- •Steps per day in youth with spina bifida was best predicted by assistive device use.
- •Youth with spina bifida who use assistive devices walk less.
- •Older age, male sex, and higher body mass index correlated with fewer steps per day.
- •Reduced lower extremity strength also related to fewer steps per day.
To assess the relationship between real-world walking activity in children and adolescents with myelomeningocele (MMC) and gross measures of lower extremity strength, range of motion, demographics, and medical history.
Participants recruited in outpatient clinics; data collected in a hospital-based motion analysis laboratory and in the community.
Children and adolescents (N=52) with daily step count data available from a larger study of ambulatory children and adolescents with MMC.
Main Outcome Measure
Univariate and multivariate regression was used to assess which participant characteristics and clinical factors were related to average number of steps per day.
Univariate analysis showed a lower number of steps per day correlated with older age, male sex, higher body mass index, higher lesion level, use of assistive devices for ambulation, history of shunt placement, more television (TV) watched per week, lower hip extension and abduction strength, knee flexion strength, and ankle dorsiflexion and plantarflexion strength, and decreased knee and hip range of motion. Only assistive device usage and hours of TV watched per week remained in the final multivariate model predicting number of steps per day.
Walking activity in children and adolescents with MMC was best predicted by assistive device use and amount of sedentary activity. Other predictors of walking activity from univariate analysis were related to assistive device use. This information can help tailor rehabilitation efforts and educate patients and families. Interventions targeting early prevention of strength loss and contractures may be important to retain or increase walking activity in children and adolescents with MMC.
List of abbreviations:BMI (body mass index), HRQL (health-related quality of life), MMT (manual muscle testing), MMC (myelomeningocele), ROM (range of motion), TV (television)
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Archives of Physical Medicine and Rehabilitation
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- The changing incidence of myelomeningocele and its impact on pediatric neurosurgery: a review from the children’s memorial hospital.Childs Nerv Syst. 2009; 25: 801-806
- Orthopedic management of spina bifida. Part I: hip, knee, and rotational deformities.J Child Orthop. 2009; 3: 441-449
- Orthopaedic management of spina bifida-part II: foot and ankle deformities.J Child Orthop. 2011; 5: 403-414
- Determinants of functional independence and quality of life in children with spina bifida.Clin Rehabil. 2005; 19: 677-685
- Functional ambulation in patients with myelomeningocele.J. Bone Joint Surg Am. 1973; 55: 137-148
- Surgeries and health outcomes among patients with spina bifida.Pediatrics. 2018; 142
- The assessment of weight status in children and young people attending a spina bifida outpatient clinic: a retrospective medical record review.Disabil Rehabil. 2013; 35: 2123-2131
- Epidemiology of physical activity and fitness in children and adolescents.Crit Rev Food Sci Nutr. 1993; 33: 403-408
- Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report.Pediatrics. 2007; 120: S164-S192
- Orthopaedic management of high-level spina bifida. Early walking compared with early use of a wheelchair.J Bone Joint Surg Am. 1989; 71: 56-61
- Walking activity during daily living in children with myelomeningocele.Disabil Rehabil. 2017; 39: 1422-1427
- An approach for determining quantitative measures for bone volume and bone mass in the pediatric spina bifida population.Clin Biomech (Bristol Avon). 2015; 30: 748-754
- Muscles testing and function.2nd ed. Williams & Wilkins, Baltimore1971
- Use of the StepWatch Activity Monitor for characterization of normal activity levels of children.J Pediatr Orthop. 2006; 26: 245-249
- Use of step activity monitoring for continuous physical activity assessment in boys with Duchenne muscular dystrophy.Arch Phys Med Rehabil. 2005; 86: 802-808
- Utility of a step activity monitor for the measurement of daily ambulatory activity in children.Arch Phys Med Rehabil. 2005; 86: 793-801
- Walking activity patterns in youth with cerebral palsy and youth developing typically.Disabil Rehabil. 2014; 36: 1279-1284
- The effects of orthoses, footwear, and walking AIDS on the walking ability of children and adolescents with spina bifida: a systematic review using International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY) as a ref.Prosthet Orthot Int. 2015; 39: 437-443
- Sociodemographic attributes and spina bifida outcomes.Pediatrics. 2015; 135: e957-e964
- Ambulation in patients with myelomeningocele: a 12-year follow-up.J Pediatr Orthop. 1999; 19: 202-206
- Factors associated with mobility outcomes in a national spina bifida patient registry.Am J Phys Med Rehabil. 2015; 94: 1015-1025
- Ambulatory outcome of children with myelomeningocele: effect of lower-extremity muscle strength.Dev Med Child Neurol. 1991; 33: 482-490
- Myelodysplasia. The influence of the quadriceps and hip abductor muscles on ambulatory function and stability of the hip.J Bone Joint Surg Am. 1978; 60: 432-443
- Associations between orthopaedic findings, ambulation and health-related quality of life in children with myelomeningocele.J Child Orthop. 2008; 2: 45-54
- Prevalence of spina bifida among children and adolescents in 10 regions in the United States.Pediatrics. 2010; 126: 274-279
- Inter-tester reliability and precision of manual muscle testing and hand-held dynamometry in lower limb muscles of children with spina bifida.Phys Occup Ther Pediatr. 2009; 29: 44-59
Published online: November 25, 2019
Supported by the National Institutes of Health – Eunice Kennedy Shriver National Institute of Child Health and Human Development (grant no. 5R01HD059826).
© 2019 by the American Congress of Rehabilitation Medicine