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Characteristic gait kinematics in persons with lumbosacral myelomeningocele
Elena M Gutierrez1, Asa Bartonek, Yvonne Haglund-Akerlind
1Centre for Surgical Sciences, Karolinska Institute, MotorikLab Q2:07 ALB, Stockholm 17176, Sweden. lanie.gutierrez@kirurgi.ki.se
Insights
Children with myelomeningocele exhibit unique gait patterns due to muscle weakness. Gait analysis reveals compensatory strategies in trunk and pelvic motion, crucial for clinical management of self-ambulation.
Area of Science:
- Pediatric Orthopedics
- Biomechanical Engineering
- Neuroscience
Background:
- Myelomeningocele often impacts ambulation.
- Understanding gait deviations is key for intervention.
Purpose of the Study:
- To analyze gait kinematics in children with myelomeningocele.
- To correlate kinematic patterns with specific muscle weakness.
Main Methods:
- Three-dimensional gait analysis was performed on 30 children with myelomeningocele and 21 controls.
- Kinematic data of the trunk, pelvis, hip, knee, and ankle were analyzed.
- Participants were grouped based on progressive muscle weakness (plantarflexors, dorsiflexors, hip abductors, hip extensors, knee flexors).
Main Results:
- Extensive plantarflexor weakness caused significant kinematic alterations in the trunk, pelvis, hip, and knee across all planes.
- Hip abductor weakness, even with preserved hip extensors, led to substantial kinematic deviations including lateral trunk sway and pelvic hike.
- Total hip extensor paresis resulted in gait similar to hip abductor weakness but with reduced sagittal plane movement and posterior trunk tilt.
Conclusions:
- Gait analysis effectively identifies compensatory strategies in children with myelomeningocele.
- Clinical management should focus on lower extremity stabilization and accommodating upper body motion to maintain self-ambulation.
- These findings aid in preserving ambulation despite significant hip muscle weakness.
Abstract:
Thirty self-ambulatory children with mid-lumbar to low-sacral myelomeningocele who walked without aids and 21 control children were evaluated by three-dimensional gait analysis. Characteristic kinematic patterns and parameters in the trunk, pelvis, hip, knee and ankle were analyzed with respect to groups with successive weakness of the ankle plantarflexor, ankle dorsiflexor, hip abductor, hip extensor and knee flexor muscles. Extensive weakness of the plantarflexors resulted in kinematic alterations in the trunk, pelvis, hip and knee and in all three planes seen as knee flexion, anterior pelvic tilt and trunk and pelvic rotation. Additional extensive weakness of the dorsiflexors made little difference in the walking strategy. Large kinematic alterations in all planes were observed where there was a large extent of additional weakness of the hip abductor but strength remaining in the hip extensors. In this group, gait was characterized by large lateral sway of the trunk, rotation of the trunk and pelvis, pelvic hike and increased extension of the knees. In the group with total poresis hip extensors but yet some knee flexion, gait was similar to the previous group but there was less sagittal plane movement greates and posterior trunk tilt. Gait analysis provides an understanding of the compensatory strategies employed in these patients. Clinical management can be directed towards stabilizing the lower extremities and accommodating large upper body motion to preserve this method of self-ambulation even in children who have considerable hip extensor and abductor weakness.
