Gait and functional issues relating to spina bifida

People with Spina Bifida have different degrees of muscle paralysis, spine and limb difficulties and thus need specialised treatments that address any deformity that interferes with the patient’s function ie. Accessibility, gait and independence.

Generally, muscular imbalance is present, which results in joint contractures and developmental problems such as hip dislocation and spinal deformities.

Initially, a general orthopaedic evaluation is performed, to detect any early changes that may require intervention. A gait analysis which looks at the patient's muscle innervation, strength, joint range of movement and coordination is also used to evaluate patients functionally.

Independent ambulation generally is a function of having an intact quadriceps muscle with good-plus or excellent-plus strength levels. Patients who do not have adequate quadriceps function may require bilateral Lofstrand crutches or may be primarily restricted to a wheelchair.

Functional ambulation generally is described according to the following levels:
• Community ambulator - Indoors or outdoors, crutches with or without braces
• Household ambulator - Only indoors, crutches with or without braces
• Nonfunctional ambulator - Wheelchair, crutches, and braces, in therapy
• Nonambulator - Wheelchair bound

In addition, patients should be monitored for appropriate development and be provided with prolonged physical therapy, gym resources, and adaptive training while in school. Subsequent efforts are necessary to encourage, develop, and maintain independence.

The goal of bracing is to allow patients to function at the maximum level permitted by their neurologic lesion and intelligence. Bracing also ensures a normal developmental progression, its aim being to enable patients to ambulate and to participate in appropriate age-related activities. Finally, orthotics should aid in minimizing energy expenditure to maintain mobility levels.

As long as flexion contractures and skeletal deformities are not severe, patients with no lower-extremity reflexes may, with determination and strong upper extremities, become ambulatory using bilateral Lofstrand or forearm crutches.