Ambulatory outcome in children with myelomeningocele: effect of lower-extremity muscle strength

Myelomeningocele is a form of spina bifida in which a portion of the spinal cord and membranes protrude; it is a congenital disorder that can be crippling. Whether children suffering from myelomeningocele are able to walk has been found to depend, in part, on the extent of the damage and the strength of the muscles in the lower body. There are no consistent data, however, that allow easy prediction of outcome with regard to mobility. Some investigators have reported that the most important muscle groups for walking (ambulation) are those in the knees, hips, and the quadriceps. In the present study, 291 children with myelomeningocele were grouped by their ability to ambulate: community ambulators, partial ambulators (able to ambulate in the home, but not in the community), and nonambulators. Muscle strength was assessed and graded as well. The purpose of the study was to determine the degree to which different muscles influence ambulation. The best predictor of ambulation was the strength of the pelvic muscles in conjunction with the quadriceps, the tibia, (a bone between the ankle and the knee), and the muscles in the buttocks. Deterioration of the strengths of these muscles was not age-related. The results provide useful information for the surgical correction of mobility problems in children suffering from myelomeningocele. (Consumer Summary produced by Reliance Medical Information, Inc.)