Associations between orthopaedic findings, ambulation and health-related quality of life in children with myelomeningocele

Aina J. Danielsson, Åsa Bartonek, Eric Levey, Kathleen McHale, Paul David Sponseller, Helena Saraste

Research output: Contribution to journalArticle

Abstract

Purpose: Modern principles for treatment of patients with myelomeningocele include early closure of the neural tube defect, neurosurgical treatment of hydrocephalus and treatment aimed at minimizing contractures and joint dislocations. The aim is to achieve a better survival rate and a better quality of life (QOL). Better ambulatory function is thought to improve the management of activities of daily living. This study focused on evaluating which factors might affect ambulation, function and health-related QOL in children with myelomeningocele. Methods: Thirty-eight patients with neurological deficit from myelomeningocele were examined in an unbiased follow-up. This included a physical examination using validated methods for ambulatory function and neuromuscular status, chart reviews and evaluation of radiographs in terms of hip dislocation and spine deformity. The Pediatric Evaluation of Disability Inventory (PEDI) was used to measure mobility, self-care and social function, and the Child Health Questionnaire (CHQ-PF50) was used to measure QOL. Results: Muscle function class, quadriceps strength, spasticity in hip and/or knee joint muscles and hip flexion contracture as well as the ambulatory level all affected functional mobility as well as self-care/ PEDI. Patients with hip dislocation, spinal deformity or those who were mentally retarded also had significantly worse functional mobility. Besides being affected by the severity of the neurological lesion, self-care/PEDI was significantly impaired by hip flexion contracture and absence of functional ambulation. General health-related QOL was significantly lower in this patient group than for US norms. Nonambulatory and mentally retarded patients had a significantly lower physical function of their QOL (CHQ). Conclusions: The severity of the disease, i.e. reduced muscle strength and occurrence of spasticity around hip/knee, affected ambulation, functional mobility and self-care. Acquired deformities (hip dislocation and spine deformity) affected functional ambulation only. Patients with reduced functional mobility and self-care experienced lower physical QOL. Children with myelomeningocele had significantly reduced QOL compared to healthy individuals.

Original languageEnglish (US)
Pages (from-to)45-54
Number of pages10
JournalJournal of Children's Orthopaedics
Volume2
Issue number1
DOIs
StatePublished - Feb 2008

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Meningomyelocele
Walking
Orthopedics
Self Care
Quality of Life
Disability Evaluation
Hip Dislocation
Hip Contracture
Mentally Disabled Persons
Pediatrics
Equipment and Supplies
Spine
Muscles
Neural Tube Defects
Hip Joint
Muscle Strength
Contracture
Hydrocephalus
Activities of Daily Living
Knee Joint

Keywords

  • Ambulation
  • Functional ability
  • Physical factors
  • Quality of life
  • Spina bifida

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Pediatrics, Perinatology, and Child Health

Cite this

Associations between orthopaedic findings, ambulation and health-related quality of life in children with myelomeningocele. / Danielsson, Aina J.; Bartonek, Åsa; Levey, Eric; McHale, Kathleen; Sponseller, Paul David; Saraste, Helena.

In: Journal of Children's Orthopaedics, Vol. 2, No. 1, 02.2008, p. 45-54.

Research output: Contribution to journalArticle

Danielsson, Aina J. ; Bartonek, Åsa ; Levey, Eric ; McHale, Kathleen ; Sponseller, Paul David ; Saraste, Helena. / Associations between orthopaedic findings, ambulation and health-related quality of life in children with myelomeningocele. In: Journal of Children's Orthopaedics. 2008 ; Vol. 2, No. 1. pp. 45-54.
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