentieva<sup>2</sup>, Ludmila S. Zubarovskaya<sup>1</sup>, Boris V. Afanasyev<sup>1</sup></p>" ["TYPE"]=> string(4) "HTML" } ["DESCRIPTION"]=> string(0) "" ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> array(2) { ["TEXT"]=> string(200) "

Alla A. Potapchuk1, Alisa G. Volkova1, Fedor V. Terentiev2, Irina G. Terentieva2, Ludmila S. Zubarovskaya1, Boris V. Afanasyev1

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Alla A. Potapchuk1, Alisa G. Volkova1, Fedor V. Terentiev2, Irina G. Terentieva2, Ludmila S. Zubarovskaya1, Boris V. Afanasyev1

" } ["SUMMARY_EN"]=> array(37) { ["ID"]=> string(2) "39" ["TIMESTAMP_X"]=> string(19) "2015-09-02 18:02:59" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(21) "Description / Summary" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(10) "SUMMARY_EN" ["DEFAULT_VALUE"]=> array(2) { ["TEXT"]=> string(0) "" ["TYPE"]=> string(4) "HTML" } ["PROPERTY_TYPE"]=> string(1) "S" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "30" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "N" ["XML_ID"]=> string(2) "39" ["FILE_TYPE"]=> string(0) "" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "0" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "N" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> string(4) "HTML" ["USER_TYPE_SETTINGS"]=> array(1) { ["height"]=> int(200) } ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> string(5) "25285" ["VALUE"]=> array(2) { ["TEXT"]=> string(987) "<p style="text-align: justify;">The present article is evaluating the effects of physical rehabilitation upon the quality of life (QoL) indexes in adolescents (12 to 17 y.o.) with oncological diseases following hematopoietic stem cell transplantation (HSCT). The proprietary technique of physical rehabilitation includes 3 stages with nine complexes of physical exercises, dependent on their age and regimen of motor activities. We have evaluated QoL, and anxiety/depressive conditions in adolescents at three stages of the study: HSCT, after it, and following rehabilitation. The data obtained confirm a positive effect of the physical rehabilitation upon QoL in the adolescents with cancer subjected to hematopoietic stem cell transplantation. </p> <h2>Keywords</h2> <p style="text-align: justify;">Physical rehabilitation, oncology, children, hematopoietic stem cell transplantation, depression, anxiety, emotional state.</p>" ["TYPE"]=> string(4) "HTML" } ["DESCRIPTION"]=> string(0) "" ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> array(2) { ["TEXT"]=> string(931) "

The present article is evaluating the effects of physical rehabilitation upon the quality of life (QoL) indexes in adolescents (12 to 17 y.o.) with oncological diseases following hematopoietic stem cell transplantation (HSCT). The proprietary technique of physical rehabilitation includes 3 stages with nine complexes of physical exercises, dependent on their age and regimen of motor activities. We have evaluated QoL, and anxiety/depressive conditions in adolescents at three stages of the study: HSCT, after it, and following rehabilitation. The data obtained confirm a positive effect of the physical rehabilitation upon QoL in the adolescents with cancer subjected to hematopoietic stem cell transplantation.

Keywords

Physical rehabilitation, oncology, children, hematopoietic stem cell transplantation, depression, anxiety, emotional state.

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The present article is evaluating the effects of physical rehabilitation upon the quality of life (QoL) indexes in adolescents (12 to 17 y.o.) with oncological diseases following hematopoietic stem cell transplantation (HSCT). The proprietary technique of physical rehabilitation includes 3 stages with nine complexes of physical exercises, dependent on their age and regimen of motor activities. We have evaluated QoL, and anxiety/depressive conditions in adolescents at three stages of the study: HSCT, after it, and following rehabilitation. The data obtained confirm a positive effect of the physical rehabilitation upon QoL in the adolescents with cancer subjected to hematopoietic stem cell transplantation.

Keywords

Physical rehabilitation, oncology, children, hematopoietic stem cell transplantation, depression, anxiety, emotional state.

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1 Raisa Gorbacheva Memorial Research Institute of Pediatric Oncology, Hematology and Transplantation, Pavlov University,
St. Petersburg, Russia
2 National State P. F. Lesgaft University of Physical Culture, Sports and Health, St. Petersburg, Russia

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1 Raisa Gorbacheva Memorial Research Institute of Pediatric Oncology, Hematology and Transplantation, Pavlov University,
St. Petersburg, Russia
2 National State P. F. Lesgaft University of Physical Culture, Sports and Health, St. Petersburg, Russia

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Алла А. Потапчук1, Алиса Г. Волкова1, Федор В. Терентьев2, Ирина Г. Терентьева2, Людмила С. Зубаровская1, Борис В. Афанасьев1

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Алла А. Потапчук1, Алиса Г. Волкова1, Федор В. Терентьев2, Ирина Г. Терентьева2, Людмила С. Зубаровская1, Борис В. Афанасьев1

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Terentiev" ["LINK_ELEMENT_VALUE"]=> bool(false) } ["SUMMARY_RU"]=> array(37) { ["ID"]=> string(2) "27" ["TIMESTAMP_X"]=> string(19) "2015-09-02 18:01:20" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(29) "Описание/Резюме" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(10) "SUMMARY_RU" ["DEFAULT_VALUE"]=> array(2) { ["TEXT"]=> string(0) "" ["TYPE"]=> string(4) "HTML" } ["PROPERTY_TYPE"]=> string(1) "S" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "30" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "N" ["XML_ID"]=> string(2) "27" ["FILE_TYPE"]=> string(0) "" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "0" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "N" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> string(4) "HTML" ["USER_TYPE_SETTINGS"]=> array(1) { ["height"]=> int(200) } ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> string(5) "25281" ["VALUE"]=> array(2) { ["TEXT"]=> string(1831) "<p style="text-align: justify;">Данная статья посвящена анализу влияния физической реабилитации на показатели качества жизни подростков 12-17 лет с онкопатологией после трансплантации гемопоэтических стволовых клеток (ТГСК). Авторская методика физической реабилитации включает три этапа, включающие девять комплексов физических упражнений в зависимости от возраста и режима двигательной активности. Проводилась оценка качества жизни, оценивался уровень тревожно-депрессивных состояний подростков на трех этапах исследования: до проведения трансплантации, после трансплантации, после реабилитации. Полученные данные свидетельствуют о положительном влиянии физической реабилитации на качество жизни подростков с онкопатологией, перенесших трансплантацию гемопоэтических стволовых клеток.</p> <h2>Ключевые слова</h2> <p style="text-align: justify;">Физическая реабилитация, онкология, дети, трансплантация гемопоэтических стволовых клеток, депрессия, тревога, эмоциональное состояние. </p>" ["TYPE"]=> string(4) "HTML" } ["DESCRIPTION"]=> string(0) "" ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> array(2) { ["TEXT"]=> string(1775) "

Данная статья посвящена анализу влияния физической реабилитации на показатели качества жизни подростков 12-17 лет с онкопатологией после трансплантации гемопоэтических стволовых клеток (ТГСК). Авторская методика физической реабилитации включает три этапа, включающие девять комплексов физических упражнений в зависимости от возраста и режима двигательной активности. Проводилась оценка качества жизни, оценивался уровень тревожно-депрессивных состояний подростков на трех этапах исследования: до проведения трансплантации, после трансплантации, после реабилитации. Полученные данные свидетельствуют о положительном влиянии физической реабилитации на качество жизни подростков с онкопатологией, перенесших трансплантацию гемопоэтических стволовых клеток.

Ключевые слова

Физическая реабилитация, онкология, дети, трансплантация гемопоэтических стволовых клеток, депрессия, тревога, эмоциональное состояние.

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Данная статья посвящена анализу влияния физической реабилитации на показатели качества жизни подростков 12-17 лет с онкопатологией после трансплантации гемопоэтических стволовых клеток (ТГСК). Авторская методика физической реабилитации включает три этапа, включающие девять комплексов физических упражнений в зависимости от возраста и режима двигательной активности. Проводилась оценка качества жизни, оценивался уровень тревожно-депрессивных состояний подростков на трех этапах исследования: до проведения трансплантации, после трансплантации, после реабилитации. Полученные данные свидетельствуют о положительном влиянии физической реабилитации на качество жизни подростков с онкопатологией, перенесших трансплантацию гемопоэтических стволовых клеток.

Ключевые слова

Физическая реабилитация, онкология, дети, трансплантация гемопоэтических стволовых клеток, депрессия, тревога, эмоциональное состояние.

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1 НИИ детской онкологии, гематологии и трансплантологии им. Р. М. Горбачевой, Первый Санкт-Петербургский государственный медицинский университет им. акад. И. П. Павлова, Санкт-Петербург, Россия
2 Национальный государственный университет физической культуры, спорта и здоровья им. П. Ф. Лесгафта, Санкт-Петербург, Россия

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1 НИИ детской онкологии, гематологии и трансплантологии им. Р. М. Горбачевой, Первый Санкт-Петербургский государственный медицинский университет им. акад. И. П. Павлова, Санкт-Петербург, Россия
2 Национальный государственный университет физической культуры, спорта и здоровья им. П. Ф. Лесгафта, Санкт-Петербург, Россия

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Introduction

Disturbed postural resistance is a common finding among the patients treated for cancer diseases, regardless of their exact nosological forms. Researchers describe imbalances in children treated for brain tumors [1, 2] and leukemia [3], in adult people treated for lung cancer [4], breast cancer [5], leukemia, lymphomas and other solid tumors [6], etc. According to evidence-based studies meta-analyses, the percentage of leukemia survivors with disturbed postural equilibrium ranged from 27% to 69% during the treatment, being 7% to 65% at later observation terms (over 5 years) following the cytostatic therapy [6]. For children treated for medulloblastoma, the development of posterior cranial fossa syndrome is characteristic which may manifest with acute postural imbalance.

Damage of brain by the growing malignancy and surgical intervention are considered to be a cause of this phenomenon in the patients with tumors located at the posterior cranial fossa. However, imbalance signs in pediatric cancer patients without evident brain lesions suggest some other possible causes of postural instability. A number of researchers attribute postural imbalance to the late toxic effects of radiation therapy [6], or consequences of chemotherapy [7]. In the literature, we have encountered only a few studies on the mechanisms of impaired postural stability in the cancer patients. In particular, Gilchrist L.S. and Tanner L.R. (2018) examined the relationships of imbalance with manifestations of peripheral neuropathy [3].

In another study of adult cancer survivors treated in their childhood, it was shown that both the disease and treatment cause long-term disturbances of postural resistance in the position with open eyes. At the same time, the authors found a similar reaction of cancer survivors and healthy subjects to closing their eyes, which allowed them to confirm a preserved role of vision for postural resistance [8]. R. Leight and D. Zee (2015) showed that the brain tumors, including cerebellum, lead to serious oculomotor disturbances, in particular, saccadic dysmetry, occurence of disruptive micro- and macrosaccades, that may affect the body equilibrium [9]. Einarsson E.J. et al. (2016) showed sufficient oculomotor disorders in patients with oncological diseases which did not directly affect the central nervous system [10]. In their opinion, these disorders may be caused by toxic effects chemotherapeutic cytostatic drugs upon brain tissues after crossing the blood-brain barrier. In 2019, the same authors described increased visual dependence in people who survived childhood cancer under the age of 12 years, which is thought to explain the visual dizziness in adults who previously received chemotherapy.

The aim of our retrospective study was to clarify a relationship between the postural stability disorders in children treated for cancer, and oculomotor muscle dysfunction.

Patients and methods

The study was carried out during their rehabilitation course at the Medical Rehabilitation Research Center Russian Field. The study involved 291 children 5-18 years old who were previously treated for a brain tumor localized in the posterior cranial fossa: medulloblastoma – 58.11%, piloid astrocytoma – 22.50%, anaplastic ependymoma – 6.25%, diffuse stem tumors – 4.36%, anaplastic astrocytoma – 2.25% ganglioglioma – 2.25% and others with a frequency of <1% and were in remission (82.3%) or stabilization (17.7%). In the vast majority of cases, the disease was diagnosed at an early age: up to 6 years, in 63.9% of girls and 53.7% of boys, from 7 to 11 years – in 26.9% of girls and 34.2% of boys (Fig. 1).

