Correlation Between Neurologic Impairment Grade and Ambulation Status in the Adult Spina Bifida Population

Abstract

Objective The aim of the study was to identify which neurologic impairment scales correlate with ambulation status in adults with spina bifida. Design A retrospective chart review was performed on patients seen at the University of Pittsburgh Medical Center Adult Spina Bifida Clinic. Findings were graded using several neurologic impairment scales: two versions of the National Spina Bifida Patient Registry classification, the International Standards for Neurological Classification of Spinal Cord Injury motor level, and the Broughton Neurologic Impairment Scale. Ambulation ability was ranked using the Hoffer classification system. Results Data collected from 409 patient records showed significant correlations between Hoffer ambulation status and all neurologic impairment scales evaluated. The strongest correlation was noted with the Broughton classification (r s = −0.771, P < 0.001). High correlations were also noted with both versions of the National Spina Bifida Patient Registry: strength 3/5 or greater (r s = −0.763, P < 0.001), and strength 1/5 or greater (r s = −0.716, P < 0.001). For the International Standards for Neurological Classification of Spinal Cord Injury motor level, only a moderate correlation was observed (r s = −0.565, P < 0.001). Conclusions Multiple grading scales can be used to measure motor function in adult spina bifida patients. Although the Broughton classification seems to be the most highly correlated with ambulation status, the less complex National Spina Bifida Patient Registry scale is also highly correlated and may be easier to administer in busy clinic settings. To Claim CME Credits Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME Objectives Upon completion of this article, the reader should be able to: (1) Explain the clinical significance of identifying ambulation status and maximizing ambulation potential in adults with spina bifida; (2) Describe each of the neurologic grading scales examined in this study, identifying potential shortcomings in applying them to the adult spina bifida population; and (3) Administer the National Spina Bifida Patient Registry (NSBPR) impairment scale motor assessment in a standard adult spina bifida outpatient clinic visit. Level Advanced Accreditation The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Relationships among classifications of impairment and measures of ambulatory function for children with spina bifida

“…Neurosegmental level as measured by the IMSG showed moderate correlation with ambulatory function based on both the Hoffer and Dias FCM scales, similar to the findings of Tita, et al for adults with myelomeningocele. [23] However, neurosegmental level as determined by X-ray was only weakly correlated with steps per day and FMS scores. These findings suggest X-ray lesion level and IMSG neurosegmental levels should not be used in isolation to classify patient function and should definitely not be used interchangeably.…”

Longitudinal evaluation of motor function in patients who underwent prenatal or postnatal neural tube defect repair

“…Also, the use of a single recorded examination for the evaluation of motor function does not allow assessment of the variability caused by acquisition, which could lead to an overestimation of the reliability of the technique 18 . It is well-established that the neurological level of the lesion in infants and adults diagnosed with neural tube defect is a predictor of ambulatory ability 19 . However, other important factors that may appear postnatally can impact significantly the ambulatory potential as adults [19][20][21] .…”

“…It is well-established that the neurological level of the lesion in infants and adults diagnosed with neural tube defect is a predictor of ambulatory ability 19 . However, other important factors that may appear postnatally can impact significantly the ambulatory potential as adults [19][20][21] .…”

The treatment of neurotrophic foot and ankle deformity of spinal bifida: 248 cases in single center

“…Therapeutic management of spina bifida anomalies is not uniform currently [6]. Neurosurgeons believe that neurolysis should be performed [7], spinal surgeons support skeletal fixation and fusion [8], and recent research studies were performed with cell therapy [9] in order to find out neurorestorative methods. As orthopaedic surgeons, in this study we had summarized our experience in the management of foot and ankle deformities in spina bifida sequelae patients.…”