# Instrumented Assessment of Gait in Pediatric Cancer Survivors: Identifying Functional Impairments After Oncological Treatment—A Pilot Study

## TL;DR

Pediatric cancer survivors show gait issues like slower walking and joint instability, likely due to chemotherapy effects, and 3D gait analysis can help detect these problems for better rehabilitation.

## Contribution

This pilot study introduces instrumented 3D gait analysis as an objective tool to detect subtle locomotor deficits in pediatric cancer survivors.

## Key findings

- Pediatric cancer survivors exhibit slower walking speed, pelvic instability, and reduced hip extension compared to healthy peers.
- Chemotherapy-induced neurotoxicity is likely linked to persistent neuromuscular impairments observed in gait patterns.
- Instrumented gait analysis can detect subtle locomotor deficits, aiding in targeted rehabilitation strategies.

## Abstract

What are the main findings?
Pediatric cancer survivors exhibit significant gait alterations compared with healthy peers, including slower walking speed, pelvic instability, reduced hip extension, knee hyperextension, and diminished ankle plantarflexor moments.These biomechanical deviations reflect persistent neuromuscular impairments likely related to chemotherapy-induced neurotoxicity and treatment-related deconditioning.

Pediatric cancer survivors exhibit significant gait alterations compared with healthy peers, including slower walking speed, pelvic instability, reduced hip extension, knee hyperextension, and diminished ankle plantarflexor moments.

These biomechanical deviations reflect persistent neuromuscular impairments likely related to chemotherapy-induced neurotoxicity and treatment-related deconditioning.

What are the implications of the main findings?
Instrumented 3D gait analysis provides an objective method to detect subtle locomotor deficits in childhood cancer survivors.Early identification of these abnormalities can guide targeted rehabilitation strategies to enhance long-term functional outcomes and quality of life.

Instrumented 3D gait analysis provides an objective method to detect subtle locomotor deficits in childhood cancer survivors.

Early identification of these abnormalities can guide targeted rehabilitation strategies to enhance long-term functional outcomes and quality of life.

Background/Objectives: Pediatric cancer survivors frequently experience neuromuscular sequelae related to chemotherapy-induced neurotoxicity. Agents such as vincristine, methotrexate, and platinum compounds can lead to persistent gait alterations and sensorimotor deficits that impair mobility and quality of life. This study aimed to objectively assess gait in pediatric cancer survivors after the completion of oncological pharmacological treatment to identify specific spatiotemporal, kinematic, and kinetic alterations and characterize neuromechanical patterns associated with neurotoxic exposure. Methods: A cross-sectional observational study was conducted including pediatric cancer survivors (6–18 years) who had completed chemotherapy and age- and sex-matched healthy controls. Gait was analyzed using a Vicon®3D motion capture system, with reflective markers placed on standardized anatomical landmarks. Spatiotemporal, kinematic, and kinetic variables were compared between groups using parametric tests and statistical parametric mapping (SPM) with Holm–Bonferroni correction (α = 0.05). Results: Pediatric cancer survivors showed slower gait velocity (Mean Difference (MD) = 0.17, p = 0.018, Confidence Interval CI95% = 0.04; 0.4), shorter step (MD = 0.1, p = 0.015, CI95% = 0.01; 0.19) and stride length (MD = 0.17, p = 0.018, CI95% = 0.03; 0.31), as well as reduced single support time (MD = 0.1, p = 0.043, CI95% = 0.01; 0.19), along with significant alterations in pelvic, hip, knee, and ankle kinematics compared with controls. Increased pelvic elevation (MD = 0.92, p = 0.018, CI95% = 0.25; 1.58), reduced hip extension during stance (MD = −2.99, p = 0.039, CI95% = −5.19; −0.74), knee hyperextension in mid-stance (MD = −3.84, p < 0.001, CI95% = −6.18; −0.72), and limited ankle dorsiflexion (MAS MD = −4.04, p < 0.001, CI95% = −6.79; −0.86, LAS MD = −3.16, p < 0.001) and plantarflexor moments in terminal stance (MAS MD = −149.65, p = 0.018, CI95% = −259.35; −48.25, LAS MD = −191.81, p = 0.008, CI95% = −323.81; −57.31) were observed. Ground reaction force peaks during loading response (MAS MD = −16.86, p < 0.001, CI95% = −26.12; −0.72 LAS MD = −11.74, p = 0.001, CI95% = −19.68; −3.94) and foot-off (MAS MD = 10.38, p = 0.015, CI95% = 0.41; 20.53, LAS MD = 11.88, p = 0.01, CI95% = 3.15; 22.38) were also reduced. Conclusions: Children who have completed chemotherapy present measurable gait deviations reflecting persistent neuromechanical impairment, likely linked to chemotherapy-induced neurotoxicity and deconditioning. Instrumented gait analysis allows early detection of these alterations and may support the design of targeted rehabilitation strategies to optimize functional recovery and long-term quality of life in pediatric cancer survivors.