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Patients in the intervention group will perform a standardized, age-adjusted, specific playful sensorimotor training (SMT) program twice a week for the duration of their medical therapy, in addition to usual care.

The control group receives treatment as usual. The control group will be given the opportunity to participate in the intervention after therapy.

For the max. duration of the first in-hospital phase (3weeks), all children will receive supervised training. When children go home they will be supplied with a manual, specific exercises and the necessary training devices. Regular supervision will allow to ensure that the training is performed at maximum benefit. Each session will last for about 20 to 30 minutes in total, including a child-specific warm-up and cool-down. The children will be asked to maintain balance in a previously acquired "short-foot-position", knees slightly flexed (30°), without shoes. Training will consist of 5 playful balance exercises chosen from a standardized pool of exercises according to the child's age, with increasing difficulty in order to allow for individual, optimal progression. Each of the 5 exercises will contain of 5 repetitions for 10sec. allowing for a 20sec. rest in between each set and a 1min rest between each exercise in order to avoid neural fatigue.

Playful sensorimotor training

Fiona Streckmann, Dr.

Jeanette Greiner, Dr

Nicolas Von Der Weid

The investigators would like to conduct a prospective, multicenter, two-armed trial (RCT with follow-up). Patients will be recruited from 7 centers (CH/D). All patients (and their guardians) scheduled to receive chemotherapy containing either a platinum derivate or vinca-alkaloid, will be asked to participate. Willing patients will then be randomized either into an intervention group or a control group. Patients in the intervention group will perform a standardized, age-adjusted, specific playful sensorimotor training (SMT) program twice a week for the duration of their medical therapy, in addition to usual care, while the control group receives treatment as usual. The CG will be given the opportunity to participate in the intervention after therapy. Data will be assessed at 3-4 time points: Prior to chemotherapy (baseline T0), after 12 weeks (T1), after completion of therapy for children that are treated \>3 months (Tp) and after 12 months follow-up (T3). Additionally, status of Chemotherapy-induced peripheral neuropathy (CIPN) reported symptoms will be monitored twice in-between (6 weeks).

The investigators hypothesize that less children in the intervention group will develop symptoms of CIPN (TNS score) with its debilitating side-effects. Furthermore, children in the intervention group will be able to maintain relevant motor and sensory functions and their associated physical functions which will enable them to receive their planned medical therapy but also to stay on the age-appropriate motor development level, improve their quality life and enhance social reintegration after therapy.

Modern therapy has improved survival for children with cancer. However, treatment has unintended consequences. Depending on the neurotoxic agent (platinum derivates or vinca-alkaloids), 52%-100% of children develop a peripheral neuropathy. Diagnosis is underreported and its impact as potentially initial cause for many sensory and motor symptoms underestimated. The severe symptoms such as loss of sensation, numbness, pain, absent reflexes as well as loss of balance control not only delays motor development milestones such as walking, running, jumping or climbing, diminishing children's quality of life and affecting their social reintegration, but is also of high clinical relevance. Additionally, recovery is poor and there are currently no effective options to prevent or treat the symptoms of Chemotherapy-induced peripheral neuropathy (CIPN). Promising results have so far been achieved with specific exercise interventions.

The investigators would therefore like to conduct a prospective, multicenter, two-armed trial (RCT with follow-up). Patients N=131 will be recruited from 7 centers: University Children's Hospital of Basel, the Inselspital Bern, Kantonsspital Aarau, Children Hospital for Eastern Switzerland St. Gallen, University Children Hospital Freiburg and the National Center for tumor diseases (NCT), University Children Hospital Heidelberg, Charité Berlin. All patients (and their guardians) scheduled to receive chemotherapy containing either a platinum derivate or vinca-alkaloid, will be asked to participate. Willing patients will then be randomized either into an intervention group or a control group (CG). Patients in the intervention group will perform a standardized, age-adjusted, specific playful sensorimotor training (SMT) program twice a week for the duration of their medical therapy, in addition to usual care, while the control group receives treatment as usual. The CG will be given the opportunity to participate in the intervention after therapy. Data will be assessed at 3-4 time points: Prior to chemotherapy (baseline T0), after 12 weeks (T1), after completion of therapy for children that are treated \>3 months (Tp) and after 12 months follow-up (T3). Additionally, status of CIPN reported symptoms will be monitored twice in-between (6 weeks). The investigators hypothesize that less children in the intervention group will develop symptoms of CIPN (TNS score) with its debilitating side-effects. Furthermore, children in the intervention group will be able to maintain relevant motor and sensory functions and their associated physical functions which will enable them to receive their planned medical therapy but also to stay on the age-appropriate motor development level, improve their quality life and enhance social reintegration after therapy.

