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Oxidative Stress, Motor Abilities, and Behavioral Adjustment in Children Treated for Acute Lymphoblastic Leukemia

Marilyn J. Hockenberry
Kevin R. Krull
Kathleen C. Insel
Lynnette L. Harris
Patricia M. Gundy
Kristin B. Adkins
Alice E. Pasvogel
Olga A. Taylor
Kari M. Koerner
David W. Montgomery
Adam K. Ross
Adam Hill
Ida M. Moore
ONF 2015, 42(5), 542-549 DOI: 10.1188/15.ONF.542-549

Purpose/Objectives: To examine associations among oxidative stress, fine and visual-motor abilities, and behavioral adjustment in children receiving chemotherapy for acute lymphoblastic leukemia (ALL).

Design: A prospective, repeated-measures design.

Setting: Two pediatric oncology settings in the southwestern United States.

Sample: 89 children with ALL were followed from diagnosis to the end of chemotherapy.

Methods: Serial cerebrospinal fluid samples were collected during scheduled lumbar punctures and analyzed for oxidative stress biomarkers. Children completed fine motor dexterity, visual processing speed, and visual-motor integration measures at three time points. Parents completed child behavior ratings at the same times.

Main Research Variables: Oxidative stress, fine motor dexterity, visual processing, visual-motor integration, and behavioral adjustment.

Findings: Children with ALL had below-average fine motor dexterity, visual processing speed, and visual-motor integration following the induction phase of ALL therapy. By end of therapy, visual processing speed normalized, and fine motor dexterity and visual-motor integration remained below average. Oxidative stress measures correlated with fine motor dexterity and visual-motor integration. Decreased motor functioning was associated with increased hyperactivity and anxiety.

Conclusions: Oxidative stress occurs following chemo-therapy for childhood ALL and is related to impaired fine motor skills and visual symptoms.

Implications for Nursing: Early intervention should be considered to prevent fine motor and visual-spatial deficits, as well as behavioral problems.

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