Chemotherapy-Induced Peripheral Neuropathy

These are instructions for Children's Hospital of Philadelphia (CHOP) oncology patients with chemotherapy-induced peripheral neuropathy.

Important information about chemotherapy-induced peripheral neuropathy:

Chemotherapy-induced peripheral neuropathy (CIPN) is a side effect of chemotherapy. It causes damage to the nerves that send messages from the brain and spinal cord to the hands and feet. As a result, your child may have difficulty with movement or sensation. CIPN can happen at any time during treatment. Symptoms usually get better after your child is finished with treatment. However, it can take a long time to improve. Sometimes, it may not completely resolve.

CIPN can cause sensory changes in the hands and feet. Your child may have pain, tingling or difficulty "feeling" their body move. Sometimes the nerves that control digestion and breathing are affected by chemotherapy. Your child may have constipation, difficulty swallowing, unexpected sweating or changes in blood pressure. If their motor nerves are affected you may see changes in their ability to walk, run, jump and balance. The symptoms of CIPN can look different depending on the age of your child.

CIPN symptoms in toddlers and preschoolers

• Difficulty walking or keeping up with family while walking

• Dragging feet

• Foot slapping

• Tripping or falling

• Walking with toes pointed outward

• Increase in sensitivity to touch on their legs or feet

• Your child may complain while standing

• Difficulty holding things. They may drop toys more often

• Lack of interest or frustration with activities like coloring or cutting

CIPN symptoms in elementary school-aged children and teenagers

• Changes in being able to keep up with peers while walking and running

• Tripping or losing their balance

• Not able to jump

• Needing to hold a handrail while on the stairs

• Handwriting that is less neat or hard to read

• May be harder to use utensils

• May be harder to open objects, such as food containers

• Difficulty with buttoning, zippering, and tying shoes when getting dressed

If you notice any of these symptoms, talk to your healthcare provider about physical and occupational therapy screenings for your child.

Therapy to treat CIPN:

It is important for children receiving cancer therapy to stay active. But general activity alone, such as walking or playing, will not improve the issues caused by CIPN. Your child will need to practice specific exercises. Physical therapy will use activities and exercises to help with issues in the lower body. Occupational therapy will use exercises and activities to target issues in the upper body. Children with CIPN may cope with a weakness by using abnormal movements. Your therapists can help identify and correct abnormal movement patterns your child may have developed.

Treatment will depend on your child's needs. Possible treatments include:

• Exercises to improve strength and flexibility in the hands and feet as well as balance. They may be prescribed at home or at weekly outpatient physical or occupational therapy appointments.

• Ankle braces or shoe inserts (orthotics). These may be worn at night for stretching or during the day to support walking. They can help your child with walking, foot position, and prevent injury while their nerves are healing.

• Hand splints to provide a gentle stretch and improve fine motor skill function.

• The healthcare team may choose to decrease or hold some of the chemotherapy depending on your child's symptoms.

Occupational therapy exercises for CIPN:

Putty squeeze

• Squeeze putty with your full fist 10 times with each hand.

• Pinch the putty between your index finger and thumb 10 times.

• Roll putty between your hands making a snake shape.

• Flatten the putty between your hands or on a table.

• Hide beads or buttons in putty and find them using just your index finger and thumb.

Physical therapy exercises for CIPN:

Reviewed on February 1, 2023, by Kristen P. DeVirgilio, PT, DPT