Dual-Task Training Improves Balance in Pediatric Ataxia Following Medulloblastoma Resection

In a new randomized, controlled, open-labeled clinical trial (NCT04860934), results showed significant efficacy of a dual-task training program on stability and function following medulloblastoma (MB) resection among pediatric patients with ataxia. These findings suggest a dual-task program is more effective than traditional physical therapy alone in improving balance in this patient population.¹

In this study of 30 patients, investigators observed a notable improvement in balance in the dual study group (n = 15) on Pediatric Balance Scale (PBS) (P = .028) and stability test (P = .0001) compared with the standard control group (n = 15). Researchers observed a discernible difference in the Functional Independent Measurement (WeeFIM) score among the 2 groups (P = .158) despite a statistically significant increase in both groups after treatment. A significant increase was also observed in all 8 components of the Stability Standing Balance Bilateral score (P <.01) and its overall score between the control and study groups (13 vs. 44, respectively, P <.001).

“We observed a significant improvement in the post-treatment assessment for the group of dual-task training programs in contrast to a modest improvement in the control group in the stability test of HUMAC. It has been shown that dual-task training has a superior effect on balance,” senior author Mostafa S. Ali, PhD, director and associate professor of physical therapy at Cairo University, and colleagues wrote.1 “In our study, we noted that initially in the dual-task group, the cognitive task affected balance, and the symptoms of ataxia increased during the training period.”

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Investigators randomized pediatric patients with ataxia after MB resection, from the Children Cancer Hospital Egypt, into 2 equal groups between March and December 2021. Both groups performed exercises as instructed by the researchers for mobility, balance, and gait training. The study group underwent a specific dual-task program that focused on training for balance and cognitive ability, with sessions 3 days per week for 8 weeks in total.2,3 The participants were assessed before and after the treatment regimen using the Scale of Assessment and Rating of Ataxia, the HUMAC Balance System, PBS, and WeeFIM.

All told, the included patients had the same type of tumor, began at the same time of surgery, followed the same protocol following surgery, and did not receive any other treatment during rehabilitation. Authors did not observe any difference between the control and dual-task training group at baseline on WeeFIM and PBS and stability test scores. The dual-task training significantly impacted both scores, with a medium to high effect size (partial eta square = .934; F = 4.475; P = .024). Similarly, the measuring periods considerably impacted the outcome (partial eta square = .987; F = 25.046; P = .002).

“Another important observation is that a general state of fatigue relatively masked the improvement in balance and rehabilitation progress due to the morbidity associated with chemotherapy and radiotherapy, which interrupted the training program,” Ali et al noted.¹ “However, after resuming training, the children quickly recovered, and the improvement in balance rapidly reappeared. We believe that whenever possible, patients should start rehabilitation soon after surgery and maintain training during chemotherapy or irradiation.”

Authors noted that the observed improvement in the dual-task program may be in part to the longer training time, considering those participants had twice the time the control group received. In addition, investigators noted that they could not eliminate the negative effect of therapy-related fatigue and interruptions on rehabilitation outcomes in each group which may have confounded the observed improvement to a variable degree.

“This study found a significant improvement in balance and posture control in favor to dual-task program shown in PBS and the stability test. The difference may be because of the more time the intervention group had than the control group. There was a nonsignificant difference in the improvement of ADL between the 2 groups. More research is warranted to investigate the effect of increasing the length of the rehabilitation period and the best timing of applying this training in relation to postoperative treatment modalities,” Ali et al noted.¹

REFERENCES
1. Selim FM, Elshafey MA, El-Ayadi MM, Albeltagi DM, Ali MS. Efficacy of dual-task training on stability and function in children with ataxia after medulloblastoma resection: A randomized controlled trial. Pediatr Blood Cancer. 2023;70(11):e30613. doi:10.1002/pbc.30613
2. Jacobi H, Alfes J, Minnerop M, Konczak J, Klockgether T, Timmann D. Dual task effect on postural control in patients with degenerative cerebellar disorders. Cerebellum Ataxias. 2015;2:6. Published 2015 May 8. doi:10.1186/s40673-015-0025-z
3. Synofzik M, Ilg W. Motor training in degenerative spinocerebellar disease: ataxia-specific improvements by intensive physiotherapy and exergames. Biomed Res Int. 2014;2014:583507. doi:10.1155/2014/583507