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Age-related walking in children with spina bifida
E N Williams1, N S Broughton, M B Menelaus
1School of Physiotherapy, The University of Melbourne, Victoria, Australia.
Insights
Children with spina bifida (myelomeningocele) show varied walking abilities based on lesion level. Some with higher lesions may walk effectively but cease by age 7, earlier than previously thought.
Area of Science:
- Pediatric Neurology
- Rehabilitation Medicine
- Developmental Pediatrics
Background:
- Myelomeningocele, a severe form of spina bifida, presents significant challenges in motor function and ambulation.
- Understanding the relationship between neurosegmental lesion level and walking prognosis is crucial for patient management and rehabilitation strategies.
Purpose of the Study:
- To investigate the walking capabilities of children with myelomeningocele based on their neurosegmental lesion level.
- To determine the incidence of walking and the average ages of walking commencement and cessation in this population.
Main Methods:
- Retrospective analysis of 173 children with myelomeningocele evaluated annually since 1978.
- Classification of patients by neurosegmental lesion level (thoracic, high-lumbar, mid-lumbar, low-lumbar, sacral).
- Assessment of community ambulation, with or without aids, and recording of walking commencement and cessation ages.
Main Results:
- Children with sacral level lesions had the highest walking incidence (100%) starting at an average age of 2 years 2 months.
- Low-lumbar lesions (L4/5) showed a high walking incidence (84%) starting at 3 years 10 months.
- Higher lesion levels (thoracic, high-lumbar) had lower walking incidence and earlier cessation, with some ceasing by age 7.
Conclusions:
- Ambulation delays are expected in children with spina bifida, even with lower lesion levels.
- Children with higher lesion levels may achieve community ambulation but can cease walking earlier than previously documented.
- Individualized assessment and long-term monitoring are essential for children with myelomeningocele regarding ambulation potential.
Abstract:
The aim of this study was to examine children with myelomeningocele (spina bifida) who were investigated according to the level of neurosegmental lesion and to determine the number who walked and their average age at commencement/cessation of walking. The data have been collected since 1978 at the Royal Children's Hospital, Melbourne during annual evaluations of patients with spina bifida and high-level paralysis. After screening for established criteria and assigning to a neurosegmental lesion level, 173 children were examined for their ability to walk, with or without aids, in a community setting. Thirty-five children had lesions at the thoracic level, and seven walked at a mean age of 4 years 6 months. Three children with a lesion at the thoracic level ceased walking at a mean age of 7 years 6 months. Ten children had lesions at the high-lumbar level (L1/2), and five walked at a mean age of 5 years 2 months. Three children who had lesions at the high-lumbar level ceased walking at a mean age of 6 years 11 months. Fifteen children had lesions at the mid-lumbar level (L3) and nine walked at a mean age of 5 years. Three ceased walking at a mean age of 7 years. Forty-five children had lesions at the low-lumbar level (L4/5) and 38 walked at a mean age of 3 years 10 months. Five ceased walking at a mean age of 9 years 1 month. Sixty-eight children had lesions at the sacral level; all of whom walked at an average age of 2 years 2 months. None had ceased walking by the end of the study period. Delay in achieving ambulation can be expected in all children with spina bifida, including those with low neurosegmental level lesions. Furthermore, some children with high lesion level, given the opportunity, might be expected to ambulate effectively in the community but may cease walking after 3 to 4 years of this activity, which is earlier than previously recorded.
