The Journal of Bone and Joint Surgery, Vol 65, Issue 3 350-356, Copyright © 1983 by Journal of Bone and Joint Surgery, Inc
Factors affecting the ambulatory status of patients with spina bifida cystica
M Asher and J Olson
Sixteen different factors that might affect the ambulatory status of
patients with myelodysplasia after the age of five years were analyzed in
ninety-eight patients using a linear regression technique (the Pearson
correlation coefficient). Included in the study were fifty male and
forty-eight female patients; the average age was fourteen years and four
months (range, five years and nine months to thirty-one years and ten
months). The sacral and fifth-lumbar paraplegics, with one exception, were
all community ambulators. Fourth-lumbar paraplegics were usually functional
ambulators, whose ability to walk was significantly influenced by
musculoskeletal deformity of the spine, pelvis, hips, knees, feet, and
ankles. Third-lumbar, first and second-lumbar, and thoracic level
paraplegics usually were not functional ambulators. Ambulatory function was
significantly influenced in third-lumbar paraplegics by hip deformity, in
first and second-lumbar paraplegics by obesity and possibly by age, and in
thoracic level paraplegics by age and by knee-foot-ankle deformities.
Transitions in ambulatory status were usually to a lower functional level
and were related to motivation, obesity, and musculoskeletal deformity.
Ultimately, ambulatory status is probably related in large measure to the
energy expenditure that is necessary to walk, but studies of energy
requirements were not done. These findings emphasize the importance of
controlling obesity as well as any musculoskeletal deformities that will
influence the patient's ultimate walking ability.
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