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Factors influencing ambulation in myelomeningocele: a cross-sectional study
1Motor Control Laboratory, Astrid Lindgren Children's Hospital, Karolinska Hospital, Stockholm, Sweden. asa.bartonek@karo.ki.se
Insights
Children with myelomeningocele (a spinal defect) often have varying ambulatory function. Factors like balance, spasticity, and shunt revisions significantly impact walking ability, highlighting the need for comprehensive assessment.
Area of Science:
- Pediatric Neurology
- Rehabilitation Medicine
- Orthopedic Surgery
Background:
- Myelomeningocele is a complex congenital condition affecting lower limb motor function.
- Predicting ambulatory potential in affected children is crucial for intervention planning.
- Variability in functional outcomes necessitates identifying contributing factors beyond motor paresis.
Purpose of the Study:
- To evaluate the ambulatory achievement in children with myelomeningocele relative to their motor deficits.
- To identify specific factors influencing ambulation outcomes in this pediatric population.
- To understand the relationship between functional skills, energy expenditure, and ambulation.
Main Methods:
- Clinical assessment of orthopedic and neurological status in 53 children (mean age 7.6 years).
- Review of medical records and documentation of orthoses use.
- Evaluation of functional mobility skills and energy expenditure.
Main Results:
- 31/53 children achieved expected ambulation; 22/53 performed below expectations.
- Significant differences observed in balance, spasticity (hip/knee), and shunt revision history between groups.
- Higher energy expenditure noted in children with poorer ambulatory function.
Conclusions:
- Ambulatory function in myelomeningocele varies significantly even with similar motor paresis.
- Balance, spasticity, and shunt history are critical factors influencing ambulation.
- Comprehensive assessment beyond motor deficits is essential for predicting and optimizing mobility outcomes.
Abstract:
A consecutive series of 53 children with myelomeningocele (mean age 7.6, range 3.2 to 11.4 years) was assessed in order to see if the children with motor paresis of the lower limbs achieved the expected level of ambulation, and if not, to identify possible causative factors. Methods used were clinical examination of orthopaedic and neurological status, information from medical reports, and documentation of orthoses use. Functional skills were documented and energy expenditure was examined. Thirty-one of 53 children had reached the expected ambulation considered possible according to their motor paresis, whereas 22 of the 53 performed worse than expected. Balance disturbances, occurrence of spasticity in knee and hip joints, and number of shunt revisions made differed significantly between the groups that achieved and did not achieve expected ambulation. Functional skills of mobility differed significantly between two muscle-function levels in children who had walking ability. Energy expenditure was higher in the non-achieving group than in the group who achieved expected ambulation in each of the muscle-function levels. Results show that children with similar muscle paresis exhibit different ambulatory function. This indicates the importance of a close analysis of other factors which may cause ambulation to deteriorate in order to predict future ambulation in children with myelomeningocele.