Clinical analysis of video recordings of the basic motor patterns (CLAVIR) for the assessment of movement disorders in children and adolescents with acute lymphoblastic leukemia

Abstract

Movement disorders arising in pediatric patients with acute lymphoblastic leukemia (ALL) during treatment require a more differentiated approach to diagnosis and the choice of rehabilitation methods. The aim of this study was to investigate the conceptional structure of supine-to-stand (STS) transition patterns and to develop a method for the diagnosis of movement disorders and the assessment of the effectiveness of medical rehabilitation in children and adolescents with ALL. We carried out a prospective comparative non-randomized study. The study was approved by the Independent Ethics Committee and the Scientific Council of the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology of Ministry of Healthcare of the Russian Federation. The study included 184 children who were assigned to three groups. Group 1 (study group) included patients with ALL treated at the Center (n = 48, the median age was 14.0 years). Group 2 (control group) included patients with various serious diseases (acute myeloid leukemia, primary immunodeficiency, CNS malignancies, bone tumors, etc.) who also underwent treatment at the Center (n = 69, the median age was 14.5 years). Group 3 (control group) included healthy children and adolescents (n = 67, the median age was 14.2 years). We analyzed the characteristics of video recordings of the supine-to-stand process in apparently healthy children (Group 3) and in the patients treated at the Center (Groups 1 and 2) and then performed comparative analysis. We managed to detect, document, and divide into phases the video-based criteria of invariant characteristics of the acyclic locomotor pattern of the STS movement (from a supine to standing position with both feet on the floor). We identified the STS movement phases and clinically significant variants of STS transition patterns which were easily detectable on the video recordings. The objectivity of the analysis of the video-based criteria of invariant characteristics of the STS movement was achieved by the registration of timing characteristics of the locomotion pattern phases on video recordings. By calculating the coefficients of variation for observations from different angles and inter-researcher variability, we detected the most representative phases of the STS movement pattern on video recordings. A quantitative analysis of the STS test performance revealed significant differences between healthy controls and children with oncological diseases. The clinical analysis of video recordings of the basic motor patterns (CLAVIR) contributes a substantial amount of objective data to the clinical assessment of the diagnostic supine-to-stand test results in children and adolescents treated for ALL.