Motor functioning during and following treatment with chemotherapy for pediatric acute lymphoblastic leukemia

摘要: Advances intreatment for acutelymphoblasticleukemia(ALL)have resulted in 5-year survival rates of up to 91% [1,2]. Despitethis success, 35–40% survivors ALL report late effectsof treatment medical, cognitive, and/or physical domains,highlighting the ongoing cost cure [3,4]. Most research on thelate effects has included treated with low dosecranial radiation, a known neurotoxic agent. While modernprotocols have substituted radiation chemother-apeutic drug methotrexate (MTX), chemotherapy-only regimescontinuetopresentrisksforshort-andlong-termadverseoutcomes,although these are less well defined [5,6].The motor system, which undergoes rapid development atthe time when most commonly presents during childhood(2–5 years age), is vulnerable chemotherapy [7,8].The robust evidence impairment children treatedfor comes from on-treatment studies describing peripheralneuropathy [9], experienced as sensory loss pain andtemperature, reduced deep tendon reflexes, balance difficulties,and muscle weakness [9–11]. However, changes notrestricted peripheral nervous frommotor-evoked potential latencies showing throughout themotor circuitry, including central system [12].Motor deficits significant concern given their toimpedecognitive,academicandsocialdevelopmentbydisruptingachild’smainpathwayofinteractionwiththeirenvironment[13–15].For entering school following treatment, reducedmotor competence areas such handwriting or ball skills placethem at disadvantage learning and playgroundenvironment [16]. Motor difficulties therefore capacity tosignificantly affect long-term quality life, particularly whenconsidering that rarely occur isolation, with35–40% experiencing multiple [17].Considering multifaceted impact motordifficultiesinchildhood,itisimportanttodeterminetheprevalence,type trajectory both aftertreatment ALL. These data should be able inform clinicalprogramsontheservicerequirementsforthispopulation,includingwhen how screening implemented intheclinicalsetting.Anunderstandingoftheprimarydomainswheredifficulties needed tailor assessments interventionsto target-specific deficits, could ultimately used informthe individualization protocols minimize lateeffects.Fivepreviouslypublishedreviewarticlesrelatetothistopic[18–22]. Three previous reviews literature examinedfine outcomes [18–20]. were not theprimary focus reviews, detailed critical appraisal ofthe abilities was provided. Two furtherreviewshaveexaminedphysicalperformanceandinterventionsthatpromote exercise [21,22].This review systematically collated summarized theresearch findings gross motor, fine visual-motorintegration forALL, evaluated this evidence. The keyresearch questions were: (1) How many experience motordifficulties ALL?; (2) Whattypes reported when?; (3) What risk factorsare associated difficulties?