Physical Activity / Participation Session 1 Physical Behavior is Associated with Age and Ambulatory Status , But Not with Gender or VO 2 peak in Wheelchair-using Youth with Spina Bifida

Physical Activity/Participation Session 1 Physical Behavior is Associated with Age and Ambulatory Status, But Not with Gender or VO2peak in Wheelchair-using Youth with Spina Bifida Bloemen, Manon, Takken, Tim, de Groot, Janke, Kruitwagen, Cas, Backx, Frank HU University of Applied Sciences Utrecht University Medical Center Utrecht Background Physical behavior (PB: expressed as type of activities and intensity) of wheelchair-using youth with Spina Bifida (SB) is unfavorable compared to peers. Evidence shows relationships between PB and age, gender and VO2peak in typically developing youth and PB and ambulatory status in youth with Cerebral Palsy. The aim of this study was to analyze the associations between PB and age, gender, VO2peak and ambulatory status in wheelchair-using youth with SB. Methods VitaMove data of 34 and Actiheart data of 36 wheelchair-using (for daily life, sports or long distances) youth with SB were used to assess PB. The VitaMove measures the type of activities. Sedentary activities were defined as sitting and lying and dynamic activities as walking, running, wheeling, (hand)biking and non-cyclic moving. The Actiheart measures the intensity. Time spent in Moderate to Vigorous Physical Activity (MVPA) was analyzed. The Shuttle Ride Test measured VO2peak and the Hoffer classification measured ambulatory status. Univariate and multivariate regression analyses were performed with PB (sedentary activities, dynamic activities, MVPA) as the dependent variable. Independent variables were age, gender, VO2peak and Hoffer (Hoffer 1–3 vs 4–5). Results Sedentary and dynamic activities during a school day are influenced by both age and Hoffer. During a weekend day, sedentary and dynamic activities are influenced by Hoffer alone. MVPA is influenced by Hoffer during a school day and by age during a weekend day. Overall, participants with Hoffer 4–5 are performing worse than Hoffer 1–3 and older participants performing worse than younger participants. Conclusions PB is associated with age and ambulatory status in wheelchair-using youth with SB, with older age and the inability to walk influencing PB negatively. Gender and VO2peak are not associated with PB in wheelchair-using youth with SB. Can Initial Assessment Findings Predict Future Mobility of Children with Spina Bifida? Botman, Antoinette, Taylor, Suzie, Quinlan, Rachal, Harris, Ryan, Paulka, Michael, Pacey, Verity The Sydney Children’s Hospitals Network Macquarie University Background Spina Bifida (SB) is a neural tube defect that affects 4.6/10,000 Australian births/year. A major barrier to participation and quality of life in individuals with SB is their decreased mobility. Current evidence suggests motor lesion level, orthopaedic surgery and ventriculoperitoneal shunt (VPS) history predict future mobility in children with SB. This study aims to determine whether physical assessment findings and comorbidities recorded before three months of age can predict the peak mobility level a child with SB can achieve prior to starting school. Methods Retrospective data analysis was undertaken on all children with SB managed at the Children’s Hospital at Westmead between 2005–2015. 54 children (34 male) with lumbosacral level SB (37 myelomeningocoele, 14 lipomeningocoele, 3 meningocoele) were included. Medical records were audited and data collected on modified manual muscle testing results, congenital lower limb deformity, demographic and medical characteristics. Stepwise multiple regression was undertaken to ascertain whether any combination of findings could predict future peak mobility. 1874-5393/17/$35.00 c © 2017 – IOS Press and the authors. All rights reserved This article is published online with Open Access and distributed under the terms of the Creative Commons Attribution Non-Commercial License (CC-BY-NC 4.0). S52 Physical Activity/Participation Session 1 Results Hip and knee extensor strength at initial assessment predicted 51% of the variance in the peak mobility a child achieved before starting school, assessed with the Hoffer Scale. The addition of VPS status raised the predictability to 62% of the variance when the Hoffer Scale was modified to account for orthotic and walking aide use (all p < 0.05). Conclusions The presence of a VPS and hip, knee and ankle strength before three months of age can explain significant variance in the future mobility status of a child with SB. These findings may increase clinicians’ confidence to predict a neonate’s future mobility and assist families and multidisciplinary treatment teams to set realistic mobility goals and assist the child to optimise their mobility potential. Using Initial Physical Assessment Findings, it is Possible to Predict the Age a Child with Spina Bifida will Commence Independent Walking: A Retrospective Chart Audit Botman, Antoinette, Quinlan, Rachal, Taylor, Suzie, Paulka, Michael, Harris, Ryan, Pacey, Verity The Sydney Children’s Hospitals Network Macquarie University Background The majority of research into predictors of walking in children with Spina Bifida (SB) has focused on the maximum ambulation that is achieved based on physical assessment findings obtained after walking has already commenced. Predictors of age of walking are unknown, but important to inform clinical practice. This study aims to investigate whether physical assessment findings in the first two months of life of a child with SB can predict the age of independent walking. Being able to predict the age that walking can be achieved gives the parents of a newborn child with SB a tangible idea of how their child may function and what to plan for in the future. Methods Retrospective data of initial modified manual muscle testing results, congenital lower limb abnormalities, and demographic and medical characteristics for 51 children (28 male) with SB managed in the Spina Bifida Service at The Children’s Hospital at Westmead, Sydney, Australia (2005–2015) was collected. A stepwise linear regression was performed with the age that walking was achieved as the dependent variable and type of SB, level of SB, congenital abnormality of hip, knee or foot, hydrocephalus, VP shunt, and the presence of neurogenic bladder or bowel as the independent variables. Results All children in the study achieved independent walking between 9 and 36 months. 83% of the variance in age of achieving walking was predicted by three factors: ankle plantarflexion strength, VP shunt history and knee extension strength (p < 0.05). Conclusions Children who have better ankle plantarflexion and knee extension strength, in the absence of a VP shunt, will achieve walking earlier in life. A clinical implication identified from this study is the ability of the clinician to better inform parents of children with SB what to expect from a developmental perspective. Walking Activity in Children with Myelomeningocele Yasmeh, Pauline, Mueske, Nicole, Yasmeh, Siamak, Ryan, Deirdre, Wren, Tishya Children’s Hospital Los Angeles University of Southern California Background Children with myelomeningocele (MM) may have some degree of spinal cord damage, paralysis, muscle weakness and loss of sensation in the lower extremities ultimately constraining mobility. This study quantified walking activity of children with MM in everyday life. Methods Walking activity was recorded using a StepWatch activity monitor over 1 week in 47 children with MM (27 males; 9.9 ± 2.6 years; 18 sacral, 9 low lumbar, 20 mid-high lumbar) and 7 children with typical development (5 males; 11.1 ± 1.9 years). Average total steps per day, number of steps and minutes spent at low, medium and high intensity stepping were evaluated. Groups were compared using t-tests and chisquared tests with Bonferroni post-hoc adjustment. Results Children with sacral and low lumbar MM exhibited no observable differences in age, height, weight or BMI compared to typically developing children. Children with sacral and low lumbar MM took a similar number of steps per day compared to typically developing children (low lumbar: 9658 ± 5331, sacral: 9166 ± 3305, control: 9589 ± 3322) and did not differ on steps at any intensity level. Children with mid-high lumbar MM were similar in age, height and weight to typically developing children but exhibited higher BMI percentiles (84.1 ± 20.0; p = 0.04) and took fewer total steps per day than all other groups (4867 ± 3316; p 0.04). Children with mid-high lumbar MM also spