Purpose: To describe motor development toward ambulation in children with myelomeningocele. Methods: Forty-three children were followed prospectively from 6 months to 6 years of age. Results: Walking function had been achieved at the 1-year follow-up in 2 of 38 children, at the 1.5-year follow-up in 7 of 39, at the 2-year follow-up in 14 of 36, at the 3-year follow-up in 21 of 28, at the 4-year follow-up in 28 of 36, and at the 6-year follow-up in 30 of 38. At the 6-year follow-up, spasticity was present in 22 of 38 children, 42 of 43 used orthoses, and 9 children had not achieved ambulation expected with respect to muscle function. Conclusions: In children with myelomeningocele, walking starts in some during the first year of life and is seen increasingly more frequently until 6 years of age. Motor development before ambulation varies among children with similar muscle function. An increased incidence of spasticity is found among those not having achieved ambulation with respect to muscle function.

Purpose: Lower limb contractures and muscle weakness are common in children with arthrogryposis multiplex congenita (AMC). To enhance or facilitate ambulation, orthoses may be used. The aim of this study was to describe gait pattern among individuals wearing their habitual orthotic devices. Methods: Fifteen children with AMC, mean age 12.4 (4.3) years, with some lower limb involvement underwent 3-D gait analysis. Three groups were defined based on orthosis use; Group 1 used knee–ankle–foot orthoses with locked knee joints, Group 2 used ankle–foot orthoses or knee–ankle–foot orthoses with open knee joints and Group 3 used no orthoses. Results: The greatest trunk and pelvis movements in all planes and the greatest hip abduction were observed in Group 1, compared to Groups 2 and 3, as well as to the gait laboratory control group. Maximum hip extension was similar in Groups 1 and 2, but in Group 3, there was less hip extension and large deviations from the control data. Lower cadence and walking speed were observed in Group 1 than in Groups 2 and 3. The step length was similar in all groups and also with respect to the gait laboratory reference values. Conclusions: Children with AMC were subdivided according to orthoses use. Kinematic data as recorded with 3-D gait analysis showed differences among the groups in trunk, pelvis and knee kinematics, and in cadence and walking speed. The step length was similar in all groups and to the gait laboratory reference values, which may be attributable to good hip extension strength in all participants.

In children with bilateral cerebral palsy (CP) maintaining a standing position can be difficult. The fundamental motor task of standing independently is achieved by an interaction between the visual, somatosensory, and vestibular systems. In CP, the motor disorders are commonly accompanied by sensory and perceptual disturbances. Our aims were to examine the influence of visual stimuli on standing posture in relation to standing ability. Three dimensional motion analysis with surface electromyography was recorded to describe body position, body movement, and muscle activity during three standing tasks: in a self-selected position, while blindfolded, and during an attention-demanding task. Participants were twenty-seven typically-developing (TD) children and 36 children with bilateral CP, of which 17 required support for standing (CP-SwS) and 19 stood without support (CP-SwoS). All children with CP stood with a more flexed body position than the TD children, even more pronounced in the children in CP-SwS. While blindfolded, the CP-SwS group further flexed their hips and knees, and increased muscle activity in knee extensors. In contrast, the children in CP-SwoS maintained the same body position but increased calf muscle activity. During the attention-demanding task, the children in CP-SwoS stood with more still head and knee positions and with less muscle activity. Visual input was important for children with CP to maintain a standing position. Without visual input the children who required support dropped into a further crouched position. The somatosensory and vestibular systems alone could not provide enough information about the body position in space without visual cues as a reference frame. In the children who stood without support, an intensified visual stimulus enhanced the ability to maintain a quiet standing position. It may be that impairments in the sensory systems are major contributors to the difficulties to stand erect in children with CP.