Mobility, Sitting Posture and Reaching Movements in Children with Myelomeningocele

Children with myelomeningocele (MMC) usually have problems with daily life activities, but the background to their problems is not altogether obvious. An understanding of the possible causes of activity problems is a prerequisite for the effectiveness of physical therapy. The overall aim of the present studies was to identify impairments above the cele level, which might influence mobility in children with MMC (study I) and to analyse sitting posture (study II) and the movement characteristics of reaching movements (study III and IV). In total, 41 children and young adults with MMC and without mental retardation were investigated. Study I comprised 32 children, 6-11 years. Mobility and the caregiver assistance required for mobility were quantified according to the Paediatric Evaluation of Disability Inventory (PEDI) and correlation between mobility and neurological impairment, hand function and cognitive function were calculated. The results showed that nine children achieved independent mobility and that there was a moderate and significant correlation between the need for physical assistance and high cele level, impaired hand function and impaired cognitive function. In those children who used a wheelchair, only poor hand strength was significantly correlated with the need for caregiver assistance. Study II comprised 11 children, 10-13 years, and a control group of 20 healthy children. Sitting posture was investigated by using a force plate and analysed from the frequency and the amplitude of the postural sway. The reaction forces before and during rapid arm lift were also analysed. The result showed that children with MMC had significantly lower sway frequency compared to the controls. In both groups, the ground reaction forces were registered before the children lifted their arms. Study III and IV comprised 31 children and young adults, 9-19 years and 31 matched controls. Reaching movements were investigated with a digitising tablet, linked to a computer. The ability to program and execute reaching movements was analysed and also the ability to adapt reaching to new visuomotor conditions. The results showed that the MMC group had poorer precision, less straight movements and shorter deceleration phases as compared to the controls. In both groups the movements were pre-programmed. In addition, adaptation of reaching to new visuomotor conditions was poor in the MMC group as compared to the controls. In conclusion we found that impairments above the cele level influenced mobility and the control of sitting posture in children with MMC. Reduced precision and co-ordination of reaching, and also difficulties with motor adaptation, could partly explain thier problems with hand activities. These findings need to be considered in therapy programs for children and young adults with MMC