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Physical activity capacity in children with myelomeningocele
Insights
Children with myelomeningocele show impairments related to motor function level. Even those without motor deficits have reduced strength, highlighting the need for quantitative muscle assessment and efficient wheelchair use.
Area of Science:
- Pediatric Rehabilitation
- Neuromuscular Function
- Biomechanical Analysis
Background:
- Myelomeningocele significantly impacts motor function and ambulation in children.
- Understanding functional deficits is crucial for optimizing mobility interventions.
- Previous assessments often rely on manual muscle testing, potentially missing subtle strength impairments.
Purpose of the Study:
- To comprehensively assess physical function in children with myelomeningocele across varying motor function levels.
- To investigate the relationship between muscle strength, ambulatory function, and aerobic capacity.
- To compare the energy efficiency of walking versus wheelchair propulsion.
Main Methods:
- Studied 33 children (10-15 years) with myelomeningocele, grouped by motor function level (L2+, L3-4, L5-sacral, no deficit).
- Measured isometric hip/knee extension strength, range of motion, ambulatory velocities, maximal aerobic capacity (VO2 max), and oxygen uptake during ambulation and wheeling.
- Correlated ambulatory velocity with hip and knee extensor strength.
Main Results:
- Maximal ambulatory velocity strongly correlated with hip extensor (r=0.85) and knee extensor (r=0.81) strength.
- All measured variables were highly dependent on the level of motor function.
- Subjects without motor deficits exhibited impairments in usual and maximal running velocities and VO2 max, linked to underlying strength deficits.
- Wheelchair propulsion was significantly more energy-efficient than walking.
Conclusions:
- Motor function level is a primary determinant of physical function in pediatric myelomeningocele.
- Quantitative muscle strength assessment is vital, as manual testing may overlook significant deficits.
- Wheelchair use offers superior energy efficiency compared to walking for individuals who can do both.
- Even children without overt motor deficits require careful strength evaluation and may benefit from assistive devices.
Abstract:
Thirty-three children (10 to 15 years of age) with myelomeningocele were studied to determine isometric muscle strength of hip and knee extension, range of hip and knee extension, usual and maximal ambulatory velocities, maximal aerobic capacity, and the energy cost (oxygen uptake) of ambulation versus wheelchair usage in subjects who both walked and wheeled. Subjects were placed into one of four groups depending on their level of motor function (those with motor levels at L2 and above, L3-4, L5 to sacral, and without motor deficit). Maximal ambulatory velocity correlated with strength of the hip extensor (r = 0.85) and knee extensor (r = 0.81) muscles. All variables were found highly dependent upon the level of motor function. Subjects with the greatest deficits had the most significant impairments and vice versa. It was found, however, that subjects without motor deficit had impairments in the usual speed of ambulation (9%), maximal running velocity (20%), and VO2 max (13%). These deficits were due to the measured strength deficits in these subjects as compared to normal values. This finding underscores the importance of quantitative assessment of muscle strength as significant deficits in strength can be missed with manual muscle testing. In those subjects who walked and wheeled, wheeling was found much more energy efficient. Wheeling at 4.8 km/hr was 11% more efficient than walking at 33% that velocity.