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Walking activity during daily living in children with myelomeningocele
Pauline Yasmeh1, Nicole M Mueske1, Siamak Yasmeh2
1a Children's Orthopaedic Center, Children's Hospital Los Angeles , Los Angeles , CA , USA.
Insights
Children with myelomeningocele (spina bifida) in the sacral and low lumbar spine showed typical walking activity, unlike those with mid-high lumbar involvement who were less active. This highlights the need for targeted rehabilitation strategies to address activity differences.
Area of Science:
- Pediatric rehabilitation
- Neurology
- Biomedical engineering
Background:
- Myelomeningocele, a severe birth defect, often impacts mobility and increases the risk of secondary health issues like obesity and osteoporosis.
- Understanding the real-world walking activity and intensity in children with myelomeningocele is crucial for effective management and intervention.
Purpose of the Study:
- To quantify and compare the daily living walking activity and stepping intensity in children with myelomeningocele across different lesion levels.
- To establish objective, real-world data on physical activity to inform rehabilitation strategies.
Main Methods:
- A prospective, cross-sectional study involving 47 children with myelomeningocele and 7 typically developing children.
- Walking activity was measured over one week using StepWatch activity monitors.
- Analysis included total steps per day, and time spent at low, medium, and high-intensity stepping, with statistical comparisons between groups.
Main Results:
- Children with sacral and low lumbar myelomeningocele demonstrated walking activity comparable to typically developing peers.
- Children with mid-high lumbar myelomeningocele had significantly fewer total steps per day and less time spent at all stepping intensities compared to other groups.
- The mid-high lumbar group also showed a higher BMI percentile than the control group.
Conclusions:
- Walking performance in children with sacral and low lumbar myelomeningocele is similar to typically developing children, even when using assistive devices.
- Reduced physical activity in children with mid-high lumbar myelomeningocele may exacerbate secondary health conditions.
- Quantified real-world walking data can guide the development of targeted rehabilitation interventions and treatment strategies for children with myelomeningocele.
Purpose:
To quantify the walking activity of children with myelomeningocele during daily living.
Method:
Walking activity was measured using a StepWatch activity monitor over one week in 47 children with myelomeningocele (27 males; 9 years 11 months SD 2 years 7 months; 18 sacral, 9 low lumbar, 20 mid-high lumbar) and seven children with typical development (5 males; 11 years 1 month SD 1 year 11 months) in a prospective, cross-sectional study. Average total steps per day, number of steps and minutes spent at low, medium and high intensity stepping were evaluated. Groups were compared using t-tests and chi-squared tests with Bonferroni post-hoc adjustment.
Results:
Children with sacral and low lumbar myelomeningocele exhibited no significant differences in demographic characteristics or walking performance compared to typically developing children. Children with mid-high lumbar myelomeningocele exhibited higher BMI percentile than the control group (p = 0.04) and took fewer total steps per day than all other groups (p ≤ 0.04). Children with mid-high lumbar myelomeningocele also spent significantly less time taking steps at all intensity levels, particularly medium-intensity, than the sacral and low lumbar groups (p ≤ 0.04).
Conclusions:
Children with sacral and low lumbar myelomeningocele had walking performance similar to typically developing children despite a common need for braces and assistive devices. Children with mid-high lumbar myelomeningocele were less active, which may lead to heightened risk for secondary health conditions in addition to those associated with myelomeningocele. Implications for Rehabilitation Obesity, muscle weakening and disuse osteoporosis are issues for those with myelomeningocele, all of which are affected by walking activity. Understanding walking activity and intensity in children and adolescents with myelomeningocele may aid in developing focused rehabilitation interventions and strategies. Real world walking activity as an objective and quantified measure has the potential to help guide therapists and surgeons to more effective treatments.
