Upper extremity dynamics during Lofstrand crutch-assisted gait in children with myelomeningocele.

The use of quantitative models for evaluating upper extremity (UE) dynamics in children with myelomeningocele (MM) is limited. A biomechanical model for assessment of UE dynamics during Lofstrand crutch-assisted gait in children with MM is presented. This pediatric model may be a valuable tool for clinicians to characterize crutch-assisted gait, which may advance treatment monitoring, crutch prescription, and rehabilitation planning for children with MM. Nine subjects with L3 or L4 level myelodysplasia (mean+/-S.D. age: 11.1+/-3.8 years) were analyzed during forearm crutch-assisted gait: (1) reciprocal gait and (2) swing-through gait. Three-dimensional (3D) dynamics of the UE were acquired and the Pediatric Outcomes Data Collection Instrument (PODCI) was administered. The goal of this study was to determine if meaningful differences occur between gait patterns in UE kinematics and kinetics, and if correlations exist between dynamics and functional outcomes. Temporal-distance parameters showed significant differences between reciprocal and swing-through gait in stride length, and stance duration. All joint ranges of motion were greater during swing-through gait. Thorax, elbow and crutch ranges of motion were found to be significantly different between gait patterns. Kinetic results demonstrated significant differences between reciprocal and swing-through gait, bilaterally, at all joints for the force variables of mean superior/inferior force, range of force, and maximum inferior force. Functional outcomes were strongly correlated with joint dynamics. Accurate quantitative assessment is essential for preventing injury in long-term crutch users. This study has potential for improving clinical intervention strategies and therapeutic planning of ambulation for children with MM.