Mitra Varedi1, Lu Lu2, Nicholas S Phillips2, Robyn E Partin2, Tara M Brinkman2, Gregory T Armstrong2, Emma Chase3, Raja B Khan4, Douglas Powell3, Raymond F McKenna5, Leslie L Robison2, Melissa M Hudson6, Kirsten K Ness2. 1. Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105-3678, USA. mitra.varedi@stjude.org. 2. Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105-3678, USA. 3. School of Health Studies, The University of Memphis, Memphis, TN, USA. 4. Division of Neurology, Department of Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA. 5. Department of Physical Therapy, Stony Brook University, Stony Brook, NY, USA. 6. Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA.
Abstract
PURPOSE: The study aims were to determine the prevalence of balance impairments in adult survivors of pediatric central nervous system (CNS) tumors, and to identify predictors of and limitations associated with balance impairments. METHODS: Participants were adult survivors (N = 329) of pediatric CNS tumors. Balance was considered impaired among those with composite scores < 70 on the sensory organization test. Potential predictors of impaired balance were evaluated with generalized linear regression. Multivariable logistic regression was used to evaluate associations between balance impairment and function. RESULTS: Balance impairment was observed in 48% of survivors, and associated with infratentorial tumor location (OR = 4.0, 95% CI, 2.0-7.6), shunt placement (OR = 3.5, 95% CI, 1.8-6.7), increased body fat percentage (OR = 1.1, 95% CI, 1.0-1.1), hearing loss (OR = 11.1, 95% CI, 5.6-22.2), flexibility limitations (OR = 2.0, 95% CI, 1.0-3.9), peripheral neuropathy (OR = 2.4, 95% CI, 1.2-4.5), and cognitive deficits (OR = 2.2, 95% CI, 1.1-4.7). In adjusted models, impaired balance was associated with limitations in overall physical performance (OR = 3.6, 95% CI, 2.0-6.3), mobility (OR = 2.6, 95% CI, 1.5-4.4), diminished walking endurance (OR = 2.9, 95% CI, 1.7-5.0), and non-independent living (OR = 2.0, 95% CI, 1.0-4.3). CONCLUSIONS: Nearly half of adult survivors of pediatric CNS tumors have impaired balance, which is associated with mobility and physical performance limitations. Interventions to address the complex needs of this population should be prioritized. IMPLICATIONS FOR CANCER SURVIVORS: Survivors with identified risk factors should be closely evaluated for presence of balance impairment. Interventions tailored to improve balance also can positively affect function and mobility in survivors.
PURPOSE: The study aims were to determine the prevalence of balance impairments in adult survivors of pediatric central nervous system (CNS) tumors, and to identify predictors of and limitations associated with balance impairments. METHODS: Participants were adult survivors (N = 329) of pediatric CNS tumors. Balance was considered impaired among those with composite scores < 70 on the sensory organization test. Potential predictors of impaired balance were evaluated with generalized linear regression. Multivariable logistic regression was used to evaluate associations between balance impairment and function. RESULTS: Balance impairment was observed in 48% of survivors, and associated with infratentorial tumor location (OR = 4.0, 95% CI, 2.0-7.6), shunt placement (OR = 3.5, 95% CI, 1.8-6.7), increased body fat percentage (OR = 1.1, 95% CI, 1.0-1.1), hearing loss (OR = 11.1, 95% CI, 5.6-22.2), flexibility limitations (OR = 2.0, 95% CI, 1.0-3.9), peripheral neuropathy (OR = 2.4, 95% CI, 1.2-4.5), and cognitive deficits (OR = 2.2, 95% CI, 1.1-4.7). In adjusted models, impaired balance was associated with limitations in overall physical performance (OR = 3.6, 95% CI, 2.0-6.3), mobility (OR = 2.6, 95% CI, 1.5-4.4), diminished walking endurance (OR = 2.9, 95% CI, 1.7-5.0), and non-independent living (OR = 2.0, 95% CI, 1.0-4.3). CONCLUSIONS: Nearly half of adult survivors of pediatric CNS tumors have impaired balance, which is associated with mobility and physical performance limitations. Interventions to address the complex needs of this population should be prioritized. IMPLICATIONS FOR CANCER SURVIVORS: Survivors with identified risk factors should be closely evaluated for presence of balance impairment. Interventions tailored to improve balance also can positively affect function and mobility in survivors.
Authors: Kirsten K Ness; E Brannon Morris; Vikki G Nolan; Carrie R Howell; Laura S Gilchrist; Marilyn Stovall; Cheryl L Cox; James L Klosky; Amar Gajjar; Joseph P Neglia Journal: Cancer Date: 2010-06-15 Impact factor: 6.860
Authors: Kirsten K Ness; Kevin R Krull; Kendra E Jones; Daniel A Mulrooney; Gregory T Armstrong; Daniel M Green; Wassim Chemaitilly; Webb A Smith; Carmen L Wilson; Charles A Sklar; Kyla Shelton; Deo Kumar Srivastava; Sabeen Ali; Leslie L Robison; Melissa M Hudson Journal: J Clin Oncol Date: 2013-11-18 Impact factor: 44.544
Authors: Roger J Packer; James G Gurney; Judy A Punyko; Sarah S Donaldson; Peter D Inskip; Marilyn Stovall; Yutaka Yasui; Ann C Mertens; Charles A Sklar; H Stacy Nicholson; Lonnie K Zeltzer; Joseph P Neglia; Leslie L Robison Journal: J Clin Oncol Date: 2003-09-01 Impact factor: 50.717