Functional Ambulation in Patients with Myelomeningocele

Hoffer, M. Mark; Feiwell, Earl; Perry, Ralph E.; Perry, Jacquelin; Bonnett, Charles A.

doi:10.2106/00004623-197355010-00014

Cited by 558 publications

(303 citation statements)

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“…These findings are in accordance with earlier publications [3,5,[15][16][17][18]. Patients with hip dislocation were also significantly more often nonambulators than those with contained hips.…”

Section: Discussionsupporting

confidence: 92%

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Associations between orthopaedic findings, ambulation and health-related quality of life in children with myelomeningocele

Danielsson

Bartonek

Levey

et al. 2008

Journal of Children's Orthopaedics

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Purpose Modern principles for treatment of patients with myelomeningocele include early closure of the neural tube defect, neurosurgical treatment of hydrocephalus and treatment aimed at minimizing contractures and joint dislocations. The aim is to achieve a better survival rate and a better quality of life (QOL). Better ambulatory function is thought to improve the management of activities of daily living. This study focused on evaluating which factors might affect ambulation, function and health-related QOL in children with myelomeningocele. Methods Thirty-eight patients with neurological deficit from myelomeningocele were examined in an unbiased follow-up. This included a physical examination using validated methods for ambulatory function and neuromuscular status, chart reviews and evaluation of radiographs in terms of hip dislocation and spine deformity. The Pediatric Evaluation of Disability Inventory (PEDI) was used to measure mobility, self-care and social function, and the Child Health Questionnaire (CHQ-PF50) was used to measure QOL. Results Muscle function class, quadriceps strength, spasticity in hip and/or knee joint muscles and hip flexion contracture as well as the ambulatory level all affected functional mobility as well as self-care/PEDI. Patients with hip dislocation, spinal deformity or those who were mentally retarded also had significantly worse functional mobility. Besides being affected by the severity of the neurological lesion, self-care/PEDI was significantly impaired by hip flexion contracture and absence of functional ambulation. General health-related QOL was significantly lower in this patient group than for US norms. Nonambulatory and mentally retarded patients had a significantly lower physical function of their QOL (CHQ). Conclusions The severity of the disease, i.e. reduced muscle strength and occurrence of spasticity around hip/knee, affected ambulation, functional mobility and self-care. Acquired deformities (hip dislocation and spine deformity) affected functional ambulation only. Patients with reduced functional mobility and self-care experienced lower physical QOL. Children with myelomeningocele had significantly reduced QOL compared to healthy individuals.

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Section: Discussionsupporting

confidence: 92%

“…The ambulatory function was assessed using the criteria of Hoffer et al [5], with some modifications [3]. For the purpose of statistical analyses, patients were grouped together as either ''ambulatory'', i.e.…”

Section: Physical Examinationmentioning

confidence: 99%

Associations between orthopaedic findings, ambulation and health-related quality of life in children with myelomeningocele

Danielsson

Bartonek

Levey

et al. 2008

Journal of Children's Orthopaedics

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“…In our series, 37.5% of patients with high or mid-lumbar levels were community walkers. This percentage is higher than those reported by DeSouza and Caroll (10%), 54 Ho er et al (31%), 14 Feiwell et al (26%), 48 Asher and Olson (25%), 51 Stilwell and Menelaus (30%) 55 and Samuelsson and Skoog (23%). 56 Only Mazur et al 57 and Shurtle et al 2 describe larger percentages of community ambulators (54 and 46.4%, respectively) in high or mid-lumbar patients.…”

Section: Discussioncontrasting

confidence: 54%

Neurological abnormalities, major orthopaedic deformities and ambulation analysis in a myelomeningocele population in Catalonia (Spain)

1999

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The aim of the study was to analyze the present status of neurologic abnormalities, major orthopaedic deformities and ambulatory status in a large myelomeningocele population. Patients and methods: Cross-sectional study based on the clinical and radiographic records of 322 patients treated and followed-up from 1967 ± 1995. The setting was a multidisciplinary spina bi®da unit within a third-level university hospital, which serves as the referral centre for these patients in Catalonia (Spain). We collected information on diagnosis, central nervous system, musculoskeletal system (spinal and hip deformities) and functional level in each patient. To study relationships among the variables, the Mann-Whitney U and the Chisquared tests were applied. Results were considered to be statistically signi®cant at P levels of 40.05. Results: Mean age was 15.9 years. 78.1% of patients had mid-lumbar, low-lumbar or sacral neurological levels; 97.5% had hydrocephalus and 68.8% were shunted. Prevalence of spine deformities was 45.3%; 38.8% had dislocation of one or both hips. Median age of walking onset was 37.1 months and 74.8% of patients were ambulatory. Median age at which ambulation ceased was 128 months (10 years and 8 months). The bivariate analysis showed statistically signi®cant relationships between neurological level and all the variables studied (P50.001, P50.02) except body mass indexes and intelligence quotient. Conclusions: Neurological level was the main factor that determined neurological abnormalities, major orthopaedic deformities and ambulatory status.

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“…The ambulation functional classification 10 and the use of walking aids were specified. Spasticity was assessed using the Ashworth scale.…”

Section: Methodsmentioning

confidence: 99%

Disability and determinants of gait performance in tropical spastic paraparesis/HTLV-I associated myelopathy (HAM/TSP)

Franzoi

Araújo

2006

Spinal Cord

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Study design: Cross-sectional. Objectives: The aim of this survey is to describe the disability profile in a group of tropical spastic paraparesis/HTLV-I-associated myelopathy patients, identifying the requirements for community ambulation. Setting: Terciary care unit, Rio de Janeiro, Brazil. Methods: Seventy-two patients were assessed (49 female and 23 male), referred by tertiary care centers, when a clinical protocol was applied. Results: The sample had an average age of 40 years and an average of 137 months of duration of the disease. The most prevalent aspects of disability found were in gait and sphincter control areas. A total of 72% of the patients were community ambulators and 17% were restricted to wheel chair. Age, strength and low-back pain interfere in activities of daily living (Po0.05). A positive correlation was found between community ambulation and the knee extensors (r ¼ 0.80) and ankle plantar flexors (r ¼ 0.74). Strength, age, low-back pain, duration of disease, asymmetric onset of the symptoms and spasticity interfered in the ability to walk (Po0.05). A rehabilitation program was proposed focusing on modifiable factors that affect disability level. Conclusion: It was possible to describe the profile of disability in this group of patients, identifying the requirements to the community ambulation. Sponsorship: Not applicable.Spinal Cord (2007) 45, 64-68.

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Functional Ambulation in Patients with Myelomeningocele

Cited by 558 publications

References 0 publications

Associations between orthopaedic findings, ambulation and health-related quality of life in children with myelomeningocele

Associations between orthopaedic findings, ambulation and health-related quality of life in children with myelomeningocele

Neurological abnormalities, major orthopaedic deformities and ambulation analysis in a myelomeningocele population in Catalonia (Spain)

Disability and determinants of gait performance in tropical spastic paraparesis/HTLV-I associated myelopathy (HAM/TSP)

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