Balance impairment in survivors of pediatric brain cancers: risk factors and associated physical limitations
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Balance impairment in survivors of pediatric brain cancers: risk factors and associated physical limitations Mitra Varedi 1 & Lu Lu 1 & Nicholas S. Phillips 1 & Robyn E. Partin 1 & Tara M. Brinkman 1 & Gregory T. Armstrong 1 & Emma Chase 2 & Raja B. Khan 3 & Douglas Powell 2 & Raymond F. McKenna 4 & Leslie L. Robison 1 & Melissa M. Hudson 5 & Kirsten K. Ness 1 Received: 11 May 2020 / Accepted: 30 August 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
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. Keywords CNS tumors . Postural balance . Pediatric cancer . Late effects . Physical performance
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11764-020-00932-5) contains supplementary material, which is available to authorized users. * Mitra Varedi [email protected] 1
Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105-3678, USA
2
School of Health Studies, The University of Memphis, Memphis, TN, USA
3
Division of Neurology, Department of Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, USA
4
Department of Physical Therapy, Stony Brook University, Stony Brook, NY, USA
5
Department
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