Managing chemotherapy induced neuropathy in Cancer patients using ExerGaming



 DESCRIPTION (provided by applicant): Chemotherapy-induced peripheral neuropathy (CIPN) is one of the most challenging and complex complications of cancer chemotherapy. Although incidence of CIPN varies among drug class, approximately 30-40% of cancer patients will be affected. Among various CIPN-related symptoms, loss of balance and walking difficulty have been identified as leading risk factors for falls. Given the high number of CIPN patients suffering from balance and gait deficits, surprisingly appropriate assessment and treatment strategies for these deficits have not been adequately developed. Current assessment of balance and gait is based on subjective rating scales which may not be accurate for estimation of fall risk and adjustment of chemotherapy dosage. Objective and clinically feasible assessment tools are lacking. Additionally, there is a lack of exercise regimes that take into account the specific CIPN related sensational deficits. CIPN patients may require uniquely designed training approaches to help compensate for these deficits. To our knowledge, no CIPN-specific balance training program has been evaluated. The primary innovation of the proposed research project is the application of a validated, wearable technology for 1) objectively assessing CIPN-related balance and gait deficits to examine the development and severity of CIPN and its association with changes in balance and gait during a period of 6 months chemotherapy treatment; and 2) evaluate the feasibility of a technology-based exercise training for improving balance and gait performance. The exercise provides an interactive sensor-based interface including real-time joint movement- feedback from lower extremity joint motion. We will conduct two clinical studies for validating/ evaluating our proposed assessment and treatment strategy. Clinical study 1 is a longitudinal study in which we will evaluate the association between CIPN and balance/ gait as measured by wearable sensor-based assessment. Sixty (60) cancer patients receiving neurotoxic chemotherapy will undergo assessment of gait and balance every two months over a period of 6 months. Additionally, development and severity of CIPN as quantified by Vibratory Perception Threshold (VPT) test and clinical examination will be obtained and fall occurrence will be monitored. Clinical study 2 is a double blinded randomized controlled trial for evaluating the effectiveness of an innovative technology-based exercise training program for improving gait and balance, and preventing falls in CIPN patients. We will randomly assign 66 eligible subjects with confirmed CIPN into a control group and intervention group and follow them for six months. The intervention group will take part in a 6-week balance training program using the proposed technology twice per week in their home. Control group will be instructed to complete a supervised validated program of non-technology home-based exercises twice per week for six weeks. We will compare the effectiveness of the intervention between groups based on quantifiable changes in balance, gait, quality of life, physical activity and risk of falling betwen pre- and post-intervention assessments.