Chechelnitskaia-fig01.jpg

Figure 1. Distribution of the children with malignancies by their gender and age of onset. Abscissa, age of the disease onset, years; ordinate, number of cases

79% of the examined children underwent radiation therapy, 75% chemotherapy, 64% received complex therapy, including surgical treatment, chemotherapy and radiation therapy.

According to the duration of remission at the time of examination, the patients were distributed as follows: up to 1 year – 15.6%, from 1 year to 3 years – 37.8%, from 4 to 7 years – 31.1%, over 8 years – 15.6%.

The control group included 182 children 6-18 years old, who were in the medical rehabilitation scientific center "Russian Field" with their siblings, and healthy children who were engaged in the group of general physical training for the first year.

The quality of the postural balance was evaluated by a stabilometric method using the computer-assisted Stabilan 01-2 device (manufacturing firm OKB RITM Russia). A stabilometric study is based on recording the parameters of the oscillations of the projection of the conditional center of mass of the person being examined on the plane of the stable platform.

Each individual test consisted of sequential trials with open and closed eyes (Romberg test) in a European installation (in heel position together, socks divorced at an angle of 30 degrees), the duration of each trial was 30 seconds [11]. The mark was stuck on the wall in front of the child. The subject should fix his eyes on it throughout the testing. We analyzed the stabilometric indicators of the displacement and dispersion of the center of human pressure in the area of support (on the reference plane, the lengths of the trajectories of the pressure center in the frontal and sagittal planes, the linear velocities of the movement of the pressure center on the reference plane, and the size of the area of the confidence ellipse of the statokinesiogram).

Chechelnitskaya-fig02.jpg

Figure 2. An example of a graphic image of a statokinesiogram. Actually, the statokinesiogram is the trajectory of pressure center oscillations during the study. The circle (a special case of an ellipse) represents a 95% confidence interval for the position of the pressure center

The center of a person’s pressure on the area of support is the projection of the general center of pressure of a person’s body on a horizontal plane. Displacements from the center of pressure are recorded as a statokinesiogram. The area of statokinesiogram forms an ellipse, which includes 95 percent of the fixed points, is called the area of the confidence ellipse. Figure 2 shows an example of a statokinesiogram with a confidence ellipse.

The patient’s data were compared with gender- and age-matched children from the control group. Postural balance indexes were registered in the Romberg test with open eyes. A test for fixing the gaze on a stimulus was used to evaluate the work of the saccadic system of eye movements [12], which allows one to characterize the degree of work of the oculomotor muscles, since the physiological fixation process requires establishing and maintaining fovea in one position. The required duration of fixation in the test (20 seconds) on each stimulus was selected, to prevent a sufficient loading of the oculomotor muscles. The test evaluates the spread and density of the gaze when fixing the patient on the stimulus.

The patient was sitting comfortably on the chair in front the monitor in the calm room for neurophysiological investigations. Eye movements were recorded by videoculography using an Arrington 60 Hz eye-tracker glasses. Patient`s head was fixed by a frontal chin support to minimize head movements. Functioning of the oculomotor muscles was evaluated by the gaze fixation test on the stimulus (Danilov et al., 2015) [12]. The stimulus were presented on a Samsung 23-inch screen (with a resolution of 1920×1080 pixels) at a distance of 60 cm from the subjects' eyes, while occupied about 45° horizontally and 26° vertically of their visual field. The stimulating object (a green dot on the screen) had a size of ~1°, having been sequentially moved in the left/right positions by 15°, and at the top/bottom direction, by 8° for 20 s for each position. Dispersion and density of the gaze fixation points on the every stimulus were evaluated. Raw dispersions of gaze fixation points were filtered in ±2σ of coordinates' distribution and fitted by ellipse Matlab function "fit_ellipse". Then the squares of the obtained ellipses were counted in deg2. Densities of the gaze fixation points were counted as a ratio of the number of fixation points to the ellipse square. The larger squares of the ellipses and the lower densities of the points reveal the more unstable gaze fixation.

Statistical evaluation of the results was performed with a modification of the Student t-test (Welch test), which suggests that the variances of the compared populations are not equal. To model relationships between of the analyzed indexes, regression analysis was used, which allowed us to analytically present the relationship models between appropriate indexes, and to quantify relative influence for distinct factors. In the course of statistical modeling of explicit asymmetric distributions, we used conversion of initial values to logarithmic form and the Box-Cox transformation.

Results

To assess the postural balance in patients treated for tumors of the posterior cranial fossa, we analyzed the stabilometric indicators of the displacement and dispersion of the fixation points of the pressure center on the reference plane, the length of the trajectories of the pressure center in the frontal and sagittal planes, the linear velocities of the pressure center on the reference plane and the magnitude areas of the confiding ellipse of the statokinesiogram. The results were compared with homologous children from the control group. Indicators of postural balance were recorded in the Romberg test with open eyes. The results are presented in Table 1.

Table 1. Indexes of postural balance in children treated for brain tumor, and in healthy children using Romberg test with open eyes

Chechelnitskaia-tab01.jpg

In our study, the average size of the estimated ellipse area in children of the main group in the position with open eyes was 673±1201.1 mm2, thus being significantly differed from the average values in the control group (258.9±162.5 mm2). To confirm the hypothesis about the relationship between the postural balance and the disease, a nonlinear (exponential) regression model was constructed for the Ellipse Area indicator:

log(Ells)=6.7 – 0.059full.year + 0.104gender – 0.57grp,
R2=0.103, p<0,05.
where log (Ells) is the logarithm (natural) of the area of the ellipse.
gender = 1 – boys, 0 – girls
grp = 1 – healthy controls; 0, treated patients.

Age of children (full_years), and disease state (grp) proved to be the statistically significant factors in this model. According to the model, the logarithm of ellipse area in healthy children was lower by 0.57 (p<0.000).

In order to study potential contribution of altered vision in the postural control, we analyzed the change in the Rom-berg test parameters when the patient changes the position with open eyes (EO) to the pose with closed eyes (EC). For analysis, the relative dynamics of indexes were calculated by the formula:

Chechelnitskaia-form01.jpg

where

Chechelnitskaia-form02.jpg

When evaluating the following indices: Assessment of movement and Quality of the equilibrium function, a minus sign was introduced before the formula, due to their special calculation modes:

Chechelnitskaia-form03.jpg

As a result, we have calculated the factors characterizing changes of stabilometric indexes when turning off the vision. The values of the coefficient equal to "0" and higher denoted the improvement of stabilometric values when closing the eyes, whereas a negative value meant their impairment (Table 2).

Table 2. Increases in the indicators of the postural balance of children treated for cancer and their healthy peers in the Romberg test when moving from the Open eyes to the Closed eyes position

Chechelnitskaia-tab02.jpg

More often, the shutdown of vision led to a positive change in the mentioned indexes. Assessment of movement and Displacement of the center of pressure along the sagittal axis (68.5%/61.1% of pediatric patients, and 30.8%/33.3% in the control group, respectively), as seen from Table 3.

Table 3. Frequencies of “atypical” reactions in the Romberg position with closed eyes, %

Chechelnitskaia-tab03.jpg

In the main group, the area of the confidence ellipse decreased in 43.2% of children by an average of 33.4%. Similar dynamics was noted in 20.5% of the examined children, the average decrease in area was 29.6% (Fig. 3). Moreover, the Romberg coefficient averaged 113% both in the main group and in the control group.

Chechelnitskaia-fig03.jpg

Figure 3. The allocation of growth rates of the indicator Ellipse area increments in the Romberg test during the transition from open to closed eyes in children of the main group

To test the hypothesis about the relationship between postural control and oculomotor activity, we analyzed the results of examination of children treated for tumors of the posterior cranial fossa, on an i-tracking. The oculomotor muscles perform fast saccadic eye movements necessary for fixing the gaze on the object, a point in space, etc., due to which the brain receives visual information. The saccadic system is a complex hierarchical system in which many brain structures are involved [19]. The variable measured in the i-tracking is the area of ellipses (deg2), in terms of the content and type of the calculation, it is related to the stabilometric parameter – the ellipse of the statokinesiogram. The larger is the area of the ellipse, the less stable the gaze is kept. Vice versa, the gaze fixation of the gaze is impaired due to various involuntary saccadic movements (disruptive, intrusive macro- and micro-amplitude involuntary saccades) and nystagmus. The second variable density of gaze fixation, with 95% of points fitting the ellipse area within a definite time period. It characterizes the presence or absence of large-amplitude movements, since with large-amplitude movements, the area of the ellipse increases when the gaze is fixed, and the density of the gaze positions, on the contrary, decreases.

We did not find any correlations between the absolute stabilometric indexes and saccadic activity. At the same time, we found a connection between saccadic activity indexes and increased stabilometry indexes in the Romberg test upon transition from open to closed eyes. Indicators of saccadic activity showed asymmetric distribution. Therefore, a power-law transformation of initial data by the Box-Cox method was performed, in order to identify their relationships with stabilometry indexes.

The simulation results showed that the mode of relationships between the saccadic activity indicators and incrementing stabilometric indices corresponded to linear regression. A moderate correlation between the conventional elliptic area during gaze fixation and increased stabilometry indices was shown by means of this model; the multiple correlation coefficient is in the range between 0.35 and 0.62. The contribution of explained variance (R2) was in the range of 13.2% to 38.0%.

The moderate correlation between the density of points in the ellipse during gaze fixation and the growth of stabilometry indicators was also demonstrable, with multiple correlation coefficients of 0.38 to 0.59. The impact of explained variance (R2) is in the range of 14.4-34.5%. The correlation coefficients of individual indicators are shown in Table 4.

Table 4. Matrix of paired correlation coefficients between the increment of stabilometry indicators and parameters of saccadic activity after the Box-Cox transformation

Chechelnitskaia-tab04.jpg

Note: *, correlation quotients are statistically significant at p <0.05

Discussion

The physical status of children who survived cancer, has become the subject of an active study in connection with the successes of modern medicine. The end of anti-cancer treatment does not mean complete recovery of the patient. Moreover, aggressive anti-cancer treatment leads to the development of multiple complications that worsen the quality of life and reduce the predicted life expectancy [13, 14, 7]. The data obtained by researchers indicate the need for physical activity programs aimed specifically at approaches to minimizing physical limitations. One of these limitations is a violation of the postural balance.

Imbalances in the body in works on children who have survived cancer, are usually detected by the Bruninks-Ozeretsky test, which allows you to study the whole range of motor qualities [8, 5, 1]. According to Gilchrist LS, Tanner LR (2018), 78% of children receiving chemotherapy courses for cancer showed reduced balance on treatment, 6 months after the end of treatment, the percentage of children with reduced rates decreased to 53% [3]. This means that more than half of the children still had difficulty holding their posture. In studies of Piscione PJ, Bouffet E et al. (2014), conducted with the participation of children with tumors of the posterior cranial fossa (cerebellar astrocytoma 43.3% and medulloblastoma 40%), a significant decrease in balance indicators was recorded in 70% of the examined [1].

We applied the method of stabilometry to assess the postural balance in children 5-18 years old. Differences between the indicators of children of the main and control groups reached the level of statistical significance, excluding the indicator, i.e., displacement length of the center of pressure in frontal plane. But at the same time, the difference in almost all parameters did not reach the level of physiological significance, since in both groups the spread of the numbers was very large.

Einarsson E-J, Patel M, et al. (2016) also described the absence of a significant difference between people who survived childhood cancer and healthy control in a calm stance [10]. But at the same time they found that former patients spend significantly more energy than healthy people to maintain vertical balance. In our further analysis, we plan to study the features of energy consumption for maintaining a vertical posture in children.

The area of confidence ellipse proved to be the most sensitive parameter in our study, since the average size of the area of the ellipse in children of the main group in the position with open eyes was 673±1201.1 mm2, and in the control group 258.9±162.5 mm2. The constructed model of nonlinear (exponential) regression for the Ellipse area indicator allowed us to confirm the relationship between the ellipse area and the disease. Consequently, a combination of not very physiologically significant deviations in the stabilometry indicators confirms the presence of postural disorders.

The leading role of vision in postural control in cancer survivors is confirmed by Einarsson E-J, Patel M, et al. (2016). According to them, vision significantly increased postural stability in both former patients and the control group. Both of them spent less energy on maintaining the posture in the position with open eyes. The authors found no evidence of dependence on chemotherapy [10].

