Ambulation in persons with myelomeningocele

Abstract

The aim was to study ambulatory function in persons with myelomeningocele. Different systems used to classify the extent of motor paresis were compared. The classification according to five commonly used systems showed a lack of congruence in classes L3 level and downward. In relation to functional ambulation groups of Hoffer, none of the patients could be classified in the same categories by all classification systems. The patient's orthopedic and neurologic status with respect to ambulation was investigated and possible causative factors influencing ambulatory function were discriminated from the influence of the motor paresis. It was found that children with similar muscle paresis exhibit different ambulatory function due to other factors involved than the mere neurological lesion level. Change in ambulatory status studied over a 12- year observation time showed downward transitions in ambulatory level explained by deterioration of the neurological level of lesion, spasticity, knee and hip flexion contractures, as well as by those of major medical events. Upper body movements in children with lumbo-sacral neurological level were quantified with motion analysis indicating that independent walking with orthoses show well defined and consistent upper body movements with the amplitudes of the upper body segments significantly correlated to the degree of muscle weakness of the lower limbs. No differences were seen in upper body segment displacements during walking with a knee-ankle-foot orthoses versus foot-ankle orthosis. This result is considered to be influenced by the achieved orthosis gait pattern and the material of the orthosis. Examination of energy expenditure in children with lumbo-sacral neurological level indicated that children with weaker hip muscles had higher energy effort as compared to children with better hip extension and abduction strength, although the difference was not statistically significant. Since energy expenditure while walking with the knee-ankle-foot orthosis was not found to be higher as compared to an ankle-foot orthosis we advise the former during childhood to vertically align the knee with shank and foot, particularly relevant in children with reduced hip abductor strength