Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Adults with spina bifida: ambulatory performance and cognitive capacity in relation to muscle function

Spinal Cord volume 60, pages 122–128 (2022)Cite this article

Subjects

Abstract

Study design

Cross-sectional study.

Objective

Describe and compare ambulatory performance and cognitive capacity in relation to muscle function in an adult cohort with spina bifida. Also, explore factors associated with ambulation in participants with muscle function level 3.

Setting

Specialist clinic for adults with spinal cord disorders in Stockholm, Sweden.

Methods

A total regional cohort of adults (n = 219) with spina bifida was invited, 196 (104 women, mean age 35 years, SD 13 years) participated. Mode of mobility, cognitive capacity and muscle function were investigated. For participants with muscle function level 3, factors associated with ambulation were investigated using multivariate logistic regression analysis.

Results

In all, 84 participants (42%) were community ambulators, 22 (12%) household ambulators and 90 (46%) wheelchair users. There was a linear association between the lower degree of muscle function and scoliosis (P < 0.001). Mode of mobility varied despite similar muscle prerequisites in participants with muscle function level 3 (n = 58). Factors associated with ambulation in participants with muscle function level 3 were the absence of scoliosis, lower BMI and higher cognitive capacity.

Conclusions

Cognitive capacity and mode of mobility varied widely across the cohort. However, in participants with muscle function level 3, despite similar muscular prerequisites, a large variation in the mode of mobility was found, suggesting that other factors were involved. It is important to prevent scoliosis, support a healthy lifestyle, as well as offer cognitive screening and support to promote ambulatory function and optimise independence in the everyday lives of adults with spina bifida.

This is a preview of subscription content

Access options

Buy article

Get time limited or full article access on ReadCube.

$32.00

Buy

All prices are NET prices.

Fig. 1: Flowchart of participants.

References

  1. Wagner R, Linroth R, Gangl C, Mitchell N, Hall M, Cady R, et al. Perception of secondary conditions in adults with spina bifida and impact on daily life. Disabil Health J. 2015;8:492–8.

    Article  Google Scholar 

  2. Copp AJ, Adzick NS, Chitty LS, Fletcher JM, Holmbeck GN, Shaw GM. Spina bifida. Nat Rev Dis Prim. 2015;1:1–18.

    Google Scholar 

  3. Bowman RM, McLone DG, Grant JA, Tomita T, Ito JA. Spina bifida outcome: a 25-year prospective. Pediatr Neurosurg. 2001;34:114–20.

    CAS  Article  Google Scholar 

  4. Liptak GS, Garver K, Dosa NP. Spina bifida grown up. J Dev Behav Pediatr. 2013;34:206–15.

    Article  Google Scholar 

  5. Fletcher JM, Copeland K, Frederick JA, Blaser SE, Kramer LA, Northrup H, et al. Spinal lesion level in spina bifida: a source of neural and cognitive heterogeneity. J Neurosurg. 2005;102:268–79.

    PubMed  Google Scholar 

  6. Dennis M, Barnes MA. The cognitive phenotype of spina bifida meningomyelocele. Dev Disabilities Res Rev. 2010;16:31–9.

    Article  Google Scholar 

  7. Del Bigio MR. Neuropathology and structural changes in hydrocephalus. Dev Disabilities Res Rev. 2010;16:16–22.

  8. Miller E, Widjaja E, Blaser S, Dennis M, Raybaud C. The old and the new: supratentorial MR findings in Chiari II malformation. Child’s Nervous Syst. 2008;24:563–75.

    Article  Google Scholar 

  9. Bartonek A, Saraste H. Factors influencing ambulation in myelomeningocele: a cross-sectional study. Dev Med Child Neurol. 2001;43:253–60.

    CAS  Article  Google Scholar 

  10. Gutierrez EM, Bartonek A, Haglund-Akerlind Y, Saraste H. Kinetics of compensatory gait in persons with myelomeningocele. Gait Posture. 2005;21:12–23.