The data given indicate that in the position with the eyes closed we are entitled to expect a significant deterioration in the main indicators of stabilometry. Perhaps even more significant than in healthy children. It is generally accepted that a healthy person has a normal reaction from the body balance control system to turning off the visual analyzer – an increase in the fluctuation of the center of pressure [15].

In our studies, we often encountered the opposite reaction – the postural balance in the position with the eyes closed improved.

The analysis of the coefficients of growth indicators obtained by us when closing the eyes showed that a positive reaction of the postural balance to turning off the vision occurs both among children treated for tumors of the posterior cranial fossa and among their healthy peers. In the group of treated children, this phenomenon occurred reliably and significantly more often. But at the same time, the values of the average coefficients of the indicators were comparable, their differences did not reach the level of statistical significance.

The most sensitive to eye closure were the indicators Assessment of movement and Displacement of the center of pressure along the sagittal. These results are consistent with the data of Andrea Berensci et al. (2005) [16] that the amplitudes of postural vibrations are greater when stimuli are presented for central vision than for peripheral vision conditions. Our study did not include children with clinically expressed central vision problems, as this was an exclusion criterion. Nevertheless, it cannot be ruled out that one of the reasons for improving the postural balance is subclinical visual acuity.

The indicator Assessment of movement should not be associated with the acuity of central vision, since it is calculated as the ratio of the indicators "Curve Length" and "Average Dispersion" and reflects the spread of fluctuations (tremor).

Earlier, a number of authors showed that patho-biomechanical changes in the structures richest in proprioreceptors (neck muscles, oculomotor muscles, chewing muscles) cause a mismatch between the real and perceived CNS position of the body parts [8, 16]. We tested the hypothesis about the role of oculomotor muscle dysfunction in disturbing postural balance in children treated for tumors of the posterior cranial fossa. Absolute indicators of stabilometry in an upright posture with open eyes were not associated with indicators of saccadic activity. At the same time, the relationship between the coefficients of change in the indicators of stabilometry when closing the eyes with the area of the ellipse of the fixation points of the gaze corresponded to linear regression and was stable in average. The share of the explained variance reached 38.0%. Equally expressed and stable was the relationship between the coefficients of change in the indicators of stabilometry and the density of the points of fixation of the gaze in the ellipse.

Since when closing the eyes there is not only a shutdown of visual afferentation, but also a decrease in the activity of the oculomotor muscles, the latter may explain the improvement in postural balance when closing the eyes. The validity of this conclusion is indirectly confirmed by a number of works.

Einarsson E-J, Patel M, et al. (2016) studied oculomotor activity in adults who received chemotherapy in childhood for a solid cancerous tumor that did not affect the central nervous system. According to them, the temporal control of smooth tracking speed (speed accuracy) was noticeably worse (p<0.001), and saccades had a disproportionately lower amplitude in survivors of childhood cancer compared with healthy subjects [10]. Patients treated before 12 years old had a more expressed oculomotor deficiency. Patients who survived childhood cancer experienced subjective symptoms of visual impairment (70%), sensations that things around them revolved or moved (87%). Several subjective symptoms were largely associated with a deficiency of oculomotor characteristics.

In our study, the phenomena of saccadic dysmetry, regardless of the direction of gaze, were associated with coefficients reflecting the change in the indicators of movement of the fixation points of the center of pressure of the body on the surface in the frontal plane and their derivatives, which is consistent with the statement of Andrea Berensci et al. [17] on the role of peripheral vision in postural stability. Changes in indicators in the sagittal plane were either not connected at all, or with a small number of variables, which indicates the absence of influence of central vision.

Conclusion

We have confirmed that, already early after the end of cytostatic treatment, the children who survived cancer develop postural balance disorders associated with the disease factor. We have revealed an improvement of postural control when closing eyes and its connection with saccadic dysmetria, thus allowing to consider this phenomenon to be a result of damage to oculomotor muscles and offering new tools and methods for rehabilitation of cancer patients.

Conflict of interest

None reported.

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  11. Nigamadyanov NR. Computer-assisted stabilometry in diagnostics and correction of postural disturbances in children with spinal pathology. Ref. PhD Thesis: Moscow. 2017: 1-20 (In Russian).
  12. Danilov Y, Kaczmarek K, Skinner K, Tyler M. Cranial Nerve Noninvasive Neuromodulation. In: Brain neurotrauma: molecular, neuropsychological, and rehabilitation aspects. Taylor & Francis, Boca Raton (FL): CRC Press. 2015, Chapter 44.
  13. Hudson MM, Oeffinger KC, Jones K, Brinkman TM, Krull KR, Mulrooney DA, Mertens A, Castellino SM, Casillas J, Gurney JG, Nathan PC, Leisenring W, Robison LL, Ness KK. Age-dependent changes in health status in the Childhood Cancer Survivor cohort. J. Clin. Oncol. 2015; 33(5):479-491.
  14. Taylor N, Absolom K, Michel G, Urquhart T, Gerrard M, Jenkins A, Lee V, Vora A, Eiser C. Comparison of self-reported late effects with medical records among survivors of childhood cancer. Eur. J. Cancer. 2010; 46(6):1069-1078.
  15. Lysenko VV, Mirzoeva EV, Ostrikov AP, Bozhkov AV. Interaction between disturbed statics and vision quality in sports. Molodoy Ucheny. 2016; 24: 565-568 (In Russian).
  16. Boulanger M, Giraudet G, Faubert J. Interaction between the oculomotor and postural systems during a dual-task: Compensatory reductions in head sway following visually-induced postural perturbations promote the production of accurate double-step saccades in standing human adults. PLoS One. 2017; 12(3): e0173678.
  17. Berensci A, Ishihara M, Imanaka K. The functional role of central and peripheral vision in the control of posture. Human Movement. 2005; 24(5-6):689-709.
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Introduction

Disturbed postural resistance is a common finding among the patients treated for cancer diseases, regardless of their exact nosological forms. Researchers describe imbalances in children treated for brain tumors [1, 2] and leukemia [3], in adult people treated for lung cancer [4], breast cancer [5], leukemia, lymphomas and other solid tumors [6], etc. According to evidence-based studies meta-analyses, the percentage of leukemia survivors with disturbed postural equilibrium ranged from 27% to 69% during the treatment, being 7% to 65% at later observation terms (over 5 years) following the cytostatic therapy [6]. For children treated for medulloblastoma, the development of posterior cranial fossa syndrome is characteristic which may manifest with acute postural imbalance.

Damage of brain by the growing malignancy and surgical intervention are considered to be a cause of this phenomenon in the patients with tumors located at the posterior cranial fossa. However, imbalance signs in pediatric cancer patients without evident brain lesions suggest some other possible causes of postural instability. A number of researchers attribute postural imbalance to the late toxic effects of radiation therapy [6], or consequences of chemotherapy [7]. In the literature, we have encountered only a few studies on the mechanisms of impaired postural stability in the cancer patients. In particular, Gilchrist L.S. and Tanner L.R. (2018) examined the relationships of imbalance with manifestations of peripheral neuropathy [3].

In another study of adult cancer survivors treated in their childhood, it was shown that both the disease and treatment cause long-term disturbances of postural resistance in the position with open eyes. At the same time, the authors found a similar reaction of cancer survivors and healthy subjects to closing their eyes, which allowed them to confirm a preserved role of vision for postural resistance [8]. R. Leight and D. Zee (2015) showed that the brain tumors, including cerebellum, lead to serious oculomotor disturbances, in particular, saccadic dysmetry, occurence of disruptive micro- and macrosaccades, that may affect the body equilibrium [9]. Einarsson E.J. et al. (2016) showed sufficient oculomotor disorders in patients with oncological diseases which did not directly affect the central nervous system [10]. In their opinion, these disorders may be caused by toxic effects chemotherapeutic cytostatic drugs upon brain tissues after crossing the blood-brain barrier. In 2019, the same authors described increased visual dependence in people who survived childhood cancer under the age of 12 years, which is thought to explain the visual dizziness in adults who previously received chemotherapy.

The aim of our retrospective study was to clarify a relationship between the postural stability disorders in children treated for cancer, and oculomotor muscle dysfunction.

Patients and methods

The study was carried out during their rehabilitation course at the Medical Rehabilitation Research Center Russian Field. The study involved 291 children 5-18 years old who were previously treated for a brain tumor localized in the posterior cranial fossa: medulloblastoma – 58.11%, piloid astrocytoma – 22.50%, anaplastic ependymoma – 6.25%, diffuse stem tumors – 4.36%, anaplastic astrocytoma – 2.25% ganglioglioma – 2.25% and others with a frequency of <1% and were in remission (82.3%) or stabilization (17.7%). In the vast majority of cases, the disease was diagnosed at an early age: up to 6 years, in 63.9% of girls and 53.7% of boys, from 7 to 11 years – in 26.9% of girls and 34.2% of boys (Fig. 1).

Chechelnitskaia-fig01.jpg

Figure 1. Distribution of the children with malignancies by their gender and age of onset. Abscissa, age of the disease onset, years; ordinate, number of cases

79% of the examined children underwent radiation therapy, 75% chemotherapy, 64% received complex therapy, including surgical treatment, chemotherapy and radiation therapy.

According to the duration of remission at the time of examination, the patients were distributed as follows: up to 1 year – 15.6%, from 1 year to 3 years – 37.8%, from 4 to 7 years – 31.1%, over 8 years – 15.6%.

The control group included 182 children 6-18 years old, who were in the medical rehabilitation scientific center "Russian Field" with their siblings, and healthy children who were engaged in the group of general physical training for the first year.

The quality of the postural balance was evaluated by a stabilometric method using the computer-assisted Stabilan 01-2 device (manufacturing firm OKB RITM Russia). A stabilometric study is based on recording the parameters of the oscillations of the projection of the conditional center of mass of the person being examined on the plane of the stable platform.

Each individual test consisted of sequential trials with open and closed eyes (Romberg test) in a European installation (in heel position together, socks divorced at an angle of 30 degrees), the duration of each trial was 30 seconds [11]. The mark was stuck on the wall in front of the child. The subject should fix his eyes on it throughout the testing. We analyzed the stabilometric indicators of the displacement and dispersion of the center of human pressure in the area of support (on the reference plane, the lengths of the trajectories of the pressure center in the frontal and sagittal planes, the linear velocities of the movement of the pressure center on the reference plane, and the size of the area of the confidence ellipse of the statokinesiogram).

Chechelnitskaya-fig02.jpg

Figure 2. An example of a graphic image of a statokinesiogram. Actually, the statokinesiogram is the trajectory of pressure center oscillations during the study. The circle (a special case of an ellipse) represents a 95% confidence interval for the position of the pressure center

The center of a person’s pressure on the area of support is the projection of the general center of pressure of a person’s body on a horizontal plane. Displacements from the center of pressure are recorded as a statokinesiogram. The area of statokinesiogram forms an ellipse, which includes 95 percent of the fixed points, is called the area of the confidence ellipse. Figure 2 shows an example of a statokinesiogram with a confidence ellipse.

The patient’s data were compared with gender- and age-matched children from the control group. Postural balance indexes were registered in the Romberg test with open eyes. A test for fixing the gaze on a stimulus was used to evaluate the work of the saccadic system of eye movements [12], which allows one to characterize the degree of work of the oculomotor muscles, since the physiological fixation process requires establishing and maintaining fovea in one position. The required duration of fixation in the test (20 seconds) on each stimulus was selected, to prevent a sufficient loading of the oculomotor muscles. The test evaluates the spread and density of the gaze when fixing the patient on the stimulus.

The patient was sitting comfortably on the chair in front the monitor in the calm room for neurophysiological investigations. Eye movements were recorded by videoculography using an Arrington 60 Hz eye-tracker glasses. Patient`s head was fixed by a frontal chin support to minimize head movements. Functioning of the oculomotor muscles was evaluated by the gaze fixation test on the stimulus (Danilov et al., 2015) [12]. The stimulus were presented on a Samsung 23-inch screen (with a resolution of 1920×1080 pixels) at a distance of 60 cm from the subjects' eyes, while occupied about 45° horizontally and 26° vertically of their visual field. The stimulating object (a green dot on the screen) had a size of ~1°, having been sequentially moved in the left/right positions by 15°, and at the top/bottom direction, by 8° for 20 s for each position. Dispersion and density of the gaze fixation points on the every stimulus were evaluated. Raw dispersions of gaze fixation points were filtered in ±2σ of coordinates' distribution and fitted by ellipse Matlab function "fit_ellipse". Then the squares of the obtained ellipses were counted in deg2. Densities of the gaze fixation points were counted as a ratio of the number of fixation points to the ellipse square. The larger squares of the ellipses and the lower densities of the points reveal the more unstable gaze fixation.

