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Independent ambulators with high sacral myelomeningocele: the relation between walking kinematics and energy
1Motion Analysis Center; Division of Pediatric Orthopaedic Surgery, Children's Memorial Hospital, Chicago, IL 60614, USA.
Insights
Children with myelomeningocele have higher oxygen costs during walking due to pelvic obliquity. Strengthening hip abductors may improve gait efficiency and reduce energy demands.
Area of Science:
- Biomechanical Engineering
- Pediatric Physical Therapy
- Neuromuscular Disorders
Background:
- Children with myelomeningocele often exhibit altered gait patterns.
- Increased energy expenditure during ambulation is a common challenge.
Purpose of the Study:
- To investigate the relationship between gait kinematics, specifically center of mass (COM) excursions, and oxygen consumption/cost in children with myelomeningocele.
- To identify factors contributing to elevated energy demands during walking.
Main Methods:
- Evaluated 14 children with myelomeningocele and 13 typically developing children during comfortable walking.
- Measured oxygen consumption and oxygen cost.
- Assessed gait kinematics, including COM excursions and pelvic obliquity.
Main Results:
- Children with myelomeningocele showed significantly higher oxygen cost and consumption (>1 SD above normal) at comfortable walking speeds.
- Pelvic obliquity was strongly correlated with increased oxygen cost, suggesting a role for hip abductor strength.
- Despite exaggerated pelvic motion, vertical and horizontal COM excursions were not significantly different from controls.
- Slower self-selected walking velocity in this population may be linked to maintaining near-normal COM movement for stability and efficiency.
Conclusions:
- Elevated oxygen cost in myelomeningocele gait is primarily associated with pelvic obliquity, not necessarily increased COM excursions.
- Interventions targeting hip abductor strength (gluteus medius/maximus) could reduce compensatory movements and improve walking efficiency.
- Optimizing gait mechanics may allow for faster, more efficient walking without excessive energy expenditure.
Abstract:
The aims of this study were to determine the relation between gait kinematics (center of mass excursions) and measures of oxygen consumption and oxygen cost. Fourteen independent ambulating children with myelomeningocele (nine females, five males; mean age 8 years 7 months) and thirteen children with no history of neuromuscular disorder were evaluated. At their comfortable walking speed all patients exhibited oxygen cost and oxygen consumption values that exceeded the normal level by more than 1 SD. Pelvic obliquity demonstrated the strongest relation with oxygen cost which suggests that ultimately hip abductor strength may play a key role in energy demands during gait. Despite the exaggerated pelvic kinematics, vertical and horizontal center of mass excursions of the trunk and whole-body during the gait cycle were not significantly greater than normal (p>0.05). Decreased self-selected walking velocity at which many of these children consider comfortable and stable may be predicated on an optimal center of mass movement that approximates the magnitude observed in normal gait. The slower walking velocity decreases walking efficiency. Conversely, the increased center of mass movement that would accompany a faster gait would probably impose intolerable oxygen consumption levels. Strengthening programs that focus on the gluteus medius and maximus to decrease compensatory trunk and pelvic motions, allowing the patients to adopt a faster gait without exacerbating kinematic and center of mass motions and which enabled more efficient walking hold promise for these patients.