This study will follow a prospective, multicenter, two-armed, randomised, controlled, assessor-blinded trial trial (RCT with follow-up).

All assessors will be blinded and participants will only be told the result of their randomization after the baseline assessment. For the following assessments patients and guardians will be instructed prior to the assessment not to reveal the arm they are in. Assessors are instructed to converse as little as possible outside the friendly instructions. Assessors and trainers will participate in separate study meetings and cannot speak to each other regarding patient matters.

Preventing Sensory and Motor Dysfunctions in Children Receiving Neurotoxic Chemotherapy

Preventing Sensory and Motor Dysfunctions in Children Receiving Neurotoxic Chemotherapy - a Randomized Controlled, Multi-center Trial

data will be shared on request after completion of the study

Primary endpoint is the Ped-mTNS score. It contains a short questionnaire as well as a clinical test battery. The questionnaire is composed of three sets of questions on sensory symptoms and pain, motor function, and autonomic function, and a five- part neurologic exam. The clinical test battery contains light touch sensation, evaluated with Semmes-Weinstein-monofilaments, pin sensibility (MediPin), vibration sensibility assessed with a biothesiometer, deep tendon reflexes of Achilles and patellar tendons and muscular strength examined by a manual muscle test36, each category is rated on a likert scale from 0-4 (0 indicating no symptoms and 4 severe symptoms).

postural control - sway path on the Leonardo force plate

dorsiflexion function, assessment of foot drop with a goniometer and hand-held dynamometer

knee extension strength will be assessed with a hand-held dynamometer

lower limb power will be assessed with the countermovement jump

10m walk test / walk to run transition time

CIPN-related pain will be assessed on a child-appropriate visual analogue scale (VAS)

participation of exercise-related leisure activities

childrens' physical self concept via questionnaire

childrens quality of life via questionnaire

Insel Gruppe AG, University Hospital Bern

Kantonsspital Aarau

Ostschweizer Kinderspital

University Hospital Heidelberg

University Hospital Freiburg

Krebsforschung Schweiz, Bern, Switzerland

Clinical Trial Unit, University Hospital Basel, Switzerland

Charite University, Berlin, Germany

National Center for Tumor Diseases, Heidelberg

University of Basel

Polyneuropathies

Brain Neoplasms

Central Nervous System Neoplasms

Nervous System Neoplasms

Brain Diseases

Central Nervous System Diseases

Brain Tumor, Childhood

Patients in the intervention group will perform a standardized, age-adjusted, specific playful sensorimotor training (SMT) program twice a week for 12 weeks in addition to usual care.

Children in the control group will receive treatment as usual. The control group will be given the opportunity to participate in the intervention after study completion

Supervised training sessions will last for about 20 to 30 minutes in total, including a child-specific warm-up and cool-down. The children will be asked to maintain balance in a previously acquired "short-foot-position", knees slightly flexed (30°), without shoes. Training will consist of 5 playful balance exercises, chosen from a standardized pool of exercises according to the child's age, with increasing difficulty (5 degrees of difficulty - e.g. by reducing the base of support, or dual task exercises - per exercise depending on the age group) in order to allow for individual, optimal progression. Each of the 5 exercises will contain of 5 repetitions for 10sec. allowing for a 20sec. rest in between each set and a 1min rest between each exercise in order to avoid neural fatigue. Children will be given a training manual and diary to train at home after the study. Guardians will be instructed in order to be able to assist their children