    Article  Google Scholar 

  11. Bendt M, Bartonek Å. Walking in adults with spina bifida with respect to muscle function. Eur J Physiother. 2016;18:154–60.

    Article  Google Scholar 

  12. Thompson RM, Foley J, Dias L, Swaroop VT. Hip status and long-term functional outcomes in spina bifida. J Pediatr Orthopaedics. 2019;39:e168–e72.

    Article  Google Scholar 

  13. Takakusaki K. Neurophysiology of gait: from the spinal cord to the frontal lobe. Mov Disord. 2013;28:1483–91.

    Article  Google Scholar 

  14. Tita AC, Frampton JR, Roehmer C, Izzo SE, Houtrow AJ, Dicianno BE. Correlation between neurologic impairment grade and ambulation status in the adult spina bifida population. Am J Phys Med Rehabilitation. 2019;98:1045–50.

    Article  Google Scholar 

  15. Bartonek A, Saraste H, Knutson LM. Comparison of different systems to classify the neurological level of lesion in patients with myelomeningocele. Dev Med Child Neurol. 1999;41:796–805.

    CAS  Article  Google Scholar 

  16. Seitzberg A, Lind M, Biering-Sorensen F. Ambulation in adults with myelomeningocele. Is it possible to predict the level of ambulation in early life? Child’s Nervous Syst. 2008;24:231–7.

    Article  Google Scholar 

  17. Bendt M, Gabrielsson H, Riedel D, Hagman G, Hultling C, Franzen E, et al. Adults with spina bifida: a cross-sectional study of health issues and living conditions. Brain Behav. 2020;10:e01736.

    Article  Google Scholar 

  18. Hislop HJ. Daniel´s and Worthingham´s muscle testing. Techniques of manual examination. Philadelphia, PA: Saunders Company; 1995.

  19. Kirshblum SC, Burns SP, Biering-Sorensen F, Donovan W, Graves DE, Jha A, et al. International standards for neurological classification of spinal cord injury (revised 2011). J Spinal Cord Med. 2011;34:535–46.

    Article  Google Scholar 

  20. Hoffer MM, Feiwell E, Perry R, Perry J, Bonnett C. Functional ambulation in patients with myelomeningocele. J bone Jt Surg Am Vol. 1973;55:137–48.

    CAS  Article  Google Scholar 

  21. Wechsler D. WAIS-III/WMSIII technical manual: Updated. San Antonio: Psychological Corporation; 2002.

  22. Tallberg IM, Ivachova E, Jones Tinghag K, Ostberg P. Swedish norms for word fluency tests: FAS, animals and verbs. Scand J Psychol. 2008;49:479–85. https://doi.org/10.1111/j.1467-9450.2008.00653.x.

  23. Heyns A, Negrini S, Jansen K, Moens P, Schelfaut S, Peers K, et al. The prevalence of scoliosis in spina bifida subpopulations: a systematic review. Am J Phys Med Rehabilitation. 2018;97:848–54.

    Article  Google Scholar 

  24. Vittinghoff E, McCulloch CE. Relaxing the rule of ten events per variable in logistic and Cox regression. Am J Epidemiol. 2007;165:710–8.

    Article  Google Scholar 

  25. Chaves ES, Boninger ML, Cooper R, Fitzgerald SG, Gray DB, Cooper RA. Assessing the influence of wheelchair technology on perception of participation in spinal cord injury. Arch Phys Med Rehabilitation. 2004;85:1854–8.

    Article  Google Scholar 

  26. Gabrielsson H, Hultling C, Cronqvist A, Asaba E. Views on everyday life among adults with spina bifida: an exploration through photovoice. Int J Qual Stud Health Well-being. 2020;15:1830702.

    Article  Google Scholar 

  27. Guidelines for the care of people with Spina Bifida. available from https://www.spinabifidaassociation.org/: Spina Bifida Association; 2020 [cited 2019 0407].

  28. Nasreddine ZS, Phillips NA, Bedirian V, Charbonneau S, Whitehead V, Collin I, et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatrics Soc. 2005;53:695–9.

