Custom Orthotics to Mitigate Effects of Chemotherapy-induced Peripheral Neuropathy
NIH study finds increased postural control with orthotic intervention in patient with chemo-induced peripheral neuropathy.
Cancer therapies often involve neurotoxic drugs that take a toll on peripheral nerves, leading to proprioceptive impairment. Numbness, pain, and loss of tactile sensation is common, and often leaves patients with compromised plantar pressure, kinesthetic awareness, and postural stability.
According to Cancer.org, CIPN occurs because chemotherapy drugs spread throughout the whole body, damaging nerves in the process. Certain types of chemotherapy drugs, such as Thalidomide or Lenalidomide can cause damage to different nerves.
A recent study performed by Earllaine Croarkin, Rachel Eisenfeld, Cris Zampieri, and Julie Rekant in the NIH Mark O. Hatfield Clinical Research Center explores the ability of custom orthotics to mitigate the effects of chemotherapy-induced Peripheral Neuropathy (CIPN).
The patient involved in the study was diagnosed with Stage II IgG kappa multiple myeloma, and was administered a combination of Carfilzomib, Lenalidomide, and Dexamethasone. He received a total of 8 months of chemotherapy, and significant neurological impairments were seen. His balance and postural stability were most affected, which limited his participation in daily activities. The patient, understanding the importance of improving proprioceptive feedback, agreed to try custom made foot orthotics. The study team took careful consideration of the patient’s abilities and pain points, and made a clinical decision regarding the orthotic intervention.
The effectiveness of the orthotics along with appropriate-fitting shoes was examined using two methods, including Opal wearable sensors and the NeuroCom Balance Master system. Both were chosen because of reliability and validity in assessing postural stability. The team used the iSway testing procedures, developed in part by APDM’s Dr. Fay Horak. By attaching sensors to the lumbar and each leg, the team could easily look at metrics such as Root Mean Square Displacement and Mean Sway Velocity. Like a typical Sway trial, as found in Mobility Lab, the patient underwent a 30-second test to analyze his sway parameters and time to fall, which was shown to be delayed with the orthotic intervention. Improvements were seen in all sway parameters when compared to barefoot and shoes-only conditions. For example, the Opal recorded significant improvements in Anterior/Posterior and Medial/Lateral RMS displacements and Mean Velocities, along with a major Time to Fall change. The patient showed improved confidence in walking as well.
Increased postural control is vital to improving fall risk, as shown by the orthotic intervention in this study. Also shown are just some of the metrics that APDM can provide when analyzing fall risk, proprioception, or postural stability. Other important metrics to consider include:
Turn Duration
Turn Speed
Steps per Turn
Sit/Stand Speed
Step Initiation
Anticipatory Postural Adjustment
Sway Area
Sway Speed
Sway Distance
Sway Path
Center of Mass Motion
For more information regarding what Opal sensors can measure, click here.
For more information regarding the study mentioned, click here.
