Photobiomodulation on postural control and gait speed in chemotherapy-induced peripheral neuropathy

Photobiomodulation on postural control and gait speed in chemotherapy-induced peripheral neuropathy | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Photobiomodulation on postural control and gait speed in chemotherapy-induced peripheral neuropathy Laura Santamarina, Mariane Oliveira de Souza, Larissa Ansani Sassaron, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5814765/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objectives: To evaluate the influence of photobiomodulation (PBM) on postural control and gait speed in patients with chemotherapy-induced peripheral neuropathy (CIPN). Methods: Prospective clinical study with 47 cancer patients undergoing treatment with platinum or taxane chemotherapy drugs and diagnosed with peripheral neuropathy of the lower limbs (LL). Patients received PBM with LED, 630 nm / 850 nm, in the lumbosacral nerve pathway for four sessions. Postural stability was assessed with the BIOMEC400 force platform, to record the amplitude and speed of displacement of the center of pressure. Power and ground reaction force were assessed using the following variables with the participant during the vertical jump: mass, jump duration, flight duration, jump speed, maximum jump force, and maximum jump power. To assess the impact of the changes studied on gait, the 10-meter walk test was performed. Results: There was a significant improvement in the mediolateral amplitude (P=0.0250), jump duration (P=0.0001), flight duration (P=0.0064), jump speed (P=0.0443), and maximum force during the jump (P=0.0002). There was no significant improvement in maximum jump power (P=0.7637), anteroposterior amplitude (P=0.4636), anteroposterior velocity (P=0.2769), mediolateral velocity (P=0.1764), and area (P=0.1215). However, the changes found with the use of PBM were sufficient to have a clinical impact on ambulation, with a significant improvement in gait speed (p=0.0315). Conclusion: PBM proved to be a promising and low-cost resource for improving postural control and gait speed in patients with CIPN. Chemotherapy Induced Peripheral Neuropathy Neuropathic Pain Photobiomodulation Force Platform Postural Control Gait Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Introduction Chemotherapy-induced peripheral neuropathy (CIPN) is one of the most common adverse events in cancer patients, affecting 38–90% of patients treated with platinum-class chemotherapy agents, such as cisplatin, oxaliplatin, thalidomide, and taxanes, such as paclitaxel and docetaxel. CIPN can be defined as any damage, inflammation or degeneration of peripheral nerves caused by the administration of chemotherapeutic agents [ 1 ]. The severity of neurotoxicity depends on the type and combination of chemotherapy drugs used, as well as the duration, cumulative dose and number of cycles performed. [ 2 ] Platinum class chemotherapy drugs induce DNA damage, causing mitochondrial denaturation, causing great harm to mitochondrial DNA transcription and replication. The interaction with DNA results in damage to mitochondria and consequent inhibition of the enzyme. Taxane class chemotherapy drugs cause damage to neuronal cells of the peripheral nervous system, increasing oxidative stress, contributing to the increase in pro-inflammatory cytokines and harm to anti-inflammatory cytokines. Oxidative stress can compromise the survival and function of sensory neurons due to DNA damage, resulting in demyelination of nerve fibers, mitochondrial destruction and dysfunction, activation of signaling pathways, and neuronal death by apoptosis [ 1 ]. After treatment, sensory disorders may continue to have significant sensory loss, which causes loss of proprioception in the lower extremities, resulting in decreased balance and gait instability, limiting patients’ mobility [ 3 ]. With significant loss of proprioception, patients may develop a condition known as sensory ataxia, which is associated with a fear of falling. Patients with CIPN often reduce their foot support due to motor dysfunction, pain, and loss of sensitivity resulting from treatment.[ 7 ] The increased risk of falls in patients with CIPN is significant, with the number of falls being up to three times higher than in patients without neuropathy, and the increase in these falls is related to the worsening of patients’ gait, clinically translated as slower steps and postural oscillation, leading to a functional decline in patients. [ 8 ] There is currently no effective gold standard treatment for CIPN. Routine treatments are inflammatory mediator drugs, neurotransmitter-based therapy, antiepileptic drugs such as gabapentin, and symptomatic treatment.[ 4 ] Photobiomodulation (PBM) has proven to be a promising resource in the treatment of CIPN, due to its regenerative and anti-inflammatory effect, which occurs when low-intensity light is absorbed by the tissue, through its effect at the molecular level, exciting electrons, moving electromagnetic charges, causing stimulation and inhibition of the physiological reactions of the tissue, with increased cellular function and regeneration through the production of adenosine triphosphate (ATP) and adenine nucleotides (NADH) [ 5 ]. PBM in CIPN prevents apoptosis and promotes neural growth. The energy released by PBM is absorbed by the mitochondria and increases cellular respiration, improving the oxidative process, which may improve the symptoms of nerve degeneration [ 6 ]. Considering that PBM can improve the sensory symptoms of CIPN, the purpose of this study