Statistical evaluation of the results was performed with a modification of the Student t-test (Welch test), which suggests that the variances of the compared populations are not equal. To model relationships between of the analyzed indexes, regression analysis was used, which allowed us to analytically present the relationship models between appropriate indexes, and to quantify relative influence for distinct factors. In the course of statistical modeling of explicit asymmetric distributions, we used conversion of initial values to logarithmic form and the Box-Cox transformation.

Results

To assess the postural balance in patients treated for tumors of the posterior cranial fossa, we analyzed the stabilometric indicators of the displacement and dispersion of the fixation points of the pressure center on the reference plane, the length of the trajectories of the pressure center in the frontal and sagittal planes, the linear velocities of the pressure center on the reference plane and the magnitude areas of the confiding ellipse of the statokinesiogram. The results were compared with homologous children from the control group. Indicators of postural balance were recorded in the Romberg test with open eyes. The results are presented in Table 1.

Table 1. Indexes of postural balance in children treated for brain tumor, and in healthy children using Romberg test with open eyes

Chechelnitskaia-tab01.jpg

In our study, the average size of the estimated ellipse area in children of the main group in the position with open eyes was 673±1201.1 mm2, thus being significantly differed from the average values in the control group (258.9±162.5 mm2). To confirm the hypothesis about the relationship between the postural balance and the disease, a nonlinear (exponential) regression model was constructed for the Ellipse Area indicator:

log(Ells)=6.7 – 0.059full.year + 0.104gender – 0.57grp,
R2=0.103, p<0,05.
where log (Ells) is the logarithm (natural) of the area of the ellipse.
gender = 1 – boys, 0 – girls
grp = 1 – healthy controls; 0, treated patients.

Age of children (full_years), and disease state (grp) proved to be the statistically significant factors in this model. According to the model, the logarithm of ellipse area in healthy children was lower by 0.57 (p<0.000).

In order to study potential contribution of altered vision in the postural control, we analyzed the change in the Rom-berg test parameters when the patient changes the position with open eyes (EO) to the pose with closed eyes (EC). For analysis, the relative dynamics of indexes were calculated by the formula:

Chechelnitskaia-form01.jpg

where

Chechelnitskaia-form02.jpg

When evaluating the following indices: Assessment of movement and Quality of the equilibrium function, a minus sign was introduced before the formula, due to their special calculation modes:

Chechelnitskaia-form03.jpg

As a result, we have calculated the factors characterizing changes of stabilometric indexes when turning off the vision. The values of the coefficient equal to "0" and higher denoted the improvement of stabilometric values when closing the eyes, whereas a negative value meant their impairment (Table 2).

Table 2. Increases in the indicators of the postural balance of children treated for cancer and their healthy peers in the Romberg test when moving from the Open eyes to the Closed eyes position

Chechelnitskaia-tab02.jpg

More often, the shutdown of vision led to a positive change in the mentioned indexes. Assessment of movement and Displacement of the center of pressure along the sagittal axis (68.5%/61.1% of pediatric patients, and 30.8%/33.3% in the control group, respectively), as seen from Table 3.

Table 3. Frequencies of “atypical” reactions in the Romberg position with closed eyes, %

Chechelnitskaia-tab03.jpg

In the main group, the area of the confidence ellipse decreased in 43.2% of children by an average of 33.4%. Similar dynamics was noted in 20.5% of the examined children, the average decrease in area was 29.6% (Fig. 3). Moreover, the Romberg coefficient averaged 113% both in the main group and in the control group.

Chechelnitskaia-fig03.jpg

Figure 3. The allocation of growth rates of the indicator Ellipse area increments in the Romberg test during the transition from open to closed eyes in children of the main group

To test the hypothesis about the relationship between postural control and oculomotor activity, we analyzed the results of examination of children treated for tumors of the posterior cranial fossa, on an i-tracking. The oculomotor muscles perform fast saccadic eye movements necessary for fixing the gaze on the object, a point in space, etc., due to which the brain receives visual information. The saccadic system is a complex hierarchical system in which many brain structures are involved [19]. The variable measured in the i-tracking is the area of ellipses (deg2), in terms of the content and type of the calculation, it is related to the stabilometric parameter – the ellipse of the statokinesiogram. The larger is the area of the ellipse, the less stable the gaze is kept. Vice versa, the gaze fixation of the gaze is impaired due to various involuntary saccadic movements (disruptive, intrusive macro- and micro-amplitude involuntary saccades) and nystagmus. The second variable density of gaze fixation, with 95% of points fitting the ellipse area within a definite time period. It characterizes the presence or absence of large-amplitude movements, since with large-amplitude movements, the area of the ellipse increases when the gaze is fixed, and the density of the gaze positions, on the contrary, decreases.

We did not find any correlations between the absolute stabilometric indexes and saccadic activity. At the same time, we found a connection between saccadic activity indexes and increased stabilometry indexes in the Romberg test upon transition from open to closed eyes. Indicators of saccadic activity showed asymmetric distribution. Therefore, a power-law transformation of initial data by the Box-Cox method was performed, in order to identify their relationships with stabilometry indexes.

The simulation results showed that the mode of relationships between the saccadic activity indicators and incrementing stabilometric indices corresponded to linear regression. A moderate correlation between the conventional elliptic area during gaze fixation and increased stabilometry indices was shown by means of this model; the multiple correlation coefficient is in the range between 0.35 and 0.62. The contribution of explained variance (R2) was in the range of 13.2% to 38.0%.

The moderate correlation between the density of points in the ellipse during gaze fixation and the growth of stabilometry indicators was also demonstrable, with multiple correlation coefficients of 0.38 to 0.59. The impact of explained variance (R2) is in the range of 14.4-34.5%. The correlation coefficients of individual indicators are shown in Table 4.

Table 4. Matrix of paired correlation coefficients between the increment of stabilometry indicators and parameters of saccadic activity after the Box-Cox transformation

Chechelnitskaia-tab04.jpg

Note: *, correlation quotients are statistically significant at p <0.05

Discussion

The physical status of children who survived cancer, has become the subject of an active study in connection with the successes of modern medicine. The end of anti-cancer treatment does not mean complete recovery of the patient. Moreover, aggressive anti-cancer treatment leads to the development of multiple complications that worsen the quality of life and reduce the predicted life expectancy [13, 14, 7]. The data obtained by researchers indicate the need for physical activity programs aimed specifically at approaches to minimizing physical limitations. One of these limitations is a violation of the postural balance.

Imbalances in the body in works on children who have survived cancer, are usually detected by the Bruninks-Ozeretsky test, which allows you to study the whole range of motor qualities [8, 5, 1]. According to Gilchrist LS, Tanner LR (2018), 78% of children receiving chemotherapy courses for cancer showed reduced balance on treatment, 6 months after the end of treatment, the percentage of children with reduced rates decreased to 53% [3]. This means that more than half of the children still had difficulty holding their posture. In studies of Piscione PJ, Bouffet E et al. (2014), conducted with the participation of children with tumors of the posterior cranial fossa (cerebellar astrocytoma 43.3% and medulloblastoma 40%), a significant decrease in balance indicators was recorded in 70% of the examined [1].

We applied the method of stabilometry to assess the postural balance in children 5-18 years old. Differences between the indicators of children of the main and control groups reached the level of statistical significance, excluding the indicator, i.e., displacement length of the center of pressure in frontal plane. But at the same time, the difference in almost all parameters did not reach the level of physiological significance, since in both groups the spread of the numbers was very large.

Einarsson E-J, Patel M, et al. (2016) also described the absence of a significant difference between people who survived childhood cancer and healthy control in a calm stance [10]. But at the same time they found that former patients spend significantly more energy than healthy people to maintain vertical balance. In our further analysis, we plan to study the features of energy consumption for maintaining a vertical posture in children.

The area of confidence ellipse proved to be the most sensitive parameter in our study, since the average size of the area of the ellipse in children of the main group in the position with open eyes was 673±1201.1 mm2, and in the control group 258.9±162.5 mm2. The constructed model of nonlinear (exponential) regression for the Ellipse area indicator allowed us to confirm the relationship between the ellipse area and the disease. Consequently, a combination of not very physiologically significant deviations in the stabilometry indicators confirms the presence of postural disorders.

The leading role of vision in postural control in cancer survivors is confirmed by Einarsson E-J, Patel M, et al. (2016). According to them, vision significantly increased postural stability in both former patients and the control group. Both of them spent less energy on maintaining the posture in the position with open eyes. The authors found no evidence of dependence on chemotherapy [10].

The data given indicate that in the position with the eyes closed we are entitled to expect a significant deterioration in the main indicators of stabilometry. Perhaps even more significant than in healthy children. It is generally accepted that a healthy person has a normal reaction from the body balance control system to turning off the visual analyzer – an increase in the fluctuation of the center of pressure [15].

In our studies, we often encountered the opposite reaction – the postural balance in the position with the eyes closed improved.

The analysis of the coefficients of growth indicators obtained by us when closing the eyes showed that a positive reaction of the postural balance to turning off the vision occurs both among children treated for tumors of the posterior cranial fossa and among their healthy peers. In the group of treated children, this phenomenon occurred reliably and significantly more often. But at the same time, the values of the average coefficients of the indicators were comparable, their differences did not reach the level of statistical significance.

The most sensitive to eye closure were the indicators Assessment of movement and Displacement of the center of pressure along the sagittal. These results are consistent with the data of Andrea Berensci et al. (2005) [16] that the amplitudes of postural vibrations are greater when stimuli are presented for central vision than for peripheral vision conditions. Our study did not include children with clinically expressed central vision problems, as this was an exclusion criterion. Nevertheless, it cannot be ruled out that one of the reasons for improving the postural balance is subclinical visual acuity.

The indicator Assessment of movement should not be associated with the acuity of central vision, since it is calculated as the ratio of the indicators "Curve Length" and "Average Dispersion" and reflects the spread of fluctuations (tremor).

Earlier, a number of authors showed that patho-biomechanical changes in the structures richest in proprioreceptors (neck muscles, oculomotor muscles, chewing muscles) cause a mismatch between the real and perceived CNS position of the body parts [8, 16]. We tested the hypothesis about the role of oculomotor muscle dysfunction in disturbing postural balance in children treated for tumors of the posterior cranial fossa. Absolute indicators of stabilometry in an upright posture with open eyes were not associated with indicators of saccadic activity. At the same time, the relationship between the coefficients of change in the indicators of stabilometry when closing the eyes with the area of the ellipse of the fixation points of the gaze corresponded to linear regression and was stable in average. The share of the explained variance reached 38.0%. Equally expressed and stable was the relationship between the coefficients of change in the indicators of stabilometry and the density of the points of fixation of the gaze in the ellipse.

Since when closing the eyes there is not only a shutdown of visual afferentation, but also a decrease in the activity of the oculomotor muscles, the latter may explain the improvement in postural balance when closing the eyes. The validity of this conclusion is indirectly confirmed by a number of works.

Einarsson E-J, Patel M, et al. (2016) studied oculomotor activity in adults who received chemotherapy in childhood for a solid cancerous tumor that did not affect the central nervous system. According to them, the temporal control of smooth tracking speed (speed accuracy) was noticeably worse (p<0.001), and saccades had a disproportionately lower amplitude in survivors of childhood cancer compared with healthy subjects [10]. Patients treated before 12 years old had a more expressed oculomotor deficiency. Patients who survived childhood cancer experienced subjective symptoms of visual impairment (70%), sensations that things around them revolved or moved (87%). Several subjective symptoms were largely associated with a deficiency of oculomotor characteristics.

