Title: ASPECT Study:The ASsessment and Physiotherapy managEment of ataxia in Children following surgical resection of posterior fossa Tumour
Funder: Health Education England

Abstract: Brain tumours are the most common type of solid tumour in children and 50% of these occur in the posterior fossa region. Children can commonly present with ataxia following surgical resection of post fossa tumour and to date there is little research on how to assess ataxia in this population and whether physiotherapy intervention is effective. The overarching aim of the study is to identify appropriate tools to assess ataxia in children with posterior fossa tumours and determine the feasibility of conducting a randomised controlled trial studying the effectiveness of physiotherapy intervention (virtual training) on this population. This will be achieved by the completion of four work packages. Work package one will focus on psychometric properties of the Scale for the Assessment and Rating of Ataxia (SARA) and Brief Ataxia Rating Scale (BARS) analysing previously collected (though not explored) data from longitudinal assessments of children with ataxia following surgical resection of post fossa tumours. Sensitivity (the ability of the scales to detect a change) and the minimum clinically important difference of these scales will be reported. The minimum clinical important difference (MCID) will provide information regarding how many points on the scale the children need to change by to reflect an important/meaningful change in physical function. Work Package 2 will consist of an e-survey with European Physiotherapists specialising in rehabilitation of children with ataxia to ensure an up to date knowledge of current practice with focus on intervention type and intensity for this population. Work Package 3 will consist of a series of workshops with innovators, therapists and service users specialising in neuro oncology aiming to explore what software/child friendly games are available for the kinect and how practical it is for the children to engage with these. Work packages 1, 2 and 3 will inform work package 4 which is a feasibility randomised controlled trial examining the effectiveness of usual care versus virtual training. The first component of this will examine process measures (e.g. number of children recruited) and appropriateness of the intervention (e.g. number of children who complete all the intervention sessions). The second part will be an embedded qualitative study to gain an understanding of the child and families perception of the virtual training. Children aged between 4-18 years of age who have had surgery for post fossa tumours will be recruited for WP4. Gaining an understanding of which outcome measures to use to measure ataxia will enable accurate assessment and ensure we are aware if the children are improving/deteriorating. This information would inform practice and the use of these scales could be immediately integrated into the clinical setting.Completing a feasibility study examining virtual training would provide weight to completing a larger multicentre trial to further examine physiotherapy intervention. This is crucial as rehabilitation is the main treatment for children with ataxia which is known to be a long term problem in children with brain tumours. Understanding what would be an effective intervention could then be integrated into patient care in line with the HEE priority of creating high quality patient care.

Lay abstract: Brain tumours are the most common type of solid tumour diagnosed in children and 50% of these occur at the back of the brain (posterior fossa region). Children can present with mobility problems both as a result of the tumour and any surgical treatment. The most frequent movement problems seen are balance and co-ordination difficulties (known as ataxia). Up to 70% of children with a posterior fossa tumour will have balance problems, and rehabilitation including physiotherapy is the main treatment offered. It is therefore important to be able to assess ataxia accurately and understand if physiotherapy can help to improve this. The overall aim of the project is to identify appropriate scales to assess ataxia in children with posterior fossa tumours and determine the feasibility of conducting a randomised controlled trial (RCT) studying the effectiveness of physiotherapy intervention (virtual training) in these children. This aim will be achieved by completing a series of studies which will build to inform the planning and completion of the feasibility RCT examining virtual training. Firstly, two scales that measure severity of ataxia which were developed for use with adults, will be tested in children with brain tumours to see if they can detect improvement. This will be done by exploring data previously collected with children with posterior fossa tumours (though not analysed) from a study that has shown that these two scales are reliable in children, and now further assessments undertaken over time will be checked to see if the scales can detect change. Assessing these scales will help to choose which assessments are the best to use in the trial. Secondly an e-survey will be carried out with physiotherapists across Europe to determine what is current practice regarding physiotherapy input for children with ataxia following surgery for post fossa tumours. This will ensure we are aware of all useful types of treatment used and understand the intensity of treatment typically used. Any new information may refine the protocol of the trial. Thirdly a series of workshops with patients, families and clinical experts will be held to ensure the type of physiotherapy treatment planned for the trial is practical to be carried out at the hospital, and also at home to allow the children to carry on their physiotherapy at home. The type of intervention chosen to test is virtual training (using X box Kinect in an interactive environment that requires arm and leg movement to react to on screen game play). This was chosen as this has been found to be effective in children with different illnesses who also present with balance problems. The trial will recruit children with ataxia from two children's hospitals who have previously had surgery for a brain tumour and will investigate usual physiotherapy care versus virtual training and usual physiotherapy care. The virtual training will consist of an 8 week programme. The children will be assessed at regular time points and the child's/families' opinions of the study will be also explored. As this will be a small study checking feasibility, the results will focus on aspects such as the number of children that entered the study, how many completed all of the virtual training sessions and whether the correct outcome measures where chosen. Examining all these results will ensure that a larger multi-centre RCT (randomised controlled trial) assessing virtual training can be successfully planned and carried out. This would provide valuable information which will be of direct benefit to children with ataxia as the results will inform physiotherapists about what treatments are effective to use.

Research activity codes: 6.7 PHYSICAL
Health categories: CANCER AND NEOPLASMS