Lesion level and associated muscle strength have the most influence on ambulatory status of children and adults with myelomeningocele. Those with traditionally described midlumbar lesions demonstrate the most variable outcomes. To clarify strength patterns and the contribution of strength to ambulatory status, 83 subjects (39 females, 44 males, 14.3 years) with partial hip and knee strength and no muscle function below the knee were selected. Subjects were grouped by strength of specific hip and knee musculature and were rated as long-distance, short-distance, or nonfunctional ambulators. The use of orthotics and walking aids to achieve ambulatory function was analyzed. Medial hamstring and gluteus medius strength were observed in subjects who had strong quadriceps and no anterior tibialis strength. No subject with antigravity or less quadriceps or iliopsoas/adductors strength functioned as a long-distance ambulator. An upper-lumbar and four midlumbar strength groups are identified, which account for most but not all of the variance in ambulation status. Ambulators were braced almost exclusively at the ankle only and used bimanual walking aids. Although all subjects had clinically stable strength, orthopedic, and medical status, 34% displayed a change in mobility function with increasing age.
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