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Ambulation in the adolescent with myelomeningocele. I: Early childhood predictors
Insights
Many children with myelomeningocele experience mobility challenges. Early predictors like independent walking and wheelchair use by age seven can accurately forecast adolescent ambulation, highlighting the importance of early interventions.
Area of Science:
- Pediatric Neurology
- Rehabilitation Medicine
- Spina Bifida Research
Background:
- Myelomeningocele is a severe birth defect impacting spinal cord development.
- Understanding long-term ambulatory outcomes is crucial for patient care and intervention planning.
Purpose of the Study:
- To assess long-term ambulation and mobility in a cohort of individuals with myelomeningocele.
- To identify predictors of adolescent ambulation in this population.
Main Methods:
- Retrospective cohort study using birth records and follow-up assessments.
- Data collection included chart reviews and questionnaires assessing ambulation, neurologic level, and early motor skills.
- Follow-up occurred in 1981 for children born between 1966-1970.
Main Results:
- Of 77 survivors, 56 were community ambulators, but many had limited daily walking distances.
- 20 children showed a decline in walking between ages 10-15, often linked to immobilization.
- Early ability to walk outdoors and use a wheelchair predicted adolescent mobility with 87% accuracy.
Conclusions:
- Ambulation in individuals with myelomeningocele can decline over time, with immobilization being a potential factor.
- Early functional milestones, such as independent walking and wheelchair use, are strong predictors of long-term mobility.
- Neurologic level is a less accurate predictor of adolescent ambulation compared to early functional abilities.
Abstract:
Birth records identified 192 children with myelomeningocele born in Minnesota in the years 1966-1970. In 1981 current ambulation, neurologic level, and early motor achievement were determined in 77 of the surviving 80 children by chart review and questionnaire. Of these 77, 20 were not walking at all, one was walking only in therapy, and the remaining 56 were community ambulators (16 of these occasionally used wheelchairs). The actual distance walked daily varied from 100 to 5,000 meters in this group, with 19 of these community ambulators never walking as far as around a block. Five children never walked, 16 had stopped walking by 1981, and another six, although still walking, were doing less than they had previously. In 20 of the 22 who showed a decrease in total walking between the ages of ten and 15, the beginning of the decline was associated with a period of immobilization, demonstrating the potentially adverse effects of immobilization in these children. The ability to walk outdoors independently and to use a wheelchair by age seven predicted ambulation as an adolescent correctly for 87% of the children. In contrast, neurologic level predicted adolescent mobility correctly for only 71%.