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ADVANCE Perspective: Physical Therapy & Rehab Medicine

Cancer Crusaders

Published February 5, 2014 12:58 PM by Danielle Bullen

LAS VEGAS, NV--"Physical therapy has positive effects for children with leukemia in many areas," says Kristin Brown, PT, MS, DDT, PCS, Hasbro Children's Hospital, Providence, Rhode Island. That was the main takeaway at this morning's Combined Sections Meeting talk, "An Evidence-Based Approach to Physical Therapy for Children with Leukemia."

Brown and Debra Seal, PT, DPT, DCS, NTMTC specifically focused on physical therapy for children diagnosed with acute lymphoblastic leukemia (ALL). It is the most common form of childhood cancer yet one of the most beatable. The five-year survival rate with medical treatment is over 90%.

 In ALL, leukemia cells crowd out normal blood cells, causing, among other things, anemia, brusing, increased ris of infection, and bone marrow failure. Weakness, fatigue and fevers can be some of the first signs of ALL.

 After several rounds of blood and platelet transfusions, children begin chemotherapy in three distinct phases. The firsr--remission induction--aims to kill of the primary cancer cells. The second--consolidation--occurs when the cancer is in remission. It is an intense six-to-nine month cycle of chemo to kill off any remaining cellls to prevent replase. Kids are frequently hospitalized during this cycle. The third--maintainance phase--is when they receive a lower chemo dose, sometimes orally, and can last for up to two years.

Every body system is affected by ALL and chemotherapy. "These kids have a lot of  pain," noted Brown. Besides pain, both during and after treatment, these patients show deficits in balance and cardiovascular pulmonary function; fatigue; decreased range of motion; and impaired motor performance. Some of those side effects can continue even into adulthood. And this is where physical therapy comes into play.

Brown explained at her hospital, physical therapy begins soon after diagnosis, before chemotherapy even starts. Yet most of the research cites the effects of PT during the maintainance phase of threatment only.

Physical theraphy interventons showed improved across several functional areas. Ankle ROM increased with skilled PT. Home exercise programs showed an increased distance in the nine-minutre walk test. A three times per week strength training program in the maintainacne phase increased the kids' strength. And a six-week home-based exercise program was shown to lower fatigue.

One of the challenges faced by PTs with this population is patient fatigue. "Fatigue impacts our therapy so much because they don't want to participage," Brown said. Another barrier to treatment is "roid rage," the negative effects the heavy doses of steroid medication have on the children's behavior. At times, Brown will skip a few PT sessions when she realizes the child will be non-compliant because of his or her attitude.

Overall, the resarch has found there are no adverse effects of physical therapy for children with leukemia.



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