Mobility Aids for Children With High‐level Myelomeningocele: Parapodium Versus Wheelchair

Abstract

SUMMARY The optimal method for providing mobility for children with myelomeningocele remains controversial. 39 children using a parapodium were compared with 29 children in wheelchairs. There were no significant differences between the two groups for medical complications, use of health‐care services or activities of daily living, although there were differences in the patterns of complications. Children using the parapodium were more likely to develop lesions of the lower extremities, to have dislocated hips, to be more obese and to watch more television; children using wheelchairs were more likely to develop lesions of the gluteal region, to have knee‐flexion contractures and to have fewer fecal accidents. The parapodium was judged by families to be less effective as a mobility aid; however, the upright posture it allows was considered extremely advantageous. A combined approach allowing upright posture and wheeled mobility would appear to be optimal. RÉSUMÉ Aides au déplacement dans les spina bifida de localisation haute: déambulateur contre fauteuil roulant La méthode optimale pour apporter la mobilité aux spina bifida est discutée. 39 enfants utilisant un déambulateur ont été comparés à 29 enfants en fauteuil roulant. Il n'y avait pas de différences significatives entre les deux groupes pour les complications médicales, l'utilisation de services de soins ou l'activité journalière, bien qu'il ait eu des différences dans l'allure des complications. Les enfants utilisant le déambulateur avaient plus de chance de développer des lésions des extrémités inférieures, étaient plus obèses et regardaient davantage la télévision; les enfants en fauteuil roulant développaient plus facilement des lésions fessières, des contractures des genoux et avaient moins d'accidents d'incontinence fécale. Le déambulateur était jugé par les families comme une aide de mobilité moins efficace; cependant la position érigée que permet le déambulateur est considérée comme très avantageuse. Une approche combinée associant la position érigée et la mobilité du fauteuil semble optimale. ZUSAMMENFASSUNG Mobilitätshilfen für Kinder mit hochsitzender Myelomeningocele: Parapodium contra Rollstuhl Es besteht keine Einigkeit über die optimale Methode, Kindern mit Myelomeningocele Mobilität zu verschaffen. 39 Kinder, die ein Parapodium benutzten, wurden mit 29 Kindern im Rollstuhl verglichen. Es fanden sich keine signifikanten Unterschiede zwischen den beiden Gruppen im Hinblick auf medizinische Komplikationen, Beanspruchung medizinischer Dienstleistungen oder Aktivitäten im täglichen Leben, es gab jedoch Unterschiede bei der Art der Komplikationen. Kinder, die ein Parapodium benutzten, entwickelten häufiger Läsionen der unteren Extremitäten, hatten eher dislozierte Hüften, waren adipöser und sahen mehr fern; Kinder im Rollstuhl entwickelten häufiger Läsionen in der Glutealregion, Beugekontrakturen der Kniegelenke und hatten seltener Stulprobleme. Nach dem Urteil der Familien war ein Parapodium als Mobilitätschilfe weniger geeignet, die dadurch gegeb...

Obesity and Myelomeningocele: Anthropometric Measures

“…The weight gain among older patients in this group agrees with an earlier study (36) but contradicts the suggestion that children either become obese and ''retreat to a wheelchair'' or become obese because they have given up walking (37,38). Patients in this least paralyzed group rarely ''retreat to wheelchairs'' (37)(38)(39)(40). The development of obesity is seen in the same level paralysis male group only after the age of graduation from high school and may be due to termination of team athletic activities and/or the adoption of a more sedentary lifestyle.…”

“…The observations we report in this study, therefore, reflect a greater emphasis on weight control and may not be comparable with other groups of myelomeningocele patients, as suggested by Liptak et al (39).…”

Efficacy of bracing the lower limbs and ambulation training in children with myelomeningocele

“…Of those, there were none at evidence level I, nine at level II 1,2,3,4,5,6,7,8,9 , none at level III, 11 at level IV 10,11,12,13,14,15,16,17,18,19,20 , and none at level V. These studies appeared to imply that there is little benefit to walking with a parapodium, hip-knee-ankle-foot orthosis, or reciprocating gait orthosis. According to the studies, most children who walked with these orthotic devices eventually gave up walking as teenagers and chose a wheelchair for a more energyefficient means of locomotion.…”

Osteoporosis in paediatric patients with spina bifida

“…In the first domain titled, 'incidence and riskof fracture,' the search provided 37 Finally, for the 'Prevention and nonpharmacological and pharmacological treatment of osteoporosis' review, we initiated our search by focusing on randomized, quasi-randomized, and non-randomized controlled trials and cohort and case-control studies. Because of the low number of studies identified, we considered case studies and case series.…”

“…Liptak et al analysed 39 children who used a parapodium and 29 children in wheelchairs with MMC in a comparative study and showed that early use of the parapodium did not protect against fractures. 37 The most ideal mobility device remains controversial. Weight bearing during ambulation should not be confused with passive weight bearing using a device, such as a standing frame.…”