Rehabilitation of children and adolescents receiving high-dose chemotherapy with subsequent haemopoietic stem cell transplantation
Topicality. Patients receiving high-dose chemotherapy with subsequent haemopoietic stem cell transplantation (HDCT + HSCT) often have various motor disorders, which significantly decreases the results of specific treatment due to persisting social disadjustement. Early diagnosis of motor disorders and their management permit an earlier completion of both medical and social rehabilitation of successfully treated patients. In fact, there are no objective from the positions of evidence-based medicine research works on motor disorders in patients who receive or received HDCT + HSCT and their locomotor rehabilitation. The objective. To show the structure of motor disorders developing in children and adolescents who receive HDCT + HSCT, to develop a protocol for diagnosis and selection of a method of locomotor rehabilitation. Materials and methods. The study included 665 children aged 0 to 18 years (mean age 7; 276 boys; 389 girls) and 46 children aged 2 to 18 years (mean age 8; 18 boys; 28 girls) who received HDCT + HSCT in the Dmitry Rogachev Federal Centre in the period 2014-2016. In the first group, retrospective clinical assessment of motor disorders was performed, in the second group, we studied the potential of the videoanalysis method for objectification of data referring to the structure of motor disorders. Results. The first group of patients permitted to form basic paradigms of patients who needed locomotor rehabilitation: «Polyneuritic», «Metabolic», «Neurooncological», «Orthopaedic», and «Mixed» types. In the «polyneuritic» and «metabolic» type, gait disorders, functional motor disorders including respiratory muscles disorders and orthostatic disorders very close by the clinical picture dominated. These disorders in total occurred in 100% of patients, which was the reason to unite these types into one clinical paradigm conditionally termed the «neurometabolic» type. In the «neurooncological» type, atactic syndrome in combination with hemiparesis was most common, para- and tetrapareses were found more rarely. In the «orthopaedic» type, contractures of compromised joints were most common. The mixed type, first of all, was characterised by a combination of polyneuritic pain with contractures after endoprosthesoplasty of large joints. The second group of study consisted of 46 children aged 2 to 18 years. Observation was performed at the conditioning stage from -7 to -2 day and after HSCT at the stage from +1 to +7 day and from +20 to +30 day. As was found, 100% of subjects had motor disorders. The range of these disorders had significant variations within the group of study. The most topical and significant part of the range is the neurometabolic type of motor disorders. It was found in all participants in the second stage of the study. The second stage resulted in elaboration of a more profound structure of motor disorders, even in patients who seemed problem-free at routine clinical examination of motor function. The most significant deformity was observed in parameters of quantitative and structural assessments. Quantitative characteristics suffered, first of all, from a sharp increase of correcting movements, and the test structure underwent fundamental changes. Based on the findings, a unified protocol of the formation of the motor regimen for such patients was created, differing only in age categories, and the general criteria of assessing the effectiveness of motor therapy were specified. A need has been shown for preventive motor intervention in patients, in whom HDCT + HSCT is planned. Conclusion. Videoanalysis of characteristics of motor disorders in severe patients together with relatively uncompromised patients permitted to find clear uniform regularities in the formation of a pathological locomotor stereotype in both categories of patients. We have developed a basic protocol for studying a locomotor stereotype that allows objective assessment of motor disorders in patients receiving intensive treatment for oncohematological diseases and duly selection of an individual programme of locomotor rehabilitation to obtain the maximum effect.