is to evaluate whether PBM influences postural control and gait speed in these patients. Some studies have already shown the positive effect of using PBM on CIPN [ 5 ], but it is unknown whether the sensory improvement is accompanied by an improvement in postural control and gait speed, which would clinically reduce the risk of falls and morbidity and mortality in this population, increasing functional capacity and quality of life. Methods Prospective quantitative clinical study with 47 cancer patients after chemotherapy treatment with platinum or taxane drugs. Patients over 18 years of age, diagnosed with CIPN in the lower limbs by a clinical oncologist, who had completed chemotherapy treatment and were not using medications for CIPN were included. Patients with decompensated diabetes mellitus, alcoholics, or patients with previously diagnosed peripheral nerve diseases were excluded. Data were collected at the UNIFAE physical therapy teaching clinic between June 2023 and September 2024. To assess postural control, the BIOMEC400 force platform (EMG System do Brasil, Ltda. São José dos Campos, SP), operating at 500 Hz, was used with the participant barefoot in the semi-tandem and vertical jump positions. All assessments were performed three times, for 30 seconds, and the highest value was considered. There was a 30-second interval between attempts. Lateral stability was assessed using the following displacement variables with the participant in the semi-tandem position: Mediolateral amplitude (ML amplitude), mediolateral velocity (ML velocity), anteroposterior amplitude (AP amplitude), anteroposterior velocity (AP velocity) and area (Fig. 1 ). The participant was asked to stand with their feet 2.5 cm apart laterally and with one foot slightly further forward than the other. The heel of the front foot was aligned with the arch of the back foot, with the weight distributed evenly between the feet. The participant could choose which foot would be in front and was instructed to try to remain in this position for 30 seconds, with their eyes open, looking at a fixed point two meters away. The participants also underwent the vertical jump test (Fig. 1 ), performed with the command “jump as high as you can with both feet together. The feet were positioned in the center (number 15) on each side of the x-axis of the force platform. Power and ground reaction force were assessed using the following variables: jump duration, flight duration, jump speed, maximum jump force, and maximum jump power. To assess the impact of the changes studied on gait, a 10-meter walk test was performed, in which the time spent with the participant walking barefoot as fast as possible, without running, was assessed. The time was recorded with a stopwatch. All patients underwent PBM in continuous emission mode with LED at wavelengths of 630 nm and 850 nm, applied with a dosage of 3J, using the PBM Class IIIB Antares® / Ibramed (Brazil) equipment, cluster with a contact area of 80 cm 2 ( ± 10%), with 13 red light LEDs (output power of 300 ( ± 20%) mW and total power of 3.90 ( ± 20%) W, irradiance of 0.049W/cm 2 ( ± 20%) and beam divergence of 1.40 ( ± 10%)) and 13 near-infrared light LEDs (output power of 500 ( ± 20%) mW and total power of 6.50 ( ± 20%) W, irradiance of 0.081W/cm 2 ( ± 20%) and beam divergence of 1.57 ( ± 10%). The PBM was applied at an angle of 90 degrees to the tissue, twice a week, for two weeks, with a space of 1 cm 2 between the points, with the Antares® / IBRAMED equipment, along the entire lumbosacral path (Fig. 2 ). The evaluation prior to the procedure of each patient was considered as the control. Descriptive statistics and independent T-test were calculated to compare the measurements between the initial and final evaluations. Significance level of 0.05. The vertical jump and gait speed assessments were performed with 44 patients, since 3 were unable to walk independently and could not be counted. Study approved by the Research Ethics Committee (CAAE:70504423.9.0000.5382), funded by CNPq (Process 403490/2021-9) and by the company IBRAMED. Results The study included the participation of 47 patients whose characteristics are described in Table 1 Table 1 Characterization of data of study participants Clinical characteristics n % Primary neoplasia Breast 30 63.83 Ovary 3 6.38 Intestine 6 12.77 Endometrium 1 2.13 Uterus 2 4.26 Stomach 1 2.13 Liver 1 2.13 Prostate 1 2.13 Lung 2 4.26 Chemotherapy Platinum 11 23.40 Taxane 36 76.60 Diabetes Yes 10 21.28 No 37 78.72 Musculoskeletal background Yes 10 21.28 No 37 78.72 Use of alcoholic beverages Yes 5 10.64 No 42 89.36 Surgical approach Yes 41 87.23 No 6 12.77 The results of the influence of the use of PBM on postural control are presented in Figs. 3 and 4. And the use of PBM positively influenced gait speed (p = 0,0315) (Fig. 5 ). Discussion The present study demonstrated that performing PBM on peripheral nerves in patients with CIPN clinically and statistically improves some aspects of postural control and gait speed. This finding has significant clinical importance since after chemotherapy treatment, sensory problems resulting from neurotoxicity remain in most patients, with significant loss of lower limb proprioception, causing worsening of gait and lack of balance, making patients afraid of falls, worsening their functionality and quality of life. [ 7 ]. Studies show that 90% of patients who used the chemotherapy drug oxiplatin developed acute neuropathy, and between 30% and 50% developed chronic neuropathy, with symptoms and duration varying, but persisting for more than 24 months. [ 2 ] The effects resulting from chemotherapy treatment can cause sensory deficits that make patients walk more slowly, have poorer balance, and increase the chances of falls. [ 8 ] Despite being a very common adverse event of cancer treatment, CIPN does not have a gold standard treatment. A systematic review shows 26 treatment options for CIPN, one of which is CIPN [ 9 ]. PBM releases energy, which when absorbed by the mitochondria increases cellular respiration, improving the oxidative process and thus improving nerve degeneration. [ 7 ] A placebo-controlled clinical trial with 70 patients, in which PBM or placebo was applied three times a week for six weeks, showed that PBM reduces sensory symptoms in chemotherapy-induced peripheral neuropathy [ 10 ], but the impact on postural control and gait speed was unknown until this study. A study evaluated the effect of PBM on nerve regeneration in 30 mice with sciatic nerve injury, applying PBM at 660 nm, with a total energy of 16.8 J divided into three types of application. The use of PBM was effective in sciatic nerve regeneration, showing that PBM is not just a resource for analgesia, but also for nerve regeneration.[ 11 ] Regeneration occurs with photobiomodulation, increasing cellular viability by activating cytochrome c oxidase of the electron transport chain, increasing mitochondrial respiration and the activity of molecules such as adenosine triphosphate (ATP), nitric oxide (NO), reactive oxygen species (ROS), calcium ions and several other molecules, accelerating axonal regeneration and suppressing neural apoptosis.[ 12 ] Neurotoxicity caused by chemotherapy affects both the axons of small fibers, causing acute pain, tingling sensation, numbness, and sensitivity to cold, and the sensory axons of large fibers, which affect proprioception. Drugs in the taxane class cause damage to sensory neurons, causing damage to A and C fibers, while medications composed of platinum compounds damage DNA, accumulating in peripheral neurons and inducing neural apoptosis. [ 13 ] PBM is a therapeutic proposal not only for symptom relief, since its objective is nerve regeneration. This study showed that the application of PBM promotes improvements in the patient’s postural stability and gait speed, reducing difficulty in walking. In order to increase gait speed, it is necessary to improve the gait phases. If the patient doesn’t become unbalanced in the support phase, possibly due to the reduction in sensory symptoms and increased proprioception, they will enter the balance phase without imbalance, when only one foot is supported. This way, there will be an improvement in gait speed and the way in which the patient walks. It is possible to infer that there will be a consequent decrease in the number of falls, which are recurrent in patients with CIPN, with an improvement in quality of life, increasing independence, and being able to perform daily activities more safely. This study demonstrated that PBM is a non-invasive, low-cost resource that acts directly on nerve regeneration and should be considered in the treatment of CIPN of the lower limbs. Conclusion PBM is a promising resource for the recovery of postural stability and gait speed resulting from CIPN. Declarations Ethical Approval The study was conducted in accordance with guidelines for research involving human subjects and was approved by the Research Ethics Committee (CAAE: 70504423.9.0000.5382). All participants were duly informed about the objectives of the study, potential adverse effects, and provided their consent to participate in the research. Clinical Trial Registration Number Not applicable. Funding The equipment used in the study was acquired through funding from the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) (Grant number: 403490/2021-9). Author Contribution All authors contributed equally to the study. They participated in the conceptualization, methodology, data collection, formal analysis, and interpretation of the results. All authors reviewed and approved the final manuscript. References Kerckhove, N., Collin, A., Condé, S., Chaleteix, C., Pezet, D., & Balayssac, D. (2017). Long-term effects, pathophysiological mechanisms, and risk factors of chemotherapy-induced peripheral neuropathies: A comprehensive literature review. Frontiers in pharmacology , 8 . doi:10.3389/fphar.2017.00086 Simão, D. A. da S., Murad, M., Martins, C., Fernandes, V. C., Captein, K. M., & Teixeira, A. L. (2015). Chemotherapy-induced peripheral neuropathy: review for clinical practice. Revista Dor , 16 (3). doi:10.5935/1806-0013.20150043 Kneis, S., Wehrle, A., Müller, J., Maurer, C., Ihorst, G., Gollhofer, A., & Bertz, H. (2019). It's never too late - balance and endurance training improves functional performance, quality of life, and alleviates neuropathic symptoms in cancer survivors suffering from chemotherapy-induced peripheral neuropathy: results of a randomized controlled trial. BMC cancer, 19(1), 414. https://doi.org/10.1186/s12885-019-5522-7 Li, Y., Lustberg, M. B., & Hu, S. (2021). Emerging pharmacological and non-pharmacological therapeutics for prevention and treatment of chemotherapy-induced peripheral neuropathy. Cancers , 13 (4), 766. doi:10.3390/cancers13040766 Wolf, S., Barton, D., Kottschade, L., Grothey, A., & Loprinzi, C. (2008). Chemotherapy-induced peripheral neuropathy: Prevention and treatment strategies. European Journal of Cancer (Oxford, England: 1990) , 44 (11), 1507–1515. doi:10.1016/j.ejca.2008.04.018 Park, H. S., Sin, W. K., Kim, H. Y., Moon, J. Y., Park, S. Y., Kim, Y. C., & Lee, S. C. (2013). Scrambler Therapy