In our study, the phenomena of saccadic dysmetry, regardless of the direction of gaze, were associated with coefficients reflecting the change in the indicators of movement of the fixation points of the center of pressure of the body on the surface in the frontal plane and their derivatives, which is consistent with the statement of Andrea Berensci et al. [17] on the role of peripheral vision in postural stability. Changes in indicators in the sagittal plane were either not connected at all, or with a small number of variables, which indicates the absence of influence of central vision.

Conclusion

We have confirmed that, already early after the end of cytostatic treatment, the children who survived cancer develop postural balance disorders associated with the disease factor. We have revealed an improvement of postural control when closing eyes and its connection with saccadic dysmetria, thus allowing to consider this phenomenon to be a result of damage to oculomotor muscles and offering new tools and methods for rehabilitation of cancer patients.

Conflict of interest

None reported.

References

  1. Piscione PJ, Bouffet E, Mabbott DJ, Shams I, Kulkarni AV. Physical functioning in pediatric survivors of childhood posterior fossa brain tumors. Neuro Oncol. 2014; 16(1): 147-155.
  2. Toy SL, Senesac C, Trombini A. Postural control and balance training in a pediatric patient status post medulloblastoma removal. Pediat Phys Ther. 2006; 18(1):107-108.
  3. Gilchrist LS, Tanner LR. Short-term recovery of balance control: association with chemotherapy-induced peripheral neuropathy in pediatric oncology. Pediat Phys Ther. 2018; 30(2): 119-124.
  4. Kumar V, Vincent D, Butler JS, Xu Y. Ataxia in long-term survivors of lung cancer after whole brain radiation therapy (WBRT). J Clin Oncol. 2016; 34(Suppl.15):e20656-e20656.
  5. Bahcaci U, Demirbuken I. Effects of chemotherapy process on postural balance control in patients with breast cancer. Indian J Cancer. 2019; 56(1):50-54.
  6. Varedi M, McKenna R, Lamberg EM. Balance in children with acute lymphoblastic leukemia. Pediat Int. 2017; 59:293-302.
  7. Ness KK, Krull KR, Jones KE, Mulrooney DA, Armstrong GT, Green DM, Chemaitilly W, Smith WA, Wilson CL, Sklar CA, Shelton K, Srivastava DK, Ali S, Robison LL, Hudson MM. Physiologic frailty as a sign of accelerated aging among adult survivors of childhood cancer: A report from the St. Jude Lifetime Cohort study. J Clin Oncol. 2013; 31(36):4496-4503.
  8. Einarsson EJ, Patel M, Petersen H, Wiebe T, Fransson PA, Magnusson M, et al. Elevated visual dependency in young adults after chemotherapy in childhood. PLoS One. 2018; 13(2):e0173678.
  9. Leigh RJ, Zee DS. The Neurology of Eye Movements. 5th edition. New York, NY: Oxford University Press: 2015, 1075 p.
  10. Einarsson EJ, Patel M, Petersen H, et al. Oculomotor deficits after chemotherapy in childhood. PLoS One. 2016; 11(1): e0147703.
  11. Nigamadyanov NR. Computer-assisted stabilometry in diagnostics and correction of postural disturbances in children with spinal pathology. Ref. PhD Thesis: Moscow. 2017: 1-20 (In Russian).
  12. Danilov Y, Kaczmarek K, Skinner K, Tyler M. Cranial Nerve Noninvasive Neuromodulation. In: Brain neurotrauma: molecular, neuropsychological, and rehabilitation aspects. Taylor & Francis, Boca Raton (FL): CRC Press. 2015, Chapter 44.
  13. Hudson MM, Oeffinger KC, Jones K, Brinkman TM, Krull KR, Mulrooney DA, Mertens A, Castellino SM, Casillas J, Gurney JG, Nathan PC, Leisenring W, Robison LL, Ness KK. Age-dependent changes in health status in the Childhood Cancer Survivor cohort. J. Clin. Oncol. 2015; 33(5):479-491.
  14. Taylor N, Absolom K, Michel G, Urquhart T, Gerrard M, Jenkins A, Lee V, Vora A, Eiser C. Comparison of self-reported late effects with medical records among survivors of childhood cancer. Eur. J. Cancer. 2010; 46(6):1069-1078.
  15. Lysenko VV, Mirzoeva EV, Ostrikov AP, Bozhkov AV. Interaction between disturbed statics and vision quality in sports. Molodoy Ucheny. 2016; 24: 565-568 (In Russian).
  16. Boulanger M, Giraudet G, Faubert J. Interaction between the oculomotor and postural systems during a dual-task: Compensatory reductions in head sway following visually-induced postural perturbations promote the production of accurate double-step saccades in standing human adults. PLoS One. 2017; 12(3): e0173678.
  17. Berensci A, Ishihara M, Imanaka K. The functional role of central and peripheral vision in the control of posture. Human Movement. 2005; 24(5-6):689-709.
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Вопрос о механизмах этого явления находится на стадии изучения. Целью проведенного нами ретроспективного исследования было уточнение связи постуральной нестабильности онкологических пациентов с дисфункцией глазодвигательных мышц. В исследовании приняли участие 291 ребенок 5-18 лет, перенесших онкологическое заболевание и находящихся в стадии ремиссии или стабилизации. В контрольную группу вошли 182 здоровых ребенка. </p> <p style="text-align: justify;"> Качество постурального баланса оценивалось методом стабилометрии на компьютерном стабилоанализаторе «Стабилан 01-2». Регистрация движений глаз производилась методом видеокулографии с помощью айтрекера Arrington. Для моделирования взаимосвязи анализируемых показателей использовался регрессионный анализ, для явно выраженных асимметричных распределений применялось преобразование исходных значений в виде логарифмирования и степенного преобразование Бокса-Кокса (Box-Cox transformation). </p> <p style="text-align: justify;"> Основные показатели стабилометрии в позе с открытыми глазами подтвердили нарушения постурального баланса у детей, переживших рак. Математически была обоснована высокая вероятность связи дисбаланса с фактором заболевания. Улучшение показателей стабилометрии при закрывании глаз выявлено в обеих группах, но среди детей, переживших рак, этот феномен выявлялся достоверно и значимо чаще. Обнаружена устойчивая связь между постуральной нестабильностью и нарушением работы глазодвигательных мышц. </p> <h2>Ключевые слова</h2> <p style="text-align: justify;"> Рак у детей, постуральный контроль, противоопухолевая терапия, токсические эффекты, глазодвигательные мышцы. </p>" ["ELEMENT_PREVIEW_PICTURE_FILE_TITLE"]=> string(239) "«Сенсорный конфликт» как возможная причина нарушения постуральной устойчивости детей, лечившихся от онкологических заболеваний" ["ELEMENT_DETAIL_PICTURE_FILE_ALT"]=> string(239) "«Сенсорный конфликт» как возможная причина нарушения постуральной устойчивости детей, лечившихся от онкологических заболеваний" ["ELEMENT_DETAIL_PICTURE_FILE_TITLE"]=> string(239) "«Сенсорный конфликт» как возможная причина нарушения постуральной устойчивости детей, лечившихся от онкологических заболеваний" ["SECTION_META_TITLE"]=> string(239) "«Сенсорный конфликт» как возможная причина нарушения постуральной устойчивости детей, лечившихся от онкологических заболеваний" ["SECTION_META_KEYWORDS"]=> string(239) "«Сенсорный конфликт» как возможная причина нарушения постуральной устойчивости детей, лечившихся от онкологических заболеваний" ["SECTION_META_DESCRIPTION"]=> string(239) "«Сенсорный конфликт» как возможная причина нарушения постуральной устойчивости детей, лечившихся от онкологических заболеваний" ["SECTION_PICTURE_FILE_ALT"]=> string(239) "«Сенсорный конфликт» как возможная причина нарушения постуральной устойчивости детей, лечившихся от онкологических заболеваний" ["SECTION_PICTURE_FILE_TITLE"]=> string(239) "«Сенсорный конфликт» как возможная причина нарушения постуральной устойчивости детей, лечившихся от онкологических заболеваний" ["SECTION_PICTURE_FILE_NAME"]=> string(100) "sensornyy-konflikt-kak-vozmozhnaya-prichina-narusheniya-posturalnoy-ustoychivosti-detey-lechivshikhs" ["SECTION_DETAIL_PICTURE_FILE_ALT"]=> string(239) "«Сенсорный конфликт» как возможная причина нарушения постуральной устойчивости детей, лечившихся от онкологических заболеваний" ["SECTION_DETAIL_PICTURE_FILE_TITLE"]=> string(239) "«Сенсорный конфликт» как возможная причина нарушения постуральной устойчивости детей, лечившихся от онкологических заболеваний" ["SECTION_DETAIL_PICTURE_FILE_NAME"]=> string(100) "sensornyy-konflikt-kak-vozmozhnaya-prichina-narusheniya-posturalnoy-ustoychivosti-detey-lechivshikhs" ["ELEMENT_PREVIEW_PICTURE_FILE_NAME"]=> string(100) "sensornyy-konflikt-kak-vozmozhnaya-prichina-narusheniya-posturalnoy-ustoychivosti-detey-lechivshikhs" ["ELEMENT_DETAIL_PICTURE_FILE_NAME"]=> string(100) "sensornyy-konflikt-kak-vozmozhnaya-prichina-narusheniya-posturalnoy-ustoychivosti-detey-lechivshikhs" } ["FIELDS"]=> array(1) { ["IBLOCK_SECTION_ID"]=> string(3) "138" } ["PROPERTIES"]=> array(18) { ["KEYWORDS"]=> array(36) { ["ID"]=> string(2) "19" ["TIMESTAMP_X"]=> string(19) "2015-09-03 10:46:01" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(27) "Ключевые слова" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(8) 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string(1) "N" ["IS_REQUIRED"]=> string(1) "N" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> string(8) "DateTime" ["USER_TYPE_SETTINGS"]=> NULL ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> string(5) "25391" ["VALUE"]=> string(22) "12/06/2019 12:00:00 am" ["DESCRIPTION"]=> string(0) "" ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> string(22) "12/06/2019 12:00:00 am" ["~DESCRIPTION"]=> string(0) "" ["~NAME"]=> string(25) "Дата принятия" ["~DEFAULT_VALUE"]=> NULL } ["PUBLISHED"]=> array(36) { ["ID"]=> string(2) "22" ["TIMESTAMP_X"]=> string(19) "2015-09-02 17:21:42" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(29) "Дата публикации" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(9) "PUBLISHED" ["DEFAULT_VALUE"]=> NULL ["PROPERTY_TYPE"]=> string(1) "S" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "30" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "N" ["XML_ID"]=> string(2) "22" ["FILE_TYPE"]=> string(0) "" 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["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "N" ["XML_ID"]=> string(2) "23" ["FILE_TYPE"]=> string(0) "" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "3" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "Y" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> string(13) "EAutocomplete" ["USER_TYPE_SETTINGS"]=> array(9) { ["VIEW"]=> string(1) "E" ["SHOW_ADD"]=> string(1) "Y" ["MAX_WIDTH"]=> int(0) ["MIN_HEIGHT"]=> int(24) ["MAX_HEIGHT"]=> int(1000) ["BAN_SYM"]=> string(2) ",;" ["REP_SYM"]=> string(1) " " ["OTHER_REP_SYM"]=> string(0) "" ["IBLOCK_MESS"]=> string(1) "N" } ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> string(5) "25392" ["VALUE"]=> string(4) "1803" ["DESCRIPTION"]=> string(0) "" ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> string(4) "1803" ["~DESCRIPTION"]=> string(0) "" ["~NAME"]=> string(14) "Контакт" ["~DEFAULT_VALUE"]=> string(0) "" } ["AUTHORS"]=> array(36) { ["ID"]=> string(2) "24" ["TIMESTAMP_X"]=> string(19) "2015-09-03 10:45:07" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(12) "Авторы" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(7) "AUTHORS" ["DEFAULT_VALUE"]=> string(0) "" ["PROPERTY_TYPE"]=> string(1) "E" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "30" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "Y" ["XML_ID"]=> string(2) "24" ["FILE_TYPE"]=> string(0) "" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "3" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "Y" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> string(13) "EAutocomplete" ["USER_TYPE_SETTINGS"]=> array(9) { ["VIEW"]=> string(1) "E" ["SHOW_ADD"]=> string(1) "Y" ["MAX_WIDTH"]=> int(0) ["MIN_HEIGHT"]=> int(24) ["MAX_HEIGHT"]=> int(1000) ["BAN_SYM"]=> string(2) ",;" ["REP_SYM"]=> string(1) " " ["OTHER_REP_SYM"]=> string(0) "" ["IBLOCK_MESS"]=> string(1) "N" } ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> array(10) { [0]=> string(5) "25523" [1]=> string(5) "25524" [2]=> string(5) "25525" [3]=> string(5) "25526" [4]=> string(5) "25527" [5]=> string(5) "25528" [6]=> string(5) "25529" [7]=> string(5) "25530" [8]=> string(5) "25531" [9]=> string(5) "25532" } ["VALUE"]=> array(10) { [0]=> string(4) "1803" [1]=> string(4) "1804" [2]=> string(4) "1805" [3]=> string(4) "1806" [4]=> string(4) "1807" [5]=> string(4) "1808" [6]=> string(4) "1809" [7]=> string(4) "1810" [8]=> string(4) "1811" [9]=> string(4) "1812" } ["DESCRIPTION"]=> array(10) { [0]=> string(0) "" [1]=> string(0) "" [2]=> string(0) "" [3]=> string(0) "" [4]=> string(0) "" [5]=> string(0) "" [6]=> string(0) "" [7]=> string(0) "" [8]=> string(0) "" [9]=> string(0) "" } ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> array(10) { [0]=> string(4) "1803" [1]=> string(4) "1804" [2]=> string(4) "1805" [3]=> string(4) "1806" [4]=> string(4) "1807" [5]=> string(4) "1808" [6]=> string(4) "1809" [7]=> string(4) "1810" [8]=> string(4) "1811" [9]=> string(4) "1812" } ["~DESCRIPTION"]=> array(10) { [0]=> string(0) "" [1]=> string(0) "" [2]=> string(0) "" [3]=> string(0) "" [4]=> string(0) "" [5]=> string(0) "" [6]=> string(0) "" [7]=> string(0) "" [8]=> string(0) "" [9]=> string(0) "" } ["~NAME"]=> string(12) "Авторы" ["~DEFAULT_VALUE"]=> string(0) "" } ["AUTHOR_RU"]=> array(36) { ["ID"]=> string(2) "25" ["TIMESTAMP_X"]=> string(19) "2015-09-02 18:01:20" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(12) "Авторы" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(9) "AUTHOR_RU" ["DEFAULT_VALUE"]=> array(2) { ["TEXT"]=> string(0) "" ["TYPE"]=> string(4) "HTML" } ["PROPERTY_TYPE"]=> string(1) "S" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "30" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "N" ["XML_ID"]=> string(2) "25" ["FILE_TYPE"]=> string(0) "" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "0" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "N" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> string(4) "HTML" ["USER_TYPE_SETTINGS"]=> array(1) { ["height"]=> int(200) } ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> string(5) "25403" ["VALUE"]=> array(2) { ["TEXT"]=> string(386) "<p> Серафима М. Чечельницкая, Владимир Н. Касаткин, Марина А. Шурупова, Ирина Д. Бородина, Юрий В. Сарайкин, Александр Ф. Карелин, Дмитрий В. Скворцов, Александра В. Баербах, Дарья В. Жук, Владислав А. Никулин </p>" ["TYPE"]=> string(4) "HTML" } ["DESCRIPTION"]=> string(0) "" ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> array(2) { ["TEXT"]=> string(374) "

