Spina bifida at the sacral level: more than minor gait disturbances

M A G C Schoenmakers, V A M Gulmans, R H J M Gooskens, P J M Helders

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

OBJECTIVE: To investigate functional outcome in two groups of children with sacral level paralysis: myelomeningocele (MMC) versus lipomyelomeningocele (LMMC). Additionally both groups were compared with each other and when possible with reference values.

DESIGN: Cross-sectional study by means of (1) clinical assessment, and (2) disability measurement.

SETTING: Spina bifida outpatient clinic at a university hospital in the Netherlands.

SUBJECTS: Sample of 30 children with MMC and 14 with LMMC. Mean age (SD) 6.0 (4.9) and 8.4 (4.9) years respectively.

MAIN MEASURES: Muscle strength, ambulation level, motor performance (Bayley Scales of Infant Development (BSID) and Movement Assessment Battery for Children), and the Pediatric Evaluation of Disability Inventory (PEDI).

RESULTS: The majority of patients in both groups were normal ambulant, 14/21 (67%) in MMC and 9/14 (64%) in LMMC. Ambulation was strongly associated with muscle strength of hip abductors (odds ratio (OR): 13.5, 95% confidence interval (CI) 2.5-73.7), and ankle dorsal-flexor muscles (OR: 110, 95% CI 8.9-135.9). No significant differences were found in lesion and ambulation level. Muscle strength and motor performance were significantly lower in the MMC group than in the LMMC group (p < 0.05). PEDI scores were comparable in both groups. Most problems were noted in mobility skills and caregiver assistance in self-care, especially regarding bladder and bowel management.

CONCLUSIONS: Gross motor and functional problems were seen in both groups. The MMC group showed more muscle weakness and motor problems. However, in both groups caregiver assistance was needed for a prolonged period, especially regarding bladder and bowel management. These findings need special attention, particularly in children who attend regular schools.

Original languageEnglish
Pages (from-to)178-85
Number of pages8
JournalClinical Rehabilitation
Volume18
Issue number2
Publication statusPublished - 2004

Keywords

  • Activities of Daily Living
  • Adolescent
  • Child
  • Child, Preschool
  • Cross-Sectional Studies
  • Disability Evaluation
  • Female
  • Gait
  • Humans
  • Infant
  • Lumbosacral Region
  • Male
  • Meningomyelocele
  • Movement Disorders
  • Netherlands
  • Paralysis
  • Spinal Dysraphism

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