for Patients with Cancer Pain - Case Series -. The Korean Journal of Pain , 26 (1), 65–71. https://doi.org/10.3344/kjp.2013.26.1.65 Lopez-Garzon, M., Canta, A., Chiorazzi, A., & Alberti, P. (2023). Gait analysis in chemotherapy-induced peripheral neurotoxicity rodent models. Brain research bulletin, 203, 110769. https://doi.org/10.1016/j.brainresbull.2023.110769 Kang, G. E., Murphy, T. K., Kunik, M. E., Badr, H. J., Workeneh, B. T., Yellapragada, S. V., Sada, Y. H., & Najafi, B. (2021). The detrimental association between fear of falling and motor performance in older cancer patients with chemotherapy-induced peripheral neuropathy. Gait & posture, 88, 161–166. https://doi.org/10.1016/j.gaitpost.2021.05.0 Hou S, Huh B, Kim HK, Kim KH, Abdi S. Treatment of Chemotherapy-Induced Peripheral Neuropathy: Systematic Review and Recommendations. Pain Physician. 2018 Nov;21(6):571-592. PMID: 30508986. Argenta, P. A., Ballman, K. V., Geller, M. A., Carson, L. F., Ghebre, R., Mullany, S. A., Teoh, D. G. K., Winterhoff, B. J. N., Rivard, C. L., & Erickson, B. K. (2017). The effect of photobiomodulation on chemotherapy-induced peripheral neuropathy: A randomized, sham-controlled clinical trial. Gynecologic Oncology , 144 (1), 159–166. https://doi.org/10.1016/j.ygyno.2016.11.013 Souza, L. G. de, Cardoso, R. B., Kuriki, H. U., Marcolino, A. M., Fonseca, M. de C. R., & Barbosa, R. I. (2020). High energy photobiomodulation therapy in the early days of injury improves sciatic nerve regeneration in mice. ABCS Health Sciences , 45 , e020016. https://doi.org/10.7322/abcshs.45.2020.1345 Joy, L., Jolien, R., Marithé, C. et al. The use of photobiomodulation therapy for the prevention of chemotherapy-induced peripheral neuropathy: a randomized, placebo-controlled pilot trial (NEUROLASER trial). Support Care Cancer 30 , 5509–5517 (2022). https://doi.org/10.1007/s00520-022-06975-x Areti A, Yerra VG, Komirishetty P, Kumar A. Potential Therapeutic Benefits of Maintaining Mitochondrial Health in Peripheral Neuropathies. Curr Neuropharmacol. 2016;14(6):593-6094 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5814765","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":405592927,"identity":"d85feb32-50c3-43da-85f8-cfeb3191d01f","order_by":0,"name":"Laura 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4","display":"","copyAsset":false,"role":"figure","size":122588,"visible":true,"origin":"","legend":"\u003cp\u003eImpact of PBM on lower limb power during vertical jump\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-5814765/v1/29a9b3a7298e4162e4e79ce7.png"},{"id":74680151,"identity":"20d34abf-7b5d-4ed4-8581-1c0cb8e0bda9","added_by":"auto","created_at":"2025-01-24 15:42:35","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":18871,"visible":true,"origin":"","legend":"\u003cp\u003eImpact of PBM on gait speed\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-5814765/v1/aa495bcb58394aba0ecede27.png"},{"id":77260687,"identity":"3cfe9da2-bae3-44fd-8e6e-d39bd12ecad3","added_by":"auto","created_at":"2025-02-26 19:01:39","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1282155,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5814765/v1/9ab53e52-9903-4869-bac5-5ad0dc350297.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Photobiomodulation on postural control and gait speed in chemotherapy-induced peripheral neuropathy","fulltext":[{"header":"Introduction","content":"\u003cp\u003eChemotherapy-induced peripheral neuropathy (CIPN) is one of the most common adverse events in cancer patients, affecting 38\u0026ndash;90% of patients treated with platinum-class chemotherapy agents, such as cisplatin, oxaliplatin, thalidomide, and taxanes, such as paclitaxel and docetaxel. CIPN can be defined as any damage, inflammation or degeneration of peripheral nerves caused by the administration of chemotherapeutic agents [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The severity of neurotoxicity depends on the type and combination of chemotherapy drugs used, as well as the duration, cumulative dose and number of cycles performed. [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/p\u003e \u003cp\u003ePlatinum class chemotherapy drugs induce DNA damage, causing mitochondrial denaturation, causing great harm to mitochondrial DNA transcription and replication. The interaction with DNA results in damage to mitochondria and consequent inhibition of the enzyme. Taxane class chemotherapy drugs cause damage to neuronal cells of the peripheral nervous system, increasing oxidative stress, contributing to the increase in pro-inflammatory cytokines and harm to anti-inflammatory cytokines. Oxidative stress can compromise the survival and function of sensory neurons due to DNA damage, resulting in demyelination of nerve fibers, mitochondrial destruction and dysfunction, activation of signaling pathways, and neuronal death by apoptosis [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAfter treatment, sensory disorders may continue to have significant sensory loss, which causes loss of proprioception in the lower extremities, resulting in decreased balance and gait instability, limiting patients\u0026rsquo; mobility [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. With significant loss of proprioception, patients may develop a condition known as sensory ataxia, which is associated with a fear of falling. Patients with CIPN often reduce their foot support due to motor dysfunction, pain, and loss of sensitivity resulting from treatment.