title: Movement analysis in neonates with spina bifida aperta.
abstract: BACKGROUND
  In neonates with spina bifida aperta (SBA), leg movements by myotomes caudal to the meningomyelocele (MMC) are transiently observed. It is unclear whether these leg movements relate to functional neural conduction through the MMC. For optimal therapeutical intervention, pathophysiological insight in these transient leg movements seems relevant. If leg movements by myotomes caudal to the MMC concur with the execution of general movements (GMs), functional neural conduction through the MMC is implicated.
  
  
  OBJECTIVE
  In neonates with SBA, we aimed to determine whether the transiently present leg movements caudal to the MMC indicate functional neural conduction through the MMC.
  
  
  METHODS
  During the perinatal period, fetuses and neonates with SBA (n = 7 and n = 13, respectively) were longitudinally analysed for concurrency between leg movements caudal to the MMC and GMs. To address the integrity of the reflex arc in spinal segments (at, or) caudal to the MMC, tendon leg reflexes were assessed during the first postnatal week.
  
  
  RESULTS
  At postnatal day 1, leg movements caudal to the MMC concurred with GMs in 12 of 13 infants. Isolated leg movements were observed in only 3 of these 12 infants (isolated vs. concurrent; p < 0.005). Leg movements concurring with GMs lasted longer than isolated leg movements (median duration = 11 s vs. 2 s; p < 0.05). Between days 1 and 7, tendon leg reflexes (at, or) caudal to the MMC had disappeared in all but 1 neonate. However, leg movements caudal to the MMC remained concurrently present with GMs in all five neonates available for follow-up after day 7. Comparing these leg movements between days 1 and 7 indicated a decreased duration (-44%, p < 0.05).
  
  
  CONCLUSIONS
  In neonates with SBA, leg movements caudal to the MMC concur with GMs, indicative of functional neural conduction through the MMC. The disappearance of these leg movements is caused by lower motor neuron dysfunction at the reflex arc, whereas neural conduction through the MMC is still functional.
authors.affiliation: Department of Pediatrics, University Medical Center Groningen, The Netherlands. d.a.sival@bkk.umcg.nl
authors.forename: D A
authors.initials: DA
authors.lastname: Sival
authors.forename: O F
authors.initials: OF
authors.lastname: Brouwer
authors.forename: J L M
authors.initials: JL
authors.lastname: Bruggink
authors.forename: J S H
authors.initials: JS
authors.lastname: Vles
authors.forename: A L
authors.initials: AL
authors.lastname: Staal-Schreinemachers
authors.forename: K M
authors.initials: KM
authors.lastname: Sollie
authors.forename: P J J
authors.initials: PJ
authors.lastname: Sauer
authors.forename: A F
authors.initials: AF
authors.lastname: Bos
mesh_terms: D005333:Fetus / Q000503:physiopathology; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D018953:Kinesiology, Applied; D007717:Knee / Q000503:physiopathology*; D007866:Leg / Q000502:physiology*; D008137:Longitudinal Studies; D008591:Meningomyelocele / Q000503:physiopathology; D009068:Movement / Q000502:physiology*; D012026:Reflex, Stretch / Q000502:physiology*; D016137:Spina Bifida Cystica / Q000503:physiopathology*