title: Balance in children with acute lymphoblastic leukemia.
abstract: BACKGROUND
  Treatment for acute lymphoblastic leukemia (ALL) can affect balance via different mechanisms, including sensory and motor peripheral neuropathy, cognitive impairment, and reduced muscle strength and flexibility. To provide an overview of what is currently known about the effects of cancer treatment on balance in pediatric ALL patients and survivors, and of the predictors of poor balance, a review of the literature was conducted.
  
  
  METHODS
  Five databases were searched for English-language original research articles on balance during or after treatment for pediatric ALL.
  
  
  RESULTS
  From a total of nine studies, six identified significant balance problems in children with ALL during or after treatment. The percentage of patients or survivors with impaired balance varied between 27% and 69% during treatment, 7% and 65% a few years after completion of treatment, and 14% and 17% many years after the completion of treatment. Factors associated with impaired balance were higher body mass index; higher intrathecal methotrexate dose; cranial radiation; knee extensor weakness; and impaired cognition.
  
  
  CONCLUSIONS
  Although heterogeneity between the studies regarding patient age; age at diagnosis; time since completion of treatment; and methods of quantifying balance make it difficult to reach a single conclusion, the evidence suggests that survivors may experience short- and/or long-term balance difficulties. While there is a need for additional studies to better understand the effects of impaired balance in survivors, clinicians treating both child and adult survivors of ALL need to be aware of these potential risks.
authors.affiliation: Rehabilitation Research and Movement Performance Laboratory, Stony Brook University, New York, USA.
authors.forename: Mitra
authors.initials: M
authors.lastname: Varedi
authors.affiliation: Rehabilitation Research and Movement Performance Laboratory, Stony Brook University, New York, USA.|Department of Physical Therapy, School of Health Technology and Management, Stony Brook University, New York, USA.
authors.forename: Raymond
authors.initials: R
authors.lastname: McKenna
authors.affiliation: Rehabilitation Research and Movement Performance Laboratory, Stony Brook University, New York, USA.|Department of Physical Therapy, School of Health Technology and Management, Stony Brook University, New York, USA.
authors.forename: Eric M
authors.initials: EM
authors.lastname: Lamberg
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D002648:Child; D006801:Humans; D004856:Postural Balance / Q000187:drug effects*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy* / Q000503:physiopathology; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents
keywords: acute lymphoblastic leukemia; balance; children; vincristine