[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThe increased risk of falls in patients with CIPN is significant, with the number of falls being up to three times higher than in patients without neuropathy, and the increase in these falls is related to the worsening of patients\u0026rsquo; gait, clinically translated as slower steps and postural oscillation, leading to a functional decline in patients. [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThere is currently no effective gold standard treatment for CIPN. Routine treatments are inflammatory mediator drugs, neurotransmitter-based therapy, antiepileptic drugs such as gabapentin, and symptomatic treatment.[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] Photobiomodulation (PBM) has proven to be a promising resource in the treatment of CIPN, due to its regenerative and anti-inflammatory effect, which occurs when low-intensity light is absorbed by the tissue, through its effect at the molecular level, exciting electrons, moving electromagnetic charges, causing stimulation and inhibition of the physiological reactions of the tissue, with increased cellular function and regeneration through the production of adenosine triphosphate (ATP) and adenine nucleotides (NADH) [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. PBM in CIPN prevents apoptosis and promotes neural growth. The energy released by PBM is absorbed by the mitochondria and increases cellular respiration, improving the oxidative process, which may improve the symptoms of nerve degeneration [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Considering that PBM can improve the sensory symptoms of CIPN, the purpose of this study is to evaluate whether PBM influences postural control and gait speed in these patients. Some studies have already shown the positive effect of using PBM on CIPN [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], but it is unknown whether the sensory improvement is accompanied by an improvement in postural control and gait speed, which would clinically reduce the risk of falls and morbidity and mortality in this population, increasing functional capacity and quality of life.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eProspective quantitative clinical study with 47 cancer patients after chemotherapy treatment with platinum or taxane drugs. Patients over 18 years of age, diagnosed with CIPN in the lower limbs by a clinical oncologist, who had completed chemotherapy treatment and were not using medications for CIPN were included. Patients with decompensated diabetes mellitus, alcoholics, or patients with previously diagnosed peripheral nerve diseases were excluded. Data were collected at the UNIFAE physical therapy teaching clinic between June 2023 and September 2024. To assess postural control, the BIOMEC400 force platform (EMG System do Brasil, Ltda. S\u0026atilde;o Jos\u0026eacute; dos Campos, SP), operating at 500 Hz, was used with the participant barefoot in the semi-tandem and vertical jump positions. All assessments were performed three times, for 30 seconds, and the highest value was considered. There was a 30-second interval between attempts. Lateral stability was assessed using the following displacement variables with the participant in the semi-tandem position: Mediolateral amplitude (ML amplitude), mediolateral velocity (ML velocity), anteroposterior amplitude (AP amplitude), anteroposterior velocity (AP velocity) and area (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The participant was asked to stand with their feet 2.5 cm apart laterally and with one foot slightly further forward than the other. The heel of the front foot was aligned with the arch of the back foot, with the weight distributed evenly between the feet. The participant could choose which foot would be in front and was instructed to try to remain in this position for 30 seconds, with their eyes open, looking at a fixed point two meters away. The participants also underwent the vertical jump test (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), performed with the command \u0026ldquo;jump as high as you can with both feet together. The feet were positioned in the center (number 15) on each side of the x-axis of the force platform. Power and ground reaction force were assessed using the following variables: jump duration, flight duration, jump speed, maximum jump force, and maximum jump power.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eTo assess the impact of the changes studied on gait, a 10-meter walk test was performed, in which the time spent with the participant walking barefoot as fast as possible, without running, was assessed. The time was recorded with a stopwatch.\u003c/p\u003e \u003cp\u003eAll patients underwent PBM in continuous emission mode with LED at wavelengths of 630 nm and 850 nm, applied with a dosage of 3J, using the PBM Class IIIB Antares\u0026reg; / Ibramed (Brazil) equipment, cluster with a contact area of 80 cm\u003csup\u003e2\u003c/sup\u003e (\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;10%), with 13 red light LEDs (output power of 300 (\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;20%) mW and total power of 3.90 (\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;20%) W, irradiance of 0.049W/cm\u003csup\u003e2\u003c/sup\u003e (\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;20%) and beam divergence of 1.40 (\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;10%)) and 13 near-infrared light LEDs (output power of 500 (\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;20%) mW and total power of 6.50 (\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;20%) W, irradiance of 0.081W/cm\u003csup\u003e2\u003c/sup\u003e (\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;20%) and beam divergence of 1.57 (\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;10%). The PBM was applied at an angle of 90 degrees to the tissue, twice a week, for two weeks, with a space of 1 cm\u003csup\u003e2\u003c/sup\u003e between the points, with the Antares\u0026reg; / IBRAMED equipment, along the entire lumbosacral path (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The evaluation prior to the procedure of each patient was considered as the control.