Sensorimotor training

Fiona Streckmann

Chemotherapy-induced peripheral neuropathy (CIPN) is a highly prevalent and clinically relevant side-effect of cancer treatment. The severe symptoms such as loss of sensation, numbness, pain, absent reflexes or loss of balance control not only diminish children's quality of life but also affect the medical therapy. To date, there are no effective treatment options to reduce the symptoms of CIPN. Promising results have so far been achieved with specific exercise interventions.

The investigators would therefore like to conduct a prospective, multicenter, two-armed trial (RCT with follow-up). Patients (N=20) will be recruited from the Hospital for Children and Adolescents, Kantonsspital Aarau. Prior to randomization, all primarily eligible patients that have received a platin derivate or vinca-alkaloid, will be screened for symptoms of CIPN. Eligible patients with a neurologically confirmed CIPN will then be randomized either into an intervention group or a control group (CG). Patients in the intervention group will perform a standardized, age-adjusted, specific playful sensorimotor training (SMT) program twice a week for 12 weeks in addition to usual care, while the control group receives treatment as usual. The CG will be given the opportunity to participate in the intervention after study completion. Data change will be assessed at 3 time points: At baseline (T0), after 12 weeks (post intervention testing, T1), and after 12 weeks of follow-up (T2). Primary endpoint is the Ped-mTNS score in order to subjectively as well as objectively assess the severity of CIPN symptoms. It contains a short questionnaire as well as more objective parameters such as light touch sensation, pin sensibility, vibration sensibility, deep tendon reflexes and muscular strength. Additionally, the CIPN symptom pattern will be assessed via nerve conduction studies, CIPN related pain, dorsiflexion and knee extension as well as postural control. Furthermore, investigators will be evaluating patients' level of physical activity, walk to run transition time, lower limb power as well as patients integration in physical education (PE) in school and sport club activities. The investigators hypothesize that patients in the intervention group will be able to reduce relevant symptoms of CIPN, improving related physical functions and enhancing children's social reintegration.

This pilot study will follow a prospective, two-armed, randomized controlled design (RCT with follow-up)

All investigators dealing with the assessments (neurological and sport scientific) and data are blinded, solely the patient as well as the training staff can't be blinded due to the nature of an exercise interventional study.

Playful Sensorimotor Training in Pediatric Brain Tumor Patients

Playful Sensorimotor Training to Reduce the Symptoms of Chemotherapy-induced Peripheral Neuropathy in Pediatric Brain Tumor Patients- a Randomized Controlled Trial

The Ped-mTNS Score comprises the patient reported outcome, in accordance with pharmaceutical studies to reduce the symptoms of CIPN as well as an objective clinical test battery, resulting in an overall score. The questionnaire contains questions regarding sensory, functional and autonomic symptoms of CIPN and will be used to document and assess the severity of the subjective peripheral neuropathy (PNP) symptoms. The clinical test battery contains light touch sensation, evaluated with Semmes-Weinstein-monofilaments, pin sensibility (MediPin), vibration sensibility assessed with a biothesiometer, deep tendon reflexes of Achilles and patellar tendons and muscular strength examined by a manual muscle test.

The short clinical test battery contains the Achilles- and patella-tendon reflexes assessed with a Taylor reflex hammer, peripheral deep sensitivity assessed with a tuning fork, proprioception with a filament, sense of position by the investigator changing the position of the patients toe and lower leg strength (see knee extension)

A force plate (Leonardo, Novotec, Pforzheim, Germany) will be used to assess changes in the center of pressure during upright static and dynamic stance. The assessment follows a standardized protocol.

