Playful Sensorimotor Training in Pediatric Brain Tumor Patients

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.