Chemotherapy-induced peripheral neuropathy (CIPN) is a common, dose-limiting side effect of neurotoxic chemotherapy agents, characterized by sensory loss, impaired proprioception, and muscle weakness, predominantly affecting the lower limbs. These impairments significantly contribute to postural instability and increase fall risk in elderly patients. Additionally, CIPN-associated microvascular changes can compromise peripheral circulation, further exacerbating neuromotor dysfunction and balance deficits.
While pharmacological options for CIPN are limited and often inadequate, exercise-based interventions have shown promise in mitigating functional impairments. Buerger's exercises, a vascular stimulation technique, are known to enhance peripheral blood flow, whereas proprioceptive drills can improve neuromuscular coordination and postural control. However, their combined effect on both postural stability and foot perfusion in elderly patients with CIPN has not been systematically studied.
Aged 65 years or older
Diagnosed with CIPN for at least 3 months
Demonstrating impaired postural stability (BBS ≤ 48 or ≥2 falls in the past year)
Medically cleared for exercise
Severe peripheral arterial disease (ABI < 0.5)
Severe postural hypotension or positional syncope
Recent orthopedic procedures or fractures (past 6 months)
Vestibular or cerebellar disorders
Parallel
Buerger's Exercises
Combination productBuerger's Exercises + Proprioceptive Drills, 3 times/week for 8 weeks: * Buerger's Exercises: * Leg elevation at 45° for 2 min until blanching * Dependent sitting for 3 min until hyperemia * Supine rest for 5 min * 3 cycles per session * Proprioceptive Drills: * Single-leg stance * Tandem stance/walking * Heel-to-toe walking * Anterior-posterior and lateral weight shifts * Mini-squats on foam * Ankle alphabet * Progressively increased difficulty Sessions supervised by trained physiotherapists.
Postural Stability Foot Perfusion
.Postural Stability: Overall Stability Index (OSI) via Biodex Balance System SD Foot Perfusion: Laser Doppler Flowmetry (LDF)
Pain scale (VAS) Quality of Life Index (QLI) - SCI Version
Pain scale (VAS) The visual analog scale (VAS) is a validated, subjective measure for acute and chronic pain. Scores are recorded by making a handwritten mark on a 10-cm line that represents a continuum between "no pain" and "worst pain." Quality of Life Index (QLI) - SCI Version Comprised of 4 domains: 1. Health and functioning 2. Psychological/spiritual 3. Social and economic 4. Family.
Weight Height Body mass index
Weight in kg, height in meter and body mass index in kg/m2
Secondary Outcomes
* Berg Balance Scale (BBS) * Timed Up and Go Test (TUG) * Activities-specific Balance Confidence Scale * Number of falls Pain scale (VAS) Quality of Life Index (QLI) - SCI Version Follow-up (Week 8)
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