Neuro inhibitory techniques for paediatric oncology patients in hospice-decreased cancer related fatigue and improved quality of llfe (QOL)

Abstract

Background: High levels of fatigue and decreased physical functioning have been reported in Pediatric palliative oncology patients. Neuro rehabilitation with neuro inhibitory techniques can be incorporated to inhibit excitatory patterns and decrease fatigue in these children. Aim: The objective of this study is to assess the effects of neuro inhibitory techniques on cancer related fatigue and quality of life(QOL) in paediatric oncology patients. Methods: Children with end stage malignant brain tumours were referred from a local tertiary paediatric speciality hospital to the Hospice physiotherapy department for neuro rehabilitation. Patients were seen in outpatient, inpatient, outreach and home care settings. Data were collected from 14 consecutive patients from 2010 till date. Neuro physiotherapy was provided with a focus on neuro inhibitory pattern techniques. Lansky and the PedsQOL were used to collect data regarding physical functioning before and after treatment. Fatigue was recorded based on the patient/ career subjective assessment. The following Neuro inhibitory techniques used: 1. Reciprocal positioning/stroking 2. Reinforcement techniques for dystonia 3. Bobath technique 4. Closed kinematic chain exercises 5. Pressure variation touch stimuli 6. Biofeedback Therapy Results: Data were collected from14 patients (11male, 4 female) aged between 8 to 16 years old. Lansky scores revealed improved QOL due to decreased fatigue and controlled segmental dystonia with Inhibitory patterns. Improvements were seen on the Physical functioning sub scale of the the pedsQOL. Subjective assessment data also showed improvement inthe symptoms of fatigue following the neuro inhibitory sessions which were sustained until the next disease progression occurred. Conclusion: The findings show a trend towards improvement in symptoms of fatigue and physical functioning in children receiving palliative care in Kuwait. There is a need for larger controlled studies to examine the effects of neuro inhibitory techniques in this population.