Серафима М. Чечельницкая, Владимир Н. Касаткин, Марина А. Шурупова, Ирина Д. Бородина, Юрий В. Сарайкин, Александр Ф. Карелин, Дмитрий В. Скворцов, Александра В. Баербах, Дарья В. Жук, Владислав А. Никулин

" ["TYPE"]=> string(4) "HTML" } ["~DESCRIPTION"]=> string(0) "" ["~NAME"]=> string(12) "Авторы" ["~DEFAULT_VALUE"]=> array(2) { ["TEXT"]=> string(0) "" ["TYPE"]=> string(4) "HTML" } } ["ORGANIZATION_RU"]=> array(36) { ["ID"]=> string(2) "26" ["TIMESTAMP_X"]=> string(19) "2015-09-02 18:01:20" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(22) "Организации" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(15) "ORGANIZATION_RU" ["DEFAULT_VALUE"]=> array(2) { ["TEXT"]=> string(0) "" ["TYPE"]=> string(4) "HTML" } ["PROPERTY_TYPE"]=> string(1) "S" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "30" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "N" ["XML_ID"]=> string(2) "26" ["FILE_TYPE"]=> string(0) "" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "0" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "N" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> string(4) "HTML" ["USER_TYPE_SETTINGS"]=> array(1) { ["height"]=> int(200) } ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> string(5) "25404" ["VALUE"]=> array(2) { ["TEXT"]=> string(370) "<p> Лечебно-реабилитационный научный центр «Русское поле», Национальный медицинский исследовательский центр детской гематологии, онкологии и иммунологии им. Дмитрия Рогачева, Москва, Россия </p>" ["TYPE"]=> string(4) "HTML" } ["DESCRIPTION"]=> string(0) "" ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> array(2) { ["TEXT"]=> string(358) "

Лечебно-реабилитационный научный центр «Русское поле», Национальный медицинский исследовательский центр детской гематологии, онкологии и иммунологии им. Дмитрия Рогачева, Москва, Россия

" ["TYPE"]=> string(4) "HTML" } ["~DESCRIPTION"]=> string(0) "" ["~NAME"]=> string(22) "Организации" ["~DEFAULT_VALUE"]=> array(2) { ["TEXT"]=> string(0) "" ["TYPE"]=> string(4) "HTML" } } ["SUMMARY_RU"]=> array(36) { ["ID"]=> string(2) "27" ["TIMESTAMP_X"]=> string(19) "2015-09-02 18:01:20" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(29) "Описание/Резюме" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(10) "SUMMARY_RU" ["DEFAULT_VALUE"]=> array(2) { ["TEXT"]=> string(0) "" ["TYPE"]=> string(4) "HTML" } ["PROPERTY_TYPE"]=> string(1) "S" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "30" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "N" ["XML_ID"]=> string(2) "27" ["FILE_TYPE"]=> string(0) "" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "0" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "N" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> string(4) "HTML" ["USER_TYPE_SETTINGS"]=> array(1) { ["height"]=> int(200) } ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> string(5) "25405" ["VALUE"]=> array(2) { ["TEXT"]=> string(3305) "<p style="text-align: justify;"> Нарушения постуральной устойчивости широко распространено среди пациентов, лечившихся от онкологических заболеваний. Вопрос о механизмах этого явления находится на стадии изучения. Целью проведенного нами ретроспективного исследования было уточнение связи постуральной нестабильности онкологических пациентов с дисфункцией глазодвигательных мышц. В исследовании приняли участие 291 ребенок 5-18 лет, перенесших онкологическое заболевание и находящихся в стадии ремиссии или стабилизации. В контрольную группу вошли 182 здоровых ребенка. </p> <p style="text-align: justify;"> Качество постурального баланса оценивалось методом стабилометрии на компьютерном стабилоанализаторе «Стабилан 01-2». Регистрация движений глаз производилась методом видеокулографии с помощью айтрекера Arrington. Для моделирования взаимосвязи анализируемых показателей использовался регрессионный анализ, для явно выраженных асимметричных распределений применялось преобразование исходных значений в виде логарифмирования и степенного преобразование Бокса-Кокса (Box-Cox transformation). </p> <p style="text-align: justify;"> Основные показатели стабилометрии в позе с открытыми глазами подтвердили нарушения постурального баланса у детей, переживших рак. Математически была обоснована высокая вероятность связи дисбаланса с фактором заболевания. Улучшение показателей стабилометрии при закрывании глаз выявлено в обеих группах, но среди детей, переживших рак, этот феномен выявлялся достоверно и значимо чаще. Обнаружена устойчивая связь между постуральной нестабильностью и нарушением работы глазодвигательных мышц. </p> <h2>Ключевые слова</h2> <p style="text-align: justify;"> Рак у детей, постуральный контроль, противоопухолевая терапия, токсические эффекты, глазодвигательные мышцы. </p>" ["TYPE"]=> string(4) "HTML" } ["DESCRIPTION"]=> string(0) "" ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> array(2) { ["TEXT"]=> string(3205) "

Нарушения постуральной устойчивости широко распространено среди пациентов, лечившихся от онкологических заболеваний. Вопрос о механизмах этого явления находится на стадии изучения. Целью проведенного нами ретроспективного исследования было уточнение связи постуральной нестабильности онкологических пациентов с дисфункцией глазодвигательных мышц. В исследовании приняли участие 291 ребенок 5-18 лет, перенесших онкологическое заболевание и находящихся в стадии ремиссии или стабилизации. В контрольную группу вошли 182 здоровых ребенка.

Качество постурального баланса оценивалось методом стабилометрии на компьютерном стабилоанализаторе «Стабилан 01-2». Регистрация движений глаз производилась методом видеокулографии с помощью айтрекера Arrington. Для моделирования взаимосвязи анализируемых показателей использовался регрессионный анализ, для явно выраженных асимметричных распределений применялось преобразование исходных значений в виде логарифмирования и степенного преобразование Бокса-Кокса (Box-Cox transformation).

Основные показатели стабилометрии в позе с открытыми глазами подтвердили нарушения постурального баланса у детей, переживших рак. Математически была обоснована высокая вероятность связи дисбаланса с фактором заболевания. Улучшение показателей стабилометрии при закрывании глаз выявлено в обеих группах, но среди детей, переживших рак, этот феномен выявлялся достоверно и значимо чаще. Обнаружена устойчивая связь между постуральной нестабильностью и нарушением работы глазодвигательных мышц.

Ключевые слова

Рак у детей, постуральный контроль, противоопухолевая терапия, токсические эффекты, глазодвигательные мышцы.

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Serafima M. Chechelnitskaia, Vladimir N. Kasatkin, Marina A. Shurupova, Irina D. Borodina, Yurij V. Sarajkin, Aleksandr F. Karelin, Dmitrij V. Skvorcov, Aleksandra V. Baerbakh, Daria V. Zhuk, Vladislav A. Nikulin

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Medical Rehabilitation Research Center "Russkoe Pole", Dmitry Rogachev National Medical Research Center for Pediatric Hematology, Oncology and Immunology, Moscow, Russia

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Disorders of postural resistance are widespread among the patients treated for cancer. The question of the mechanism of this phenomenon is under the study. The aim of our retrospective study was to clarify the relationship of postural instability in cancer patients with oculomotor muscle dysfunction.

Patients and methods

The study involved 291 children 5-18 years old who had cancer and were in remission state or stable clinical condition. The control group included 182 healthy children. The quality of postural balance was evaluated by stabilometric method using a computer-assisted stabilizer (Stabilan 01-2 model). The eye movements were recorded by videoculography using the Arrington eye-tracker. Regression analysis was used to assess relationships of the analyzed parameters. For explicit asymmetric distributions, we used conversion of initial values to logarithmic form and the Box-Cox transformation.

Results

The main stabilometric indicators in the position with open eyes confirmed impaired postural balance in the children who survived cancer. We have substantiated a high probability of correlation between the postural imbalance and disease factor. Improvement in stabilometric indexes with eyes closed was detected for both groups. However, this phenomenon proved to be significant and was more common among the children who survived cancer.

Conclusion

A stable relationship was found between the postural instability and altered functioning of oculomotor muscles.

Keywords

Childhood cancer, postural control, anticancer therapy, toxic effects, oculomotor muscles.

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Chechelnitskaia, Vladimir N. Kasatkin, Marina A. Shurupova, Irina D. Borodina, Yurij V. Sarajkin, Aleksandr F. Karelin, Dmitrij V. Skvorcov, Aleksandra V. Baerbakh, Daria V. Zhuk, Vladislav A. Nikulin </p>" ["TYPE"]=> string(4) "HTML" } ["DESCRIPTION"]=> string(0) "" ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> array(2) { ["TEXT"]=> string(224) "

Serafima M. Chechelnitskaia, Vladimir N. Kasatkin, Marina A. Shurupova, Irina D. Borodina, Yurij V. Sarajkin, Aleksandr F. Karelin, Dmitrij V. Skvorcov, Aleksandra V. Baerbakh, Daria V. Zhuk, Vladislav A. Nikulin

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Serafima M. Chechelnitskaia, Vladimir N. Kasatkin, Marina A. Shurupova, Irina D. Borodina, Yurij V. Sarajkin, Aleksandr F. Karelin, Dmitrij V. Skvorcov, Aleksandra V. Baerbakh, Daria V. Zhuk, Vladislav A. Nikulin

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Disorders of postural resistance are widespread among the patients treated for cancer. The question of the mechanism of this phenomenon is under the study. The aim of our retrospective study was to clarify the relationship of postural instability in cancer patients with oculomotor muscle dysfunction.