Ankle dorsiflexion strength and active ankle range of motion are measured using a hand-held dynamometer (Alluris, Freiburg, Germany) and a goniometer (Lafayette extendable goniometer), respectively. For measuring ankle dorsiflexion strength, participants are lying in a supine position; legs straight and foot maximal dorsiflexed. The responsible researcher places the dynamometer on the participant's inset of the foot and incrementally increases the force until the patient gives away (break technique). For measuring active ankle range of motion, two measurements are conducted; (1) children are sitting with straight legs (2) children are lying in a supine position with the legs supported by an adequate padding and the knees flexed to minimize potential impact of the flexibility of the gastrocnemius muscle. All dorsiflexion function measurements are carried out bilaterally and repeated two times, recording the best value of each foot as well as a mean value of both feet for analysis.

In addition to ankle dorsiflexion strength, we will additionally assess knee extension strength to get a better overview of lower leg strength. To measure knee extension strength, a hand-held dynamometer (Alluris, Freiburg, Germany) and the break technique are used, as described in the section "dorsiflexion function". Participants sit upright with a hip and knee angle of 90°.

Power and strength of the lower limbs are crucial for any kind of locomotor performance in daily life as well as sports participation. The countermovement jump test is a simple, functional, valid and highly reliable measurement of lower body power that is influenced by sensorimotor training. Following instruction and familiarization trials, children perform 5 consecutive countermovement jumps (CMJ) on a force-plate (Leonardo, Novotec, Pforzheim, Germany). The jumps are performed in an upright position with arms placed akimbo. The applied sampling frequency is 1000 Hz. Jumping height is computed using the flight time method. The best of the five attempts will be analyzed. Between jumps, a break of one minute will be provided.

Fast walking demands a high intramuscular coordination and stability. People with decreased stability and coordination tend to transit from slow walking straight to running as this requires less strength and coordination. The walk-to-run-transition time is the preferred speed at which human change gait from walking to running and is defined as the initial moment where both feet are off the ground at the same time. To assess the participants' preferred walk-to-run-transition time, a treadmill test is performed. After a short familiarization on the treadmill (walking at various speeds), the test protocol provides an age-specific start-speed which is incrementally increased (every 10 seconds by 0,045 m/sec) by the researcher until the participant switches to a run for the first time.

In line with pharmaceutical studies to reduce the symptoms of CIPN, we will also measure intensity of CIPN-related pain using a FacesPain scale for children up to 12 years and a visual analogue scale (VAS) for children and adolescents aged 13 or older, both, starting at 0 = no pain, up to 10 = unbearable pain. These measurements have been reviewed and are recommended through the pediatric initiative on methods, measurement, and pain assessment in clinical trials (PedIMMPACT) group.

We would furthermore like to add questions concerning childrens' integration and participation in PE in school as well as in physically demanding leisure activities. For this purpose, children will answer the standardized questionnaire of the KiGGS study (German Health Interviews and Examination Survey for Children and Adolescents) (Bös 2009), offered in two different versions (for kindergartners and for students). Cancer- and treatment-related questions about potential barriers preventing from taking part in sporting activities are added (i.e. anxiety, prohibition by physician or parents or others, lack of time). All questions are answered via interview.

To assess the significance of CIPN, we would like to add a self-developed questionnaire regarding childrens' and parents' prioritization regarding the side-effects of chemotherapy. Therefore, typical CIPN symptoms, further side-effects of chemotherapy as well as their impact on the active lifestyle are described in age-appropriate language; subjective perception and perceived burden can be assessed on a five point-likert scale, respectively.

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization	Link
Preventing Sensory and Motor Dysfunctions in Children Receiving Neurotoxic Chemotherapy	NCT05606588	Chemotherapy-in... Pediatric Cance...	Playful sensori...	6 Years - 18 Years	University of Basel
Playful Sensorimotor Training in Pediatric Brain Tumor Patients	NCT03334162	Pediatric Cance... Pediatric Brain... Chemotherapy-in... Sensorimotor Po...	Sensorimotor tr...	6 Years - 18 Years	University of Basel

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