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


Study design

Cross-sectional study.


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.


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


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.


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.


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.

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Fig. 1: Flowchart of participants.


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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



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


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.


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.

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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).

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