GAIT ELECTROMYOGRAPHY IN CHILDREN WITH MYELOMENINGOCELE AT THE SACRALLEVEL

Objective: Patients with sacral level myelomeningocele can be expected to maintain a high level of ambulatory status long into adulthood, Ga it deterioration and knee pain reported in this population may be attr ibuted to compensatory movements and increased recruitment of less aff ected muscle groups to achieve this desired level of ambulation. The o bjective of this study was to analyze the effect of the solid ankle-fo ot-orthoses (AFOs) on the muscular activity of selected muscles during walking. Design: Cohort/outcome. Setting: Laboratory. Patients: Twent y four patients with sacral level myelomeningocele between 4 to 17 yea rs of age, Intervention: Electromyographic activity of selected muscle groups were studied during barefoot walking and walking with solid AF Os at a self-selected walking velocity, Main Outcome Measures: Timing of electromyographic activity and sagittal plane knee kinematics. Comp arison to normal electromyographic patterns and changes between barefo ot and AFO walking conditions, Results: With the AFOs there was signif icantly less prolonged stance phase quadriceps activity compared with barefoot walking, although greater than normal activity persisted, The re was no change between conditions for the other monitored muscle gro ups, All muscles elicited greater duration of activity over the course of the gait cycle. Conclusions: Our results show that solid AFOs impr ove the prolonged knee extensor activity evident for barefoot walking. This is clinically relevant to the gait deterioration and knee pain s ometimes seen in this patient population, We espouse early and persist ent orthotic intervention to reduce compensatory muscular overactivity and maintain gait quality. (C) 1997 by the American Congress of Rehab ilitation Medicine and the American Academy of Physical Medicine and R ehabilitation.