“How could I apply this information?”
Because of the insult to the spinal cord, we know that infants with lumbar and sacral level myelomeningocele (MMC) demonstrate decreased activity of the lower extremities and impaired gross motor skills. As a result of diminished movement, and thus lessened forces to the bone, infants with MMC present with reduced whole body and body segment bone mineral content compared with infants with typical development. Pediatric physical therapists have the opportunity to influence this reduction in bone mineralization by promoting weight-bearing activities at an early age. The results of this study suggest incorporation of both standing and stepping practice into regular therapy sessions and home exercise programs during infancy, even before these behaviors would typically occur. Parents of children who potentially may not ambulate should be educated on the added benefits of standing and weight-bearing positions to diminish future complications such as poor bone growth, osteopenia/osteoporosis, and pathologic fractures.
“What should I be mindful about when applying this information?”
The ability for infants with MMC to elicit independent steps will vary on the basis of their individual patterns of motor and sensory loss. Infants with higher-level lesions may require outside supports such as standers or gait trainers to assist with weight-bearing practice, which may not produce the same results as the pediatric treadmill used in this study. Therapists can use the International Myelodysplasia Study Group Criteria for Assigning Motor Levels to help guide their future predictions of functional level.1 This tool may be helpful when training families on early standing and stepping practice. Therapists should be careful to fully educate families about realistic therapy goals, explaining that the exercises are used to promote bone health and prevent secondary complications versus independent standing and walking.
Kristin Flynn, PT, DPT
Jill Ordorica, PT, DPT, PCS
Children's Hospital Los Angeles, Los Angeles, California
1. Shurtleff DB. IMSG. International Myelodysplasia Study Group Database Coordination. Seattle, WA: Department of Pediatrics, University of Washington; 1993.