Patients and methods

The study involved 291 children 5-18 years old who had cancer and were in remission state or stable clinical condition. The control group included 182 healthy children. The quality of postural balance was evaluated by stabilometric method using a computer-assisted stabilizer (Stabilan 01-2 model). The eye movements were recorded by videoculography using the Arrington eye-tracker. Regression analysis was used to assess relationships of the analyzed parameters. For explicit asymmetric distributions, we used conversion of initial values to logarithmic form and the Box-Cox transformation.

Results

The main stabilometric indicators in the position with open eyes confirmed impaired postural balance in the children who survived cancer. We have substantiated a high probability of correlation between the postural imbalance and disease factor. Improvement in stabilometric indexes with eyes closed was detected for both groups. However, this phenomenon proved to be significant and was more common among the children who survived cancer.

Conclusion

A stable relationship was found between the postural instability and altered functioning of oculomotor muscles.

Keywords

Childhood cancer, postural control, anticancer therapy, toxic effects, oculomotor muscles.

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Disorders of postural resistance are widespread among the patients treated for cancer. The question of the mechanism of this phenomenon is under the study. The aim of our retrospective study was to clarify the relationship of postural instability in cancer patients with oculomotor muscle dysfunction.

Patients and methods

The study involved 291 children 5-18 years old who had cancer and were in remission state or stable clinical condition. The control group included 182 healthy children. The quality of postural balance was evaluated by stabilometric method using a computer-assisted stabilizer (Stabilan 01-2 model). The eye movements were recorded by videoculography using the Arrington eye-tracker. Regression analysis was used to assess relationships of the analyzed parameters. For explicit asymmetric distributions, we used conversion of initial values to logarithmic form and the Box-Cox transformation.

Results

The main stabilometric indicators in the position with open eyes confirmed impaired postural balance in the children who survived cancer. We have substantiated a high probability of correlation between the postural imbalance and disease factor. Improvement in stabilometric indexes with eyes closed was detected for both groups. However, this phenomenon proved to be significant and was more common among the children who survived cancer.

Conclusion

A stable relationship was found between the postural instability and altered functioning of oculomotor muscles.

Keywords

Childhood cancer, postural control, anticancer therapy, toxic effects, oculomotor muscles.

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Medical Rehabilitation Research Center "Russkoe Pole", Dmitry Rogachev National Medical Research Center for Pediatric Hematology, Oncology and Immunology, Moscow, Russia

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Medical Rehabilitation Research Center "Russkoe Pole", Dmitry Rogachev National Medical Research Center for Pediatric Hematology, Oncology and Immunology, Moscow, Russia

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Серафима М. Чечельницкая, Владимир Н. Касаткин, Марина А. Шурупова, Ирина Д. Бородина, Юрий В. Сарайкин, Александр Ф. Карелин, Дмитрий В. Скворцов, Александра В. Баербах, Дарья В. Жук, Владислав А. Никулин

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Chechelnitskaia" ["LINK_ELEMENT_VALUE"]=> bool(false) } ["SUMMARY_RU"]=> array(37) { ["ID"]=> string(2) "27" ["TIMESTAMP_X"]=> string(19) "2015-09-02 18:01:20" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(29) "Описание/Резюме" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(10) "SUMMARY_RU" ["DEFAULT_VALUE"]=> array(2) { ["TEXT"]=> string(0) "" ["TYPE"]=> string(4) "HTML" } ["PROPERTY_TYPE"]=> string(1) "S" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "30" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "N" ["XML_ID"]=> string(2) "27" ["FILE_TYPE"]=> string(0) "" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "0" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "N" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> string(4) "HTML" ["USER_TYPE_SETTINGS"]=> array(1) { ["height"]=> int(200) } ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> string(5) "25405" ["VALUE"]=> array(2) { ["TEXT"]=> string(3305) "<p style="text-align: justify;"> Нарушения постуральной устойчивости широко распространено среди пациентов, лечившихся от онкологических заболеваний. Вопрос о механизмах этого явления находится на стадии изучения. Целью проведенного нами ретроспективного исследования было уточнение связи постуральной нестабильности онкологических пациентов с дисфункцией глазодвигательных мышц. В исследовании приняли участие 291 ребенок 5-18 лет, перенесших онкологическое заболевание и находящихся в стадии ремиссии или стабилизации. В контрольную группу вошли 182 здоровых ребенка. </p> <p style="text-align: justify;"> Качество постурального баланса оценивалось методом стабилометрии на компьютерном стабилоанализаторе «Стабилан 01-2». Регистрация движений глаз производилась методом видеокулографии с помощью айтрекера Arrington. Для моделирования взаимосвязи анализируемых показателей использовался регрессионный анализ, для явно выраженных асимметричных распределений применялось преобразование исходных значений в виде логарифмирования и степенного преобразование Бокса-Кокса (Box-Cox transformation). </p> <p style="text-align: justify;"> Основные показатели стабилометрии в позе с открытыми глазами подтвердили нарушения постурального баланса у детей, переживших рак. Математически была обоснована высокая вероятность связи дисбаланса с фактором заболевания. Улучшение показателей стабилометрии при закрывании глаз выявлено в обеих группах, но среди детей, переживших рак, этот феномен выявлялся достоверно и значимо чаще. Обнаружена устойчивая связь между постуральной нестабильностью и нарушением работы глазодвигательных мышц. </p> <h2>Ключевые слова</h2> <p style="text-align: justify;"> Рак у детей, постуральный контроль, противоопухолевая терапия, токсические эффекты, глазодвигательные мышцы. </p>" ["TYPE"]=> string(4) "HTML" } ["DESCRIPTION"]=> string(0) "" ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> array(2) { ["TEXT"]=> string(3205) "

Нарушения постуральной устойчивости широко распространено среди пациентов, лечившихся от онкологических заболеваний. Вопрос о механизмах этого явления находится на стадии изучения. Целью проведенного нами ретроспективного исследования было уточнение связи постуральной нестабильности онкологических пациентов с дисфункцией глазодвигательных мышц. В исследовании приняли участие 291 ребенок 5-18 лет, перенесших онкологическое заболевание и находящихся в стадии ремиссии или стабилизации. В контрольную группу вошли 182 здоровых ребенка.

Качество постурального баланса оценивалось методом стабилометрии на компьютерном стабилоанализаторе «Стабилан 01-2». Регистрация движений глаз производилась методом видеокулографии с помощью айтрекера Arrington. Для моделирования взаимосвязи анализируемых показателей использовался регрессионный анализ, для явно выраженных асимметричных распределений применялось преобразование исходных значений в виде логарифмирования и степенного преобразование Бокса-Кокса (Box-Cox transformation).

Основные показатели стабилометрии в позе с открытыми глазами подтвердили нарушения постурального баланса у детей, переживших рак. Математически была обоснована высокая вероятность связи дисбаланса с фактором заболевания. Улучшение показателей стабилометрии при закрывании глаз выявлено в обеих группах, но среди детей, переживших рак, этот феномен выявлялся достоверно и значимо чаще. Обнаружена устойчивая связь между постуральной нестабильностью и нарушением работы глазодвигательных мышц.

Ключевые слова

Рак у детей, постуральный контроль, противоопухолевая терапия, токсические эффекты, глазодвигательные мышцы.

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Нарушения постуральной устойчивости широко распространено среди пациентов, лечившихся от онкологических заболеваний. Вопрос о механизмах этого явления находится на стадии изучения. Целью проведенного нами ретроспективного исследования было уточнение связи постуральной нестабильности онкологических пациентов с дисфункцией глазодвигательных мышц. В исследовании приняли участие 291 ребенок 5-18 лет, перенесших онкологическое заболевание и находящихся в стадии ремиссии или стабилизации. В контрольную группу вошли 182 здоровых ребенка.

Качество постурального баланса оценивалось методом стабилометрии на компьютерном стабилоанализаторе «Стабилан 01-2». Регистрация движений глаз производилась методом видеокулографии с помощью айтрекера Arrington. Для моделирования взаимосвязи анализируемых показателей использовался регрессионный анализ, для явно выраженных асимметричных распределений применялось преобразование исходных значений в виде логарифмирования и степенного преобразование Бокса-Кокса (Box-Cox transformation).

Основные показатели стабилометрии в позе с открытыми глазами подтвердили нарушения постурального баланса у детей, переживших рак. Математически была обоснована высокая вероятность связи дисбаланса с фактором заболевания. Улучшение показателей стабилометрии при закрывании глаз выявлено в обеих группах, но среди детей, переживших рак, этот феномен выявлялся достоверно и значимо чаще. Обнаружена устойчивая связь между постуральной нестабильностью и нарушением работы глазодвигательных мышц.

Ключевые слова

Рак у детей, постуральный контроль, противоопухолевая терапия, токсические эффекты, глазодвигательные мышцы.

" } ["ORGANIZATION_RU"]=> array(37) { ["ID"]=> string(2) "26" ["TIMESTAMP_X"]=> string(19) "2015-09-02 18:01:20" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(22) "Организации" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(15) "ORGANIZATION_RU" ["DEFAULT_VALUE"]=> array(2) { ["TEXT"]=> string(0) "" ["TYPE"]=> string(4) "HTML" } ["PROPERTY_TYPE"]=> string(1) "S" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "30" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "N" ["XML_ID"]=> string(2) "26" ["FILE_TYPE"]=> string(0) "" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "0" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "N" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> string(4) "HTML" ["USER_TYPE_SETTINGS"]=> array(1) { ["height"]=> int(200) } ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> string(5) "25404" ["VALUE"]=> array(2) { ["TEXT"]=> string(370) "<p> Лечебно-реабилитационный научный центр «Русское поле», Национальный медицинский исследовательский центр детской гематологии, онкологии и иммунологии им. Дмитрия Рогачева, Москва, Россия </p>" ["TYPE"]=> string(4) "HTML" } ["DESCRIPTION"]=> string(0) "" ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> array(2) { ["TEXT"]=> string(358) "

Лечебно-реабилитационный научный центр «Русское поле», Национальный медицинский исследовательский центр детской гематологии, онкологии и иммунологии им. Дмитрия Рогачева, Москва, Россия

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Лечебно-реабилитационный научный центр «Русское поле», Национальный медицинский исследовательский центр детской гематологии, онкологии и иммунологии им. Дмитрия Рогачева, Москва, Россия

" } } } }

Rehabilitation

Effects of motor exercises upon life quality of adolescents subjected to hematopoietic stem cell transplantation

Alla A. Potapchuk1, Alisa G. Volkova1, Fedor V. Terentiev2, Irina G. Terentieva2, Ludmila S. Zubarovskaya1, Boris V. Afanasyev1

Sensory conflict as a possible reason for disturbed postural stability in the children treated for cancer

Serafima M. Chechelnitskaia, Vladimir N. Kasatkin, Marina A. Shurupova, Irina D. Borodina, Yurij V. Sarajkin, Aleksandr F. Karelin, Dmitrij V. Skvorcov, Aleksandra V. Baerbakh, Daria V. Zhuk, Vladislav A. Nikulin

Rehabilitation

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Алла А. Потапчук1, Алиса Г. Волкова1, Федор В. Терентьев2, Ирина Г. Терентьева2, Людмила С. Зубаровская1, Борис В. Афанасьев1

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1 НИИ детской онкологии, гематологии и трансплантологии им. Р. М. Горбачевой, Первый Санкт-Петербургский государственный медицинский университет им. акад. И. П. Павлова, Санкт-Петербург, Россия
2 Национальный государственный университет физической культуры, спорта и здоровья им. П. Ф. Лесгафта, Санкт-Петербург, Россия

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Данная статья посвящена анализу влияния физической реабилитации на показатели качества жизни подростков 12-17 лет с онкопатологией после трансплантации гемопоэтических стволовых клеток (ТГСК). Авторская методика физической реабилитации включает три этапа, включающие девять комплексов физических упражнений в зависимости от возраста и режима двигательной активности. Проводилась оценка качества жизни, оценивался уровень тревожно-депрессивных состояний подростков на трех этапах исследования: до проведения трансплантации, после трансплантации, после реабилитации. Полученные данные свидетельствуют о положительном влиянии физической реабилитации на качество жизни подростков с онкопатологией, перенесших трансплантацию гемопоэтических стволовых клеток.

