Efficacy of bracing the lower limbs and ambulation training in children with myelomeningocele

Orthotics and physical therapy are offered to children with myelomeningocele, often without objective evidence of efficacy. Bracing of the lower limbs in children with myelomeningocele can be categorized into three groups based on the degree and extent of muscle weakness. Children with lesions at the thoracic and upper-lumbar level lack strength in hip extensors, hip abductors, knee flexors, knee extensors, ankle plantarflexors, and ankle dorsiflexors. They require the support of an orthosis such as a parapodium (standing frame), parawalker, reciprocating gait orthosis, or hip-knee-ankle-foot orthosis. Children with a low-lumbar level of paralysis lack strength in hip extensors, ankle plantarflexors, and ankle dorsiflexors and may need a solid ankle–foot orthosis to stabilize the ankle and assist knee extension in the stance phase of gait. Children with lesions at the sacral level either need no bracing or may need a foot orthosis to compensate for weak intrinsic foot muscles.