    Article  Google Scholar 

  29. Müller EB, Nordwall A, Odén A. Progression of scoliosis in children with myelomeningocele. Spine. 1994;19:147–50.

    Article  Google Scholar 

  30. Agha M, Agha R. The rising prevalence of obesity: part A: impact on public health. Int J Surg Oncol. 2017;2:e17.

    Article  Google Scholar 

  31. Hoyer WJ, Stawski RS, Wasylyshyn C, Verhaeghen P. Adult age and digit symbol substitution performance: a meta-analysis. Psychol Aging. 2004;19:211–4.

    Article  Google Scholar 

  32. Polfuss M, Bandini LG, Sawin KJ. Obesity prevention for individuals with spina bifida. Curr Obes Rep. 2017;6:116–26.

    Article  Google Scholar 

  33. Holmlund T, Ekblom-Bak E, Franzén E, Hultling C, Wikmar LN, Wahman K. Energy expenditure in people with motor-complete paraplegia. Spinal Cord. 2017;55:774–81.

    CAS  Article  Google Scholar 

  34. Jørgensen V, Butler Forslund E, Opheim A, Franzén E, Wahman K, Hultling C, et al. Falls and fear of falling predict future falls and related injuries in ambulatory individuals with spinal cord injury: a longitudinal observational study. J Physiother. 2017;63:108–13.

    Article  Google Scholar 

Download references

Acknowledgements

We would like to thank the study participants for taking part in this study. We would also like to thank OT, MSc Dorothy Riedel, RN Gabriella Innerstedt and RN PhD Hanna Gabrielsson for their valuable contributions during the data collection and Lena Lindbo (Operational manager at the Spinalis Outpatient Clinic), Aleris Rehab Station and Karolinska Institutet for their support.

Author information

Authors and Affiliations

  1. Aleris Rehab Station, Spinalis Outpatient Clinic, Solna, Sweden

    Martina Bendt, Åke Seiger & Emelie Butler Forslund

  2. Department of Neurobiology, Care Science and Society, Karolinska Institutet, Stockholm, Sweden

    Martina Bendt, Åke Seiger, Göran Hagman, Claes Hultling, Erika Franzén & Emelie Butler Forslund

  3. Spinalis, Foundation, Stockholm, Sweden

    Claes Hultling

  4. Sophiahemmet, University College, Stockholm, Sweden

    Claes Hultling

  5. Allied Health Professionals, Medical Unit Occupational Therapy and Physical Therapy, Karolinska University Hospital, Stockholm, Sweden

    Erika Franzén

  6. Stockholms Sjukhem R & D Unit, Stockholm, Sweden

    Erika Franzén

Authors
  1. Martina Bendt
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Åke Seiger
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Göran Hagman
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Claes Hultling
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Erika Franzén
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Emelie Butler Forslund
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

MB, EBF, EF and ÅS designed the study. Authors MB, EBF and GH conducted the data analysis, while all authors (ÅS, EF, CH) contributed to the interpretation of the data. MB drafted the manuscript. All authors revised the manuscript for important intellectual content and approved the final version.

Corresponding author

Correspondence to Martina Bendt.

Ethics declarations

Funding

The contents of this publication were developed with grants from the Caroline Montgomery Foundation, the Spinalis Foundation, the Promobilia Foundation, and support from the Aleris Rehab Station.

Ethics

We certify that all applicable institutional and governmental regulations concerning the ethical use of human volunteers were followed during the course of this research. Verbal and written information was provided before the participants gave their written informed consent. The study was approved by the Regional Ethical Review Board in Stockholm (Dnr: 2014/1111-31).

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Bendt, M., Seiger, Å., Hagman, G. et al. Adults with spina bifida: ambulatory performance and cognitive capacity in relation to muscle function. Spinal Cord 60, 122–128 (2022). https://doi.org/10.1038/s41393-021-00658-w

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41393-021-00658-w

Search

Advanced search

Quick links