Relationship between Movement Quality, Functional Ambulation Status, and Spatiotemporal Gait Parameters in Children with Myelomeningocele

Abstract

Aims

We investigated relationships among the Pediatric Neuromuscular Recovery Scale (Peds NRS), modified Hoffer Scale, and spatiotemporal gait parameters in children with myelomeningocele (MMC).

Methods

21 children with MMC, age 5.3 years (SD = 2.6), were assessed by three clinicians using the Peds NRS and modified Hoffer Scale. In eight children, gait parameters were also measured.

Results

The Peds NRS summary score demonstrated good correlation with modified Hoffer Scale score (r = −0.64, p = 0.002) that accounted for 41% of variation in summary score. Six Peds NRS seated/standing items exhibited good relationships with modified Hoffer Scale (r = −0.51 to −0.70, p ≤ 0.023), and the sit-to-stand item demonstrated an excellent relationship (r = −0.85, p < 0.001). Sit-to-stand and three standing/walking items exhibited excellent associations with cadence (R_s = 0.81 to 0.88, p ≤ 0.014), and swing and stance time (both R_s = −0.83 to −0.90, p ≤ 0.01). Two Peds NRS standing items and modified Hoffer Scale score demonstrated good correlations with velocity (R_s = 0.71, p = 0.047; R_s = −0.73, p = 0.04, respectively).

Conclusions

Our findings suggest that children with MMC who exhibit greater movement quality and trunk control are likely to be functional ambulators with more optimal spatiotemporal gait parameters.

Keywords:

• Functional assessment
• gait
• movement analysis
• myelomeningocele
• pediatrics
• spina bifida
• spinal cord injury

Acknowledgments

This study would not have been possible without the dedication of Melissa Clarke, OTR/L, Germaine Ferreira, DPT, Christy Fryatt, DPT, and Susan Nickelson, OTR, OTD. The authors would like to thank the children and families who participated in this study, as well as Jessica Crosby, DPT, Jacob Golembeski, MOT, Shelby Schultz, DPT, Emma Tuskey, MOT, and Laura Waples, DPT for their assistance in data collection.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1 G*Power Version 3.1.9.2, Franz Faul, Universitat Kiel, Germany.

2 ProtoKinetics, Havertown, Pennsylvania.

3 IBM Corporation, Armonk, New York.

Additional information

Funding

This was an internal grant from the Board of Directors at University of St. Augustine for Health Sciences.

Notes on contributors

Megan B. Flores

Megan B. Flores is an APTA Board Certified Clinical Specialist in Pediatric Physical Therapy and an Assistant Professor in the University of St. Augustine for Health Sciences in Austin, Texas, where she teaches pediatric and neuromuscular classes. Dr. Flores completed a Master of Physical Therapy from University of Texas Southwestern Medical Center in 2004 and a PhD in Physical Therapy from Texas Woman's University in 2019. Her research focuses on outcome measures and interventions in children with neuromotor disabilities (Down syndrome, spina bifida, and cerebral palsy). Megan has dedicated her clinical experience to neurorehabilitation of pediatric and adult patients. She has worked in a variety of settings, including: acute care, inpatient rehabilitation, home health and hippotherapy.

Kathleen J. Manella

Kathleen J. Manella, PT, PhD is an Associate Professor at the University of St. Augustine's Austin Campus DPT program. Dr. Manella earned a BSPT from University of Illinois (1975), a MSPT from University of Southern California (1987), and a PhD in PT/Neuroscience from University of Miami (2011). Dr. Manella has extensive clinical experience in orthopedic and neurorehabilitation of pediatric and adult individuals. Dr. Manella's research is focused on measurement of abnormal lower limb reflex activity and operant conditioning interventions for people with spinal cord injury and stroke. She has developed a smart phone video based clinical tool for ankle clonus measurement.

Elizabeth M. Ardolino

Elizabeth M. Ardolino, PT, PhD is an Associate Professor in the University of St. Augustine's Austin Campus DPT program. Dr. Ardolino earned a MPT from the University of Scranton in 2002, and a Masters of Science Degree in Physical Therapy from Temple University in 2008, and a PhD in 2010 from Seton Hall University. Dr. Ardolino's clinical experience has focused on the neurorehabilitation of pediatric and adult clients. Dr. Ardolino's research is centered on assessing and promoting trunk control in both adults and children with neurologic disorders. She has developed three outcome measures for the adult and pediatric neuro populations.