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Relationships among classifications of impairment and measures of ambulatory function for children with spina bifida
Susan A Rethlefsen1, Melissa A Bent1,2, Nicole M Mueske1
1Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA, USA.
Insights
The Dias Functional Classification of Myelomeningocele (FCM) best reflects daily walking activity in children with Spina Bifida, correlating better than neurosegmental classifications. This functional classification is recommended for patient assessment.
Area of Science:
- Pediatric Rehabilitation
- Clinical Biomechanics
- Neuroscience
Background:
- Spina Bifida classification systems aim to standardize patient assessment.
- Understanding the relationship between classification and functional mobility is crucial for effective rehabilitation.
Purpose of the Study:
- To investigate the association between neurosegmental and functional level classifications in children with Spina Bifida.
- To determine which classification system most accurately reflects daily walking activity.
Main Methods:
- A prospective correlational study involving 61 children with Spina Bifida.
- Assessment of neurosegmental levels (X-ray, International Myelodysplasia Study Group [IMSG]) and functional levels (Hoffer, Dias Functional Classification of Myelomeningocele [FCM], Functional Mobility Scale [FMS]).
- Daily walking activity measured using StepWatch monitors; data analyzed with Spearman rank correlation.
Main Results:
- Neurosegmental classifications showed poor correlation with each other.
- Dias FCM and FMS demonstrated strong correlation (r=0.80-0.87).
- Dias FCM and FMS showed moderate to good correlation with daily steps (r=0.53-0.62), outperforming IMSG (r=0.45) and X-ray levels (r=0.03).
Conclusions:
- The Dias FCM, incorporating neurosegmental and functional elements, is a comprehensive classification that correlates well with walking activity.
- Functional classifications, particularly Dias FCM, are superior to neurosegmental classifications for reflecting daily mobility in Spina Bifida.
- Recommend Dias FCM for classifying Spina Bifida patients and combining FMS with activity monitoring for clinical and research purposes.
Purpose:
To examine associations between neurosegmental and functional level classifications in children with Spina Bifida, and determine which classification best reflects daily walking activity.
Materials And Methods:
A prospective correlational study was conducted. Children with Spina Bifida were given ratings for lesion level [X-ray and International Myelodysplasia Study Group (IMSG) level determined by muscle strength] and functional level [Hoffer ambulatory level and Dias functional classification of myelomeningocele (FCM), Functional Mobility Scale (FMS)]. Daily walking activity was measured with a StepWatch monitor. Data were analyzed using Spearman rank correlation.
Results:
Sixty-one children were included, [56% male, average age 9.8 (SD 2.7) years]. The neurosegmental level classifications, X-ray lesion level and IMSG level showed little to no correlation with each other (r = 0.17). Among functional classifications, the Dias FCM correlated strongly with the FMS (r = 0.80-0.87). Correlations with steps per day were moderate to good for the Dias FCM and the FMS (r = 0.53-0.62), fair for IMSG level (r = 0.45), and little to none for X-ray lesion level (r = 0.03).
Conclusions:
The Dias FCM is comprehensive, including elements of neurosegmental level and function, and correlates well with walking activity. We recommend its use for classifying function in patients with Spina Bifida.Implications for rehabilitationFunctional classifications correlate better with daily walking activity than neurosegmental level classifications for patients with Spina Bifida.The Dias FCM includes neurosegmental and functional level elements, correlates well with daily activity, and is recommended for use in classifying Spina Bifida patients.Combined use of the FMS and activity monitoring is recommended for research and clinical assessment.
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