Telerehabilitation in Central and Peripheral Neurological Sequelae From Chemotherapy

PAM13 is a 13-item scale that assesses a person's underlying knowledge, skills and confidence integral to managing his or her health and healthcare. PAM13 total score ranging from 0 to 100. Higher values represent a better outcome. Specifically, individuals in the lowest activation level do not yet understand the importance of their role in managing their health and have significant knowledge gaps and limited self-management skills. Individuals in the highest activation level are proactive with their health, have developed strong self- management skills, and are resilient in times of stress or change.

FACT-Cog is a 37 item self-report tool on 5-point Likert scale to assess perceived cognitive function in adult cancer patients with chemotherapy-induced cognitive problems

EORTC CIPN-20 is a 20-item self-report questionnaire to assess patients' experience of symptoms and functional limitations related to chemotherapy-induced peripheral neuropathy;

Patient Health Engagement Scale (PHE-s) is a validated tool designed to measure a person's level of engagement in managing their own health, based on the Patient Health Engagement (PHE) Model.

MoCA is a screening test for global cognitive functioning. It includes tasks involving several domains: visuospatial/executive function tests, naming, selective and sustained attention, language, abstraction, memory and orientation. High scores are indicative of better general cognitive performance.

TMT is a neuropsychological test that involves visual scanning (TMT-A) and dual-task (TMT-B). The TMT is scored by how long it takes to complete each part of the test. High execution times indicate poor performance.

FCSRT is a visual memory test that maximises encoding specificity. It assesses learning (immediate recall) and visual long-term (delayed recall) memory of visual stimuli. The administration is divided into three phases: 1) Encoding phase: naming of stimuli (three boards with four coloured stimuli each) and verification of encoding with cue; 2) Immediate recall phase: free immediate recall + recall with a cue for not recalled stimuli (this sequence is repeated three times with interference task between trials); 3) deferred recall phase (after 30 minutes of non-verbal tasks): free deferred recall + recall with a cue for not recalled stimuli. Six scores can be obtained: Immediate Free Recall (spontaneous recall in the three trials; range 0-36); Immediate Total Recall (total recall in the three trials - range 0-36); Delayed-Free Recall (range 0-12); Delayed Total Recall (range 0-12); Index of Sensitivity of Cueing (ISC) and Number of intrusions. Higher scores indicate better performance.

The Mini-BESTest aims to identify the disordered systems underlying the postural control responsible for poor functional balance. This tool is composed by 27 tasks (36 items in total) assessing bio-mechanical constraints, stability limits/verticality, anticipatory responses, postural responses, sensory orientation, and stability in gait. Each item is scored based on ordinal scale scoring from 0- 3 where 3 = best performances and 0 = worst performances. The total score is provided as a percentage. Higher scores are indicative of better performance.

6' Minute Walking Test (6MWT) has been validated as a general indicator of overall physical performance and mobility for older people (Duncan et al 1993; Harad et al 1999). The total distance walked is measured.

dynamometer

T1-3D MPRAGE, FLAIR 3D and T2 will be collected to test changes in brain morphometry

DWI sequences will be collected to detect changes in structural connectivity

Resting-State fMRI (Multi echo - Multi-Band) and EPI-T2* images will be collected for the assessment of brain activity at rest and functional connectivity.

T2 mapping (T2 SE multi-echo) will be collected to measure change in inflammation

Muscle diffusion tensor imaging (DWI-STE) will be collected to measure muscle fiber integrity

Multi-point Dixon (6-point multi-echo GRE Dixon) will be collected to evaluate fat fraction.

The sera will be collected, centrifuged, stored, frozen at -80 C degrees, and shipped (when necessary) to the chosen sample-processing center. The serum will be used to measure by Enzyme-Linked ImmunoSorbent Assay (ELISA) and by Automated Immunoassay System (ELLA) the Inflammatory cytokines (TNF, IL1beta, TGF-beta, IL-6), and Anti-inflammatory cytokines (IL-10).

The sera will be collected, centrifuged, stored, frozen at -80 C degrees, and shipped (when necessary) to the chosen sample-processing center. The serum will be used to measure by Enzyme-Linked ImmunoSorbent Assay (ELISA) and by Automated Immunoassay System (ELLA) the neurotrophic and neuroendocrine factors such as Brain-derived neurotrophic factor (BDNF), neurofilaments and neurotransmitters (acetylcholine, noradrenaline, and adrenaline), cortisol, VEGF, IGF-1 and irisin.