Gait in childhood and adulthood in persons with myelomeningocele – a retrospective analysis

Abstract Background Gait patterns in children with myelomeningocele (MMC) at various neurological levels have been described, both with and without orthotic support. Although the neurological level of the lesion serves as an important predictor of ambulatory potential, the expected walking ability is not always achieved, as additional factors such as spasticity may influence gait negatively. The aim of this study was to retrospectively compare gait patterns as assessed in childhood with those observed in adulthood. Methods Of 59 individuals with MMC aged 18 years or older, 29 had undergone three-dimensional gait analysis in childhood (Ch-GA). These data were retrospectively analysed and compared with findings from a subsequent adult gait analysis (Ad-GA). The mean (standard deviation) age at the time of Ch-GA was 11.6 (4.1) years and at Ad-GA 25.9 (3.9) years. The median (range) interval between assessments was 15.0 years (5.1–17.2). Results Twenty-two participants maintained independent, non-assisted walking (Group A), 5 had transitioned from independent walking to using a walking aid (Group B), and 2 used a walking aid at both Ch-GA and Ad-GA (Group C), with individualized orthotic prescriptions provided at both time points. In Group A, two of eleven kinematic variables and six of eleven kinetic variables in the hip, knee, and ankle showed deterioration, and walking speed had decreased. Functional ambulation declined from 18 community ambulators and 4 household ambulators (Ha) in childhood to 8 and 14, respectively, in adulthood. In Group B, analysed with only Gait Deviation Index (GDI), values were unchanged, but all temporospatial gait parameters had deteriorated. Functional ambulation decreased from five individuals classified as Ha to two Ha and three non-functional ambulators. The two individuals in Group C, who used a walker at both assessments, largely maintained the same GDI values and temporospatial parameters as in childhood. Conclusion Largely consistent with our original expectations, the findings indicate that gait patterns remain relatively stable from childhood to adulthood in individuals with MMC when supported by appropriate rehabilitation interventions, though some deterioration of gait and ambulation occurred. The results reflect gait-related changes that can be expected during growth in this population.