title: The Effectiveness of Incorporating a Play-based Intervention to Improve Functional Mobility for a Child with Relapsed Acute Lymphoblastic Leukaemia: A Case Report.
abstract: OBJECTIVE
  Acute lymphoblastic leukaemia (ALL) is one of the most common forms of cancer seen in children, accounting for one-fourth of all childhood cancers. These children typically present with decreased functional mobility, weakened lower extremity muscle strength and reduced exercise endurance and interests because of disease progressions and chemotherapy treatments. The purpose of this case report was to examine the effectiveness of incorporating a play-based physical therapy (PT) intervention programme to improve functional mobility for an inpatient with relapsed ALL undergoing chemotherapy.
  
  
  METHODS
  The patient was a 3-year-old male admitted to the hospital for relapsed ALL. He was diagnosed approximately 1 year earlier for which he had undergone chemotherapy and was later considered in remission at that time. When the patient relapsed, he underwent another round of chemotherapy and was waiting for a bone marrow transplant during his treatment during the course of this case report. For PT intervention, therapeutic exercises were incorporated into play to strengthen his lower extremity strength and muscle endurance. Functional activities were also incorporated into play to improve his aerobic capacity and overall quality of life. Multi-attribute health status classification system (HUI3) utility scores, 6-minute walk test distance (6MWT), lower extremity (LE) strength, transfer and tolerated treatment time were assessed to identify the effect of a PT intervention.
  
  
  RESULTS
  Despite experiencing fatigue, the patient completed most of the treatments incorporated into play. After 5 weeks of PT intervention, the participant improved on HUI3 (pre: 0.72 and post: 0.92), 6MWT (pre: 156 ft and post: 489 ft), LE strength (squat), transfer (sit to stand) and tolerated treatment time (pre: 16 minutes and post: 44 minutes).
  
  
  CONCLUSIONS
  This case report suggests that incorporating a play-based PT intervention programme could be physically tolerable and functionally beneficial for a young child with relapsed ALL undergoing inpatient chemotherapy. Copyright © 2016 John Wiley & Sons, Ltd.
authors.affiliation: A to Z Pediatric Therapy, North Richland Hills, TX, USA.
authors.forename: Paula
authors.initials: P
authors.lastname: Vercher
authors.affiliation: Department of Physical Therapy, Angelo State University, San Angelo, TX, USA.
authors.forename: You-Jou
authors.initials: YJ
authors.lastname: Hung
authors.affiliation: Department of Physical Therapy, Angelo State University, San Angelo, TX, USA.
authors.forename: Mansoo
authors.initials: M
authors.lastname: Ko
mesh_terms: D002675:Child, Preschool; D005081:Exercise Therapy / Q000379:methods*; D006801:Humans; D008297:Male; D053580:Muscle Strength / Q000502:physiology; D018908:Muscle Weakness / Q000534:rehabilitation*; D010807:Physical Endurance / Q000502:physiology*; D010809:Physical Fitness / Q000502:physiology*; D026741:Physical Therapy Modalities; D010989:Play Therapy / Q000379:methods*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000175:diagnosis / Q000534:rehabilitation*; D011788:Quality of Life; D012008:Recurrence; D016896:Treatment Outcome
keywords: acute lymphoblastic leukaemia (ALL); physical therapy; relapsed