title: Spina bifida at the sacral level: more than minor gait disturbances.
abstract: OBJECTIVE
  To investigate functional outcome in two groups of children with sacral level paralysis: myelomeningocele (MMC) versus lipomyelomeningocele (LMMC). Additionally both groups were compared with each other and when possible with reference values.
  
  
  METHODS
  Cross-sectional study by means of (1) clinical assessment, and (2) disability measurement.
  
  
  METHODS
  Spina bifida outpatient clinic at a university hospital in the Netherlands.
  
  
  METHODS
  Sample of 30 children with MMC and 14 with LMMC. Mean age (SD) 6.0 (4.9) and 8.4 (4.9) years respectively.
  
  
  METHODS
  Muscle strength, ambulation level, motor performance (Bayley Scales of Infant Development (BSID) and Movement Assessment Battery for Children), and the Pediatric Evaluation of Disability Inventory (PEDI).
  
  
  RESULTS
  The majority of patients in both groups were normal ambulant, 14/21 (67%) in MMC and 9/14 (64%) in LMMC. Ambulation was strongly associated with muscle strength of hip abductors (odds ratio (OR): 13.5, 95% confidence interval (CI) 2.5-73.7), and ankle dorsal-flexor muscles (OR: 110, 95% CI 8.9-135.9). No significant differences were found in lesion and ambulation level. Muscle strength and motor performance were significantly lower in the MMC group than in the LMMC group (p < 0.05). PEDI scores were comparable in both groups. Most problems were noted in mobility skills and caregiver assistance in self-care, especially regarding bladder and bowel management.
  
  
  CONCLUSIONS
  Gross motor and functional problems were seen in both groups. The MMC group showed more muscle weakness and motor problems. However, in both groups caregiver assistance was needed for a prolonged period, especially regarding bladder and bowel management. These findings need special attention, particularly in children who attend regular schools.
authors.affiliation: Department of Paediatric Physiotherapy, Wilhelmina Children's Hospital, University Medical Centre, Utrecht, The Netherlands. M.A.G.C.Schoenmakers@wkz.azu.nl
authors.forename: M A G C
authors.initials: MA
authors.lastname: Schoenmakers
authors.forename: V A M
authors.initials: VA
authors.lastname: Gulmans
authors.forename: R H J M
authors.initials: RH
authors.lastname: Gooskens
authors.forename: P J M
authors.initials: PJ
authors.lastname: Helders
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D005260:Female; D005684:Gait; D006801:Humans; D007223:Infant; D008161:Lumbosacral Region; D008297:Male; D008591:Meningomyelocele / Q000150:complications / Q000503:physiopathology*; D009069:Movement Disorders / Q000209:etiology; D009426:Netherlands; D010243:Paralysis / Q000209:etiology / Q000503:physiopathology; D016135:Spinal Dysraphism / Q000150:complications / Q000503:physiopathology*