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e\u003c/h2\u003e \u003cp\u003eDescriptive statistics and independent T-test were calculated to compare the measurements between the initial and final evaluations. Significance level of 0.05. The vertical jump and gait speed assessments were performed with 44 patients, since 3 were unable to walk independently and could not be counted. Study approved by the Research Ethics Committee (CAAE:70504423.9.0000.5382), funded by CNPq (Process 403490/2021-9) and by the company IBRAMED.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe study included the participation of 47 patients whose characteristics are described in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacterization of data of study participants\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClinical characteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary neoplasia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBreast\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e63.83\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOvary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.38\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntestine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12.77\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEndometrium\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUterus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.26\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStomach\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLiver\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProstate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLung\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.26\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChemotherapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePlatinum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e23.40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTaxane\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e76.60\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e21.28\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e78.72\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMusculoskeletal background\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e21.28\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e78.72\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUse of alcoholic beverages\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10.64\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e89.36\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgical approach\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e87.23\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12.77\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe results of the influence of the use of PBM on postural control are presented in Figs.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e and 4. And the use of PBM positively influenced gait speed (p\u0026thinsp;=\u0026thinsp;0,0315) (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe present study demonstrated that performing PBM on peripheral nerves in patients with CIPN clinically and statistically improves some aspects of postural control and gait speed. This finding has significant clinical importance since after chemotherapy treatment, sensory problems resulting from neurotoxicity remain in most patients, with significant loss of lower limb proprioception, causing worsening of gait and lack of balance, making patients afraid of falls, worsening their functionality and quality of life. [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Studies show that 90% of patients who used the chemotherapy drug oxiplatin developed acute neuropathy, and between 30% and 50% developed chronic neuropathy, with symptoms and duration varying, but persisting for more than 24 months. [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] The effects resulting from chemotherapy treatment can cause sensory deficits that make patients walk more slowly, have poorer balance, and increase the chances of falls. [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eDespite being a very common adverse event of cancer treatment, CIPN does not have a gold standard treatment. A systematic review shows 26 treatment options for CIPN, one of which is CIPN [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. PBM releases energy, which when absorbed by the mitochondria increases cellular respiration, improving the oxidative process and thus improving nerve degeneration. [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eA placebo-controlled clinical trial with 70 patients, in which PBM or placebo was applied three times a week for six weeks, showed that PBM reduces sensory symptoms in chemotherapy-induced peripheral neuropathy [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], but the impact on postural control and gait speed was unknown until this study.