Cancer patients undergoing chemotherapy often experience a range of side effects, including fatigue, neuropathy, and changes in cognitive function, which collectively contribute to an increased risk of falls. These side effects can impair balance and coordination, making it essential for healthcare providers to assess falls risk in this vulnerable population. Utilizing specific tools to test balance and falls risk is critical to developing targeted interventions that can help mitigate this risk. By integrating these assessment tools into routine evaluations, healthcare professionals can better understand each patient’s unique balance challenges. This information allows for the development of tailored exercise programs focused on strength and coordination, thereby reducing the likelihood of falls and enhancing the overall quality of life for cancer patients navigating the complexities of chemotherapy.
“Evidence has mounted that cancer survivors demonstrate impaired balance, gait, and increased risk of falls following chemotherapy treatment.”
Rehab Oncology
Cancer Patients and Increased Risk of Falls
Romberg Test for Assessment of Cancer Patients and an Increased Risk of Falls
A robust balance assessment can help healthcare professionals monitor a cancer survivors recovery progression over time. Utilizing state-of-the-art technology and assessments, clinicians can establish baseline measurements of a patient’s balance performance before and after interventions. This data-driven approach allows for the refinement of therapeutic strategies, ensuring that survivors receive the most effective care possible. It also encourages an interdisciplinary collaboration amongst oncologists, physical therapists, and occupational therapists, all of whom play a vital role in supporting the holistic recovery of cancer survivors. Ultimately, prioritizing balance system testing can significantly enhance the quality of life for these individuals, promoting not just physical recovery, but also fostering emotional resilience and social reintegration.
We’re going to start testing the balance system which is critical to assess cancer patients and an increased risk of falls. We’re going to start with the Romberg. The Romberg was developed to test tabes dorsalis or dorsal column disease. it is a good test for fall prevention and a great test for peripheral neuropathy. It’s not a great test if you’re trying to test using vestibular information for balance.
She will stand with her feet together, arms across her chest, and I’m just going to time her with her eyes open. We typically go for 30 seconds. I’m not going to go that long today. I’m looking to see if she can maintain this. But this is just the baseline; if she falls during this condition, it indicates a motor problem.
The next thing I’m going to have her do is I’m going to have her close her eyes, and again, I’m going to go for 30 seconds. Again, I won’t do it today just for time, but I’m looking for sway. I’m looking if she falls. If she falls during this condition, she will have trouble using somatosensory information for balance. The goal is to prevent a fall after chemotherapy cancer treatment by understanding the treatments impact on the vestibular system.
Remember that on a firm surface with eyes closed, she should primarily be using somatosensation, so if she falls here, there’s peripheral neuropathy.
OK, you can open your eyes and put your arms down. The next thing I will have her do is a single limb stance. Usually, we do want to try both legs, so you can start with whichever one you want. And so I want her to stand, bending the leg up, not touching the other leg. I want her to hold it as long as she can. Again, we want to go for about 30 seconds. I’m looking for the amount of sway. I’m looking for trunk movements, arm movements, and leg movements. If any of those starts, I stop the time. OK, and switch legs. Good.
Again, I want to do both legs and see how she does. The inability to maintain a single limb stance for about five seconds indicates fall risk in older adults. It also has been shown that people with low back pain will have a decreased ability to stand on one foot, especially on the involved side. OK, you can stop.
Sharpened Romberg
The last thing we’re going to do to assess cancer patients and increased risk of falls is what’s called a Sharpened Romberg. It’s basically standing in tandem–so one foot in front of the other, heel to toe. And again, we’re going to do this primarily, eyes open. This isn’t normal to be able to maintain this with your eyes closed once you start getting older, so we’re going to do it with your eyes open. Again, time for 30. You want to do it with the dominant foot both in front and behind. It should be more difficult with the dominant foot in front. Again, 30 seconds. Now go ahead and switch feet and then stand. Sharpened Romberg, again, is testing more somatosensory, but it also tests motor. You have to be able to use a hip strategy to maintain standing in tandem.
Learn More about Cancer Patients and Increased Risk of Falls
For a comprehensive approach for PT courses on balance and fall prevention, go to www.healthclick.com and utilize the resources provided in the Balance and Falls Series of comprehensive courses within the All-Access Healthclick Subscription. Some of the courses in this series are:
Evidence-Based Outcome tools for Treating Balance Dysfunction
Balance and Falls in the Elderly
Progressive Vestibular Treatments for the Over 60 Population
References
Criss, Michelle G. PT, DPT, PhD1; Wingood, Mariana PT, DPT, PhD, MPH2; Staples, William H. PT, DPT, DHSc, FAPTA3; Southard, Veronica PT, DHSc4; Miller, Kenneth L. PT, DPT5; Norris, Traci L. PT, DPT6; Avers, Dale PT, DPT, PhD, FAPTA7; Ciolek, Cathy H. PT, DPT, FAPTA8; Lewis, Carole B. PT, DPT, MSG, MPA, PhD, FSOAE, FAPTA9; Strunk, Ellen R. PT, MS10. APTA Geriatrics’ Guiding Principles for Best Practices in Geriatric Physical Therapy: An Executive Summary. Journal of Geriatric Physical Therapy: April/June 2022 – Volume 45 – Issue 2 – p 70-75 doi: 10.1519/JPT.0000000000000342
Cohen, Helen S. “A review on screening tests for vestibular disorders.” Journal of Neurophysiology 122.1 (2019): 81-92.
Wechsler, Stephen PT, DPT; Wood, Lisa PhD, RN. The Effect of Chemotherapy on Balance, Gait, and Falls Among Cancer Survivors: A Scoping Review. Rehabilitation Oncology: January 2021 – Volume 39 – Issue 1 – p 6-22 doi: 10.1097/01.REO.0000000000000238
