Motor Function in Pediatric ALL Survivors after Chemotherapy-Only
26 April 2017 (online)
Background: Up to 40% of childhood ALL survivors suffer from fine-motor problems interfering with school performance and daily life. So far, drawing and handwriting skills as well as manual dexterity are not well understood in childhood ALL survivors after chemotherapy-only. Until now, ataxia or tremor have not been tested with standardized tools in chemotherapy-only survivors.
Purpose: This study was to analyze drawing and handwriting skills, incidence and extent of ataxia, tremor and hand steadiness in nonirradiated childhood ALL survivors. We then searched for clinical risk factors.
Results: Nonirradiated ALL survivors (n = 31) were examined neurologically including examination for handedness (Edinburgh Handedness Inventory), ataxia-testing (International Cooperative Ataxia Rating Scale [ICARS]), drawing and writing skills (digitizing tablet, with low- and high-complexity tasks), and tremor and hand steadiness (Nine Hole Steadiness Tester [NHST]). ALL survivors and healthy peers (ICARS n = 52, digitizing tablet n = 187, NHST n = 1142) were compared matching for age and gender. We revealed significant motor impairment in childhood ALL survivors at a median time of 3.5 years after chemotherapy. More impaired drawing and writing correlated with length of the intensive part of therapy and shorter time since end of therapy. ALL survivors were significantly more frequently left-handers than healthy control subjects.
Conclusion: We detected significant fine-motor impairment in ALL survivors. Complications prolonging the intensive part of therapy as well as shorter recovery time may influence motor function loss. We conclude that ALL patients should be routinely examined during therapy and surveillance for fine-motor skills allowing therapeutic interventions if needed.