Ключевые слова

Физическая реабилитация, онкология, дети, трансплантация гемопоэтических стволовых клеток, депрессия, тревога, эмоциональное состояние.

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Alla A. Potapchuk1, Alisa G. Volkova1, Fedor V. Terentiev2, Irina G. Terentieva2, Ludmila S. Zubarovskaya1, Boris V. Afanasyev1

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1 Raisa Gorbacheva Memorial Research Institute of Pediatric Oncology, Hematology and Transplantation, Pavlov University,
St. Petersburg, Russia
2 National State P. F. Lesgaft University of Physical Culture, Sports and Health, St. Petersburg, Russia

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The present article is evaluating the effects of physical rehabilitation upon the quality of life (QoL) indexes in adolescents (12 to 17 y.o.) with oncological diseases following hematopoietic stem cell transplantation (HSCT). The proprietary technique of physical rehabilitation includes 3 stages with nine complexes of physical exercises, dependent on their age and regimen of motor activities. We have evaluated QoL, and anxiety/depressive conditions in adolescents at three stages of the study: HSCT, after it, and following rehabilitation. The data obtained confirm a positive effect of the physical rehabilitation upon QoL in the adolescents with cancer subjected to hematopoietic stem cell transplantation.

Keywords

Physical rehabilitation, oncology, children, hematopoietic stem cell transplantation, depression, anxiety, emotional state.

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Effects of motor exercises upon life quality of adolescents subjected to hematopoietic stem cell transplantation

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Alla A. Potapchuk1, Alisa G. Volkova1, Fedor V. Terentiev2, Irina G. Terentieva2, Ludmila S. Zubarovskaya1, Boris V. Afanasyev1

1 Raisa Gorbacheva Memorial Research Institute of Pediatric Oncology, Hematology and Transplantation, Pavlov University,
St. Petersburg, Russia
2 National State P. F. Lesgaft University of Physical Culture, Sports and Health, St. Petersburg, Russia

The present article is evaluating the effects of physical rehabilitation upon the quality of life (QoL) indexes in adolescents (12 to 17 y.o.) with oncological diseases following hematopoietic stem cell transplantation (HSCT). The proprietary technique of physical rehabilitation includes 3 stages with nine complexes of physical exercises, dependent on their age and regimen of motor activities. We have evaluated QoL, and anxiety/depressive conditions in adolescents at three stages of the study: HSCT, after it, and following rehabilitation. The data obtained confirm a positive effect of the physical rehabilitation upon QoL in the adolescents with cancer subjected to hematopoietic stem cell transplantation.

Keywords

Physical rehabilitation, oncology, children, hematopoietic stem cell transplantation, depression, anxiety, emotional state.

Rehabilitation

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	Серафима М. Чечельницкая, Владимир Н. Касаткин, Марина А. Шурупова, Ирина Д. Бородина, Юрий В. Сарайкин, Александр Ф. Карелин, Дмитрий В. Скворцов, Александра В. Баербах, Дарья В. Жук, Владислав А. Никулин
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Серафима М. Чечельницкая, Владимир Н. Касаткин, Марина А. Шурупова, Ирина Д. Бородина, Юрий В. Сарайкин, Александр Ф. Карелин, Дмитрий В. Скворцов, Александра В. Баербах, Дарья В. Жук, Владислав А. Никулин

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Лечебно-реабилитационный научный центр «Русское поле», Национальный медицинский исследовательский центр детской гематологии, онкологии и иммунологии им. Дмитрия Рогачева, Москва, Россия

[TYPE] => HTML ) [~DESCRIPTION] => [~NAME] => Организации [~DEFAULT_VALUE] => Array ( [TEXT] => [TYPE] => HTML ) ) [SUMMARY_RU] => Array ( [ID] => 27 [TIMESTAMP_X] => 2015-09-02 18:01:20 [IBLOCK_ID] => 2 [NAME] => Описание/Резюме [ACTIVE] => Y [SORT] => 500 [CODE] => SUMMARY_RU [DEFAULT_VALUE] => Array ( [TEXT] => [TYPE] => HTML ) [PROPERTY_TYPE] => S [ROW_COUNT] => 1 [COL_COUNT] => 30 [LIST_TYPE] => L [MULTIPLE] => N [XML_ID] => 27 [FILE_TYPE] => [MULTIPLE_CNT] => 5 [TMP_ID] => [LINK_IBLOCK_ID] => 0 [WITH_DESCRIPTION] => N [SEARCHABLE] => N [FILTRABLE] => N [IS_REQUIRED] => N [VERSION] => 1 [USER_TYPE] => HTML [USER_TYPE_SETTINGS] => Array ( [height] => 200 ) [HINT] => [PROPERTY_VALUE_ID] => 25405 [VALUE] => Array ( [TEXT] => <p style="text-align: justify;"> Нарушения постуральной устойчивости широко распространено среди пациентов, лечившихся от онкологических заболеваний. Вопрос о механизмах этого явления находится на стадии изучения. Целью проведенного нами ретроспективного исследования было уточнение связи постуральной нестабильности онкологических пациентов с дисфункцией глазодвигательных мышц. В исследовании приняли участие 291 ребенок 5-18 лет, перенесших онкологическое заболевание и находящихся в стадии ремиссии или стабилизации. В контрольную группу вошли 182 здоровых ребенка. </p> <p style="text-align: justify;"> Качество постурального баланса оценивалось методом стабилометрии на компьютерном стабилоанализаторе «Стабилан 01-2». Регистрация движений глаз производилась методом видеокулографии с помощью айтрекера Arrington. Для моделирования взаимосвязи анализируемых показателей использовался регрессионный анализ, для явно выраженных асимметричных распределений применялось преобразование исходных значений в виде логарифмирования и степенного преобразование Бокса-Кокса (Box-Cox transformation). </p> <p style="text-align: justify;"> Основные показатели стабилометрии в позе с открытыми глазами подтвердили нарушения постурального баланса у детей, переживших рак. Математически была обоснована высокая вероятность связи дисбаланса с фактором заболевания. Улучшение показателей стабилометрии при закрывании глаз выявлено в обеих группах, но среди детей, переживших рак, этот феномен выявлялся достоверно и значимо чаще. Обнаружена устойчивая связь между постуральной нестабильностью и нарушением работы глазодвигательных мышц. </p> <h2>Ключевые слова</h2> <p style="text-align: justify;"> Рак у детей, постуральный контроль, противоопухолевая терапия, токсические эффекты, глазодвигательные мышцы. </p> [TYPE] => HTML ) [DESCRIPTION] => [VALUE_ENUM] => [VALUE_XML_ID] => [VALUE_SORT] => [~VALUE] => Array ( [TEXT] =>

Нарушения постуральной устойчивости широко распространено среди пациентов, лечившихся от онкологических заболеваний. Вопрос о механизмах этого явления находится на стадии изучения. Целью проведенного нами ретроспективного исследования было уточнение связи постуральной нестабильности онкологических пациентов с дисфункцией глазодвигательных мышц. В исследовании приняли участие 291 ребенок 5-18 лет, перенесших онкологическое заболевание и находящихся в стадии ремиссии или стабилизации. В контрольную группу вошли 182 здоровых ребенка.

Качество постурального баланса оценивалось методом стабилометрии на компьютерном стабилоанализаторе «Стабилан 01-2». Регистрация движений глаз производилась методом видеокулографии с помощью айтрекера Arrington. Для моделирования взаимосвязи анализируемых показателей использовался регрессионный анализ, для явно выраженных асимметричных распределений применялось преобразование исходных значений в виде логарифмирования и степенного преобразование Бокса-Кокса (Box-Cox transformation).

Основные показатели стабилометрии в позе с открытыми глазами подтвердили нарушения постурального баланса у детей, переживших рак. Математически была обоснована высокая вероятность связи дисбаланса с фактором заболевания. Улучшение показателей стабилометрии при закрывании глаз выявлено в обеих группах, но среди детей, переживших рак, этот феномен выявлялся достоверно и значимо чаще. Обнаружена устойчивая связь между постуральной нестабильностью и нарушением работы глазодвигательных мышц.

Ключевые слова

Рак у детей, постуральный контроль, противоопухолевая терапия, токсические эффекты, глазодвигательные мышцы.

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Serafima M. Chechelnitskaia, Vladimir N. Kasatkin, Marina A. Shurupova, Irina D. Borodina, Yurij V. Sarajkin, Aleksandr F. Karelin, Dmitrij V. Skvorcov, Aleksandra V. Baerbakh, Daria V. Zhuk, Vladislav A. Nikulin

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Medical Rehabilitation Research Center "Russkoe Pole", Dmitry Rogachev National Medical Research Center for Pediatric Hematology, Oncology and Immunology, Moscow, Russia

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Disorders of postural resistance are widespread among the patients treated for cancer. The question of the mechanism of this phenomenon is under the study. The aim of our retrospective study was to clarify the relationship of postural instability in cancer patients with oculomotor muscle dysfunction.

Patients and methods

The study involved 291 children 5-18 years old who had cancer and were in remission state or stable clinical condition. The control group included 182 healthy children. The quality of postural balance was evaluated by stabilometric method using a computer-assisted stabilizer (Stabilan 01-2 model). The eye movements were recorded by videoculography using the Arrington eye-tracker. Regression analysis was used to assess relationships of the analyzed parameters. For explicit asymmetric distributions, we used conversion of initial values to logarithmic form and the Box-Cox transformation.

Results

The main stabilometric indicators in the position with open eyes confirmed impaired postural balance in the children who survived cancer. We have substantiated a high probability of correlation between the postural imbalance and disease factor. Improvement in stabilometric indexes with eyes closed was detected for both groups. However, this phenomenon proved to be significant and was more common among the children who survived cancer.

Conclusion

A stable relationship was found between the postural instability and altered functioning of oculomotor muscles.

Keywords

Childhood cancer, postural control, anticancer therapy, toxic effects, oculomotor muscles.

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Sensory conflict as a possible reason for disturbed postural stability in the children treated for cancer

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Serafima M. Chechelnitskaia, Vladimir N. Kasatkin, Marina A. Shurupova, Irina D. Borodina, Yurij V. Sarajkin, Aleksandr F. Karelin, Dmitrij V. Skvorcov, Aleksandra V. Baerbakh, Daria V. Zhuk, Vladislav A. Nikulin

Medical Rehabilitation Research Center "Russkoe Pole", Dmitry Rogachev National Medical Research Center for Pediatric Hematology, Oncology and Immunology, Moscow, Russia

Disorders of postural resistance are widespread among the patients treated for cancer. The question of the mechanism of this phenomenon is under the study. The aim of our retrospective study was to clarify the relationship of postural instability in cancer patients with oculomotor muscle dysfunction.

Patients and methods

The study involved 291 children 5-18 years old who had cancer and were in remission state or stable clinical condition. The control group included 182 healthy children. The quality of postural balance was evaluated by stabilometric method using a computer-assisted stabilizer (Stabilan 01-2 model). The eye movements were recorded by videoculography using the Arrington eye-tracker. Regression analysis was used to assess relationships of the analyzed parameters. For explicit asymmetric distributions, we used conversion of initial values to logarithmic form and the Box-Cox transformation.

Results

The main stabilometric indicators in the position with open eyes confirmed impaired postural balance in the children who survived cancer. We have substantiated a high probability of correlation between the postural imbalance and disease factor. Improvement in stabilometric indexes with eyes closed was detected for both groups. However, this phenomenon proved to be significant and was more common among the children who survived cancer.

Conclusion

A stable relationship was found between the postural instability and altered functioning of oculomotor muscles.

Keywords

Childhood cancer, postural control, anticancer therapy, toxic effects, oculomotor muscles.