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
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
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.