Rehabilitation of a child with a split cord malformation and hemimeningomyelocele

The purpose of this case report is to recount the rehabilitation progress of a child with a hemimeningomyelocele and to clarify terminology used to describe this condition.

A young girl with a diagnosis of a hemimeningomyelocele, involving the left hemicord only, at the level of the seventh to the ninth thoracic vertebrae, was followed from two and a half months until seven years of age. Deciphering the medical record was a challenge because clinicians involved in the case used different terminology to describe the split cord malformation. The authors had to review the literature about split cord malformations to interpret the medical record. The child also had a severe kyphoscoliosis and a ventriculoperitoneal shunt (Arnold-Chiari II deformity). The child was followed by an orthopedist and a neurosurgeon. She participated in an early intervention program that included physical therapy. Her clinical course did not follow that anticipated for a child with a meningomyelocele at the seventh through ninth thoracic vertebrae. Standing and ambulation typically are goals for children with thoracic-level lesions, primarily for exercise and for movement within the home or classroom. However, by four years of age this child was able to ambulate on even and uneven surfaces using a single-quad cane. She exhibited a normal gait pattern in the right lower extremity during ambulation. Additionally, functional movement in the left lower extremity during ambulation occurred without the use of an ankle-foot orthosis.

The rehabilitation progress of this child was atypical of that seen in a child with a meningomyelocele at the level of the seventh through ninth thoracic vertebrae. Because of her split cord malformation, she retained normal function in the right lower extremity although function was impaired in the left lower extremity.