\u003c/p\u003e \u003cp\u003eA study evaluated the effect of PBM on nerve regeneration in 30 mice with sciatic nerve injury, applying PBM at 660 nm, with a total energy of 16.8 J divided into three types of application. The use of PBM was effective in sciatic nerve regeneration, showing that PBM is not just a resource for analgesia, but also for nerve regeneration.[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] Regeneration occurs with photobiomodulation, increasing cellular viability by activating cytochrome c oxidase of the electron transport chain, increasing mitochondrial respiration and the activity of molecules such as adenosine triphosphate (ATP), nitric oxide (NO), reactive oxygen species (ROS), calcium ions and several other molecules, accelerating axonal regeneration and suppressing neural apoptosis.[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eNeurotoxicity caused by chemotherapy affects both the axons of small fibers, causing acute pain, tingling sensation, numbness, and sensitivity to cold, and the sensory axons of large fibers, which affect proprioception. Drugs in the taxane class cause damage to sensory neurons, causing damage to A and C fibers, while medications composed of platinum compounds damage DNA, accumulating in peripheral neurons and inducing neural apoptosis. [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] PBM is a therapeutic proposal not only for symptom relief, since its objective is nerve regeneration. This study showed that the application of PBM promotes improvements in the patient\u0026rsquo;s postural stability and gait speed, reducing difficulty in walking. In order to increase gait speed, it is necessary to improve the gait phases. If the patient doesn\u0026rsquo;t become unbalanced in the support phase, possibly due to the reduction in sensory symptoms and increased proprioception, they will enter the balance phase without imbalance, when only one foot is supported. This way, there will be an improvement in gait speed and the way in which the patient walks. It is possible to infer that there will be a consequent decrease in the number of falls, which are recurrent in patients with CIPN, with an improvement in quality of life, increasing independence, and being able to perform daily activities more safely.\u003c/p\u003e \u003cp\u003eThis study demonstrated that PBM is a non-invasive, low-cost resource that acts directly on nerve regeneration and should be considered in the treatment of CIPN of the lower limbs.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003ePBM is a promising resource for the recovery of postural stability and gait speed resulting from CIPN.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003e\u003cstrong\u003eEthical Approval\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eThe study was conducted in accordance with guidelines for research involving human subjects and was approved by the Research Ethics Committee (CAAE: 70504423.9.0000.5382). All participants were duly informed about the objectives of the study, potential adverse effects, and provided their consent to participate in the research.\u003c/p\u003e\n\u003ch2\u003eClinical Trial Registration Number\u003c/h2\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eThe equipment used in the study was acquired through funding from the Conselho Nacional de Desenvolvimento Cient\u0026iacute;fico e Tecnol\u0026oacute;gico (CNPq) (Grant number: 403490/2021-9).\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\n\u003cp\u003eAll authors contributed equally to the study. They participated in the conceptualization, methodology, data collection, formal analysis, and interpretation of the results. All authors reviewed and approved the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eKerckhove, N., Collin, A., Cond\u0026eacute;, S., Chaleteix, C., Pezet, D., \u0026amp; Balayssac, D. (2017). Long-term effects, pathophysiological mechanisms, and risk factors of chemotherapy-induced peripheral neuropathies: A comprehensive literature review. \u003cem\u003eFrontiers in pharmacology\u003c/em\u003e, \u003cem\u003e8\u003c/em\u003e. doi:10.3389/fphar.2017.00086\u003c/li\u003e\n\u003cli\u003eSim\u0026atilde;o, D. A. da S., Murad, M., Martins, C., Fernandes, V. C., Captein, K. M., \u0026amp; Teixeira, A. L. (2015). Chemotherapy-induced peripheral neuropathy: review for clinical practice. \u003cem\u003eRevista Dor\u003c/em\u003e, \u003cem\u003e16\u003c/em\u003e(3). doi:10.5935/1806-0013.20150043\u003c/li\u003e\n\u003cli\u003eKneis, S., Wehrle, A., M\u0026uuml;ller, J., Maurer, C., Ihorst, G., Gollhofer, A., \u0026amp; Bertz, H. (2019). It\u0026apos;s never too late - balance and endurance training improves functional performance, quality of life, and alleviates neuropathic symptoms in cancer survivors suffering from chemotherapy-induced peripheral neuropathy: results of a randomized controlled trial. BMC cancer, 19(1), 414. https://doi.org/10.1186/s12885-019-5522-7\u003c/li\u003e\n\u003cli\u003eLi, Y., Lustberg, M. B., \u0026amp; Hu, S. (2021). Emerging pharmacological and non-pharmacological therapeutics for prevention and treatment of chemotherapy-induced peripheral neuropathy. \u003cem\u003eCancers\u003c/em\u003e, \u003cem\u003e13\u003c/em\u003e(4), 766. doi:10.3390/cancers13040766\u003c/li\u003e\n\u003cli\u003eWolf, S., Barton, D., Kottschade, L., Grothey, A., \u0026amp; Loprinzi, C. (2008). Chemotherapy-induced peripheral neuropathy: Prevention and treatment strategies. \u003cem\u003eEuropean Journal of Cancer (Oxford, England: 1990)\u003c/em\u003e, \u003cem\u003e44\u003c/em\u003e(11), 