title: Physical functioning in pediatric survivors of childhood posterior fossa brain tumors.
abstract: BACKGROUND
  Survival rates for children diagnosed with posterior fossa brain tumors (PFBTs) have improved significantly over the past several decades, and long-term functioning assessments have become priorities. These evaluations have occurred frequently in adults but only rarely in children. This study describes a cross-sectional assessment of physical functioning in pediatric survivors of PFBTs using the Bruininks-Osteretsky Test of Motor Performance, Second Edition (BOT-2).
  
  
  METHODS
  Primary analyses compared BOT-2 scores to normative data using 1-sample t tests for each gross motor subscale (Bilateral Coordination, Balance, Running Speed/Agility, Strength) and motor-area composite (Body Coordination and Strength and Agility). Second, the cohort was stratified by diagnostic or treatment variables. Group differences and groups vs norms were evaluated using independent 2-sample and 1-sample t tests, respectively. Primary analyses compared BOT-2 scores with normative data using 1-sample t tests for each gross motor subscale (Bilateral Coordinationcoordination, Balance, Running Speed/Agility, Strength) and motor-area composite (Body Coordination and Strength and Agility). Second, the cohort was stratified by diagnostic or treatment variables. Group differences and groups vs norms were evaluated using independent 2-sample and 1-sample t tests, respectively.
  
  
  RESULTS
  Mean age of 30 participants was 11.4 years (range, 4.9y-18.2y), and mean time from diagnosis was 6.1 years (range, 1.1y-16.7y). Cerebellar astrocytoma (43.3%) and medulloblastoma (40%) were the most common diagnoses. As a group, significantly decreased functioning, compared with norms, was observed in Balance (P < .001) and Running Speed/Agility (P = .005). Specifically in Balance, 21 (70%) participants performed below or well-below average. Participants with a non-astrocytoma performed significantly lower than norms in all areas, independent of age at diagnosis. Survivors with tumors infiltrating the vermis demonstrated significantly lower Body Coordination than norms (P < .001).
  
  
  CONCLUSIONS
  Pediatric survivors of PFBTs demonstrated decreased physical functioning, most notably in Balance. These data underscore the need for further research and implementation of physical activity programs aimed specifically at approaches to minimize physical limitations.
authors.affiliation: Corresponding author: P. Janine Piscione, MSc, BScPT, Department of Rehabilitation, Hospital for Sick Children, 555 University Avenue, S229, Toronto, Ontario, Canada M5G 1X8. janine.piscione@sickkids.ca.
authors.forename: P Janine
authors.initials: PJ
authors.lastname: Piscione
authors.forename: Eric
authors.initials: E
authors.lastname: Bouffet
authors.forename: Donald J
authors.initials: DJ
authors.lastname: Mabbott
authors.forename: Iffat
authors.initials: I
authors.lastname: Shams
authors.forename: Abhaya V
authors.initials: AV
authors.lastname: Kulkarni
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D001932:Brain Neoplasms / Q000503:physiopathology*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D015192:Infratentorial Neoplasms / Q000503:physiopathology*; D008297:Male; D009043:Motor Activity / Q000502:physiology*; D010372:Pediatrics; D011379:Prognosis; D011446:Prospective Studies; D011788:Quality of Life; D017741:Survivors; D055815:Young Adult
keywords: cancer survivor; disability; long-term outcome; pediatric; physical function; posterior fossa brain tumor