1507\u0026ndash;1515. doi:10.1016/j.ejca.2008.04.018\u003c/li\u003e\n\u003cli\u003ePark, H. S., Sin, W. K., Kim, H. Y., Moon, J. Y., Park, S. Y., Kim, Y. C., \u0026amp; Lee, S. C. (2013). Scrambler Therapy for Patients with Cancer Pain - Case Series -. \u003cem\u003eThe Korean Journal of Pain\u003c/em\u003e, \u003cem\u003e26\u003c/em\u003e(1), 65\u0026ndash;71. https://doi.org/10.3344/kjp.2013.26.1.65\u003c/li\u003e\n\u003cli\u003eLopez-Garzon, M., Canta, A., Chiorazzi, A., \u0026amp; Alberti, P. (2023). Gait analysis in chemotherapy-induced peripheral neurotoxicity rodent models. Brain research bulletin, 203, 110769. https://doi.org/10.1016/j.brainresbull.2023.110769\u003c/li\u003e\n\u003cli\u003eKang, G. E., Murphy, T. K., Kunik, M. E., Badr, H. J., Workeneh, B. T., Yellapragada, S. V., Sada, Y. H., \u0026amp; Najafi, B. (2021). The detrimental association between fear of falling and motor performance in older cancer patients with chemotherapy-induced peripheral neuropathy. Gait \u0026amp; posture, 88, 161\u0026ndash;166. https://doi.org/10.1016/j.gaitpost.2021.05.0\u003c/li\u003e\n\u003cli\u003eHou S, Huh B, Kim HK, Kim KH, Abdi S. Treatment of Chemotherapy-Induced Peripheral Neuropathy: Systematic Review and Recommendations. Pain Physician. 2018 Nov;21(6):571-592. PMID: 30508986.\u003c/li\u003e\n\u003cli\u003eArgenta, P. A., Ballman, K. V., Geller, M. A., Carson, L. F., Ghebre, R., Mullany, S. A., Teoh, D. G. K., Winterhoff, B. J. N., Rivard, C. L., \u0026amp; Erickson, B. K. (2017). The effect of photobiomodulation on chemotherapy-induced peripheral neuropathy: A randomized, sham-controlled clinical trial. \u003cem\u003eGynecologic Oncology\u003c/em\u003e, \u003cem\u003e144\u003c/em\u003e(1), 159\u0026ndash;166. https://doi.org/10.1016/j.ygyno.2016.11.013\u003c/li\u003e\n\u003cli\u003eSouza, L. G. de, Cardoso, R. B., Kuriki, H. U., Marcolino, A. M., Fonseca, M. de C. R., \u0026amp; Barbosa, R. I. (2020). High energy photobiomodulation therapy in the early days of injury improves sciatic nerve regeneration in mice. \u003cem\u003eABCS Health Sciences\u003c/em\u003e, \u003cem\u003e45\u003c/em\u003e, e020016. https://doi.org/10.7322/abcshs.45.2020.1345\u003c/li\u003e\n\u003cli\u003eJoy, L., Jolien, R., Marith\u0026eacute;, C. \u003cem\u003eet al.\u003c/em\u003e The use of photobiomodulation therapy for the prevention of chemotherapy-induced peripheral neuropathy: a randomized, placebo-controlled pilot trial (NEUROLASER trial). \u003cem\u003eSupport Care Cancer\u003c/em\u003e \u003cstrong\u003e30\u003c/strong\u003e, 5509\u0026ndash;5517 (2022). https://doi.org/10.1007/s00520-022-06975-x\u003c/li\u003e\n\u003cli\u003eAreti A, Yerra VG, Komirishetty P, Kumar A. Potential Therapeutic Benefits of Maintaining Mitochondrial Health in Peripheral Neuropathies. Curr Neuropharmacol. 2016;14(6):593-6094\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Chemotherapy, Induced Peripheral Neuropathy, Neuropathic Pain, Photobiomodulation, Force Platform, Postural Control, Gait","lastPublishedDoi":"10.21203/rs.3.rs-5814765/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5814765/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjectives: \u003c/strong\u003eTo evaluate the influence of photobiomodulation (PBM) on postural control and gait speed in patients with chemotherapy-induced peripheral neuropathy (CIPN).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e \u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eProspective clinical study with 47 cancer patients undergoing treatment with platinum or taxane chemotherapy drugs and diagnosed with peripheral neuropathy of the lower limbs (LL). Patients received PBM with LED, 630 nm / 850 nm, in the lumbosacral nerve pathway for four sessions. Postural stability was assessed with the BIOMEC400 force platform, to record the amplitude and speed of displacement of the center of pressure. Power and ground reaction force were assessed using the following variables with the participant during the vertical jump: mass, jump duration, flight duration, jump speed, maximum jump force, and maximum jump power. To assess the impact of the changes studied on gait, the 10-meter walk test was performed.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eThere was a significant improvement in the mediolateral amplitude (P=0.0250), jump duration (P=0.0001), flight duration (P=0.0064), jump speed (P=0.0443), and maximum force during the jump (P=0.0002). There was no significant improvement in maximum jump power (P=0.7637), anteroposterior amplitude (P=0.4636), anteroposterior velocity (P=0.2769), mediolateral velocity (P=0.1764), and area (P=0.1215). However, the changes found with the use of PBM were sufficient to have a clinical impact on ambulation, with a significant improvement in gait speed (p=0.0315).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e PBM proved to be a promising and low-cost resource for improving postural control and gait speed in patients with CIPN.\u003c/p\u003e","manuscriptTitle":"Photobiomodulation on postural control and gait speed in chemotherapy-induced peripheral neuropathy","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-01-24 15:42:30","doi":"10.21203/rs.3.rs-5814765/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7a4bd469-b2bb-4b00-84e7-8481ac29c2f8","owner":[],"postedDate":"January 24th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-02-26T18:53:32+00:00","versionOfRecord":[],"versionCreatedAt":"2025-01-24 15:42:30","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5814765","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5814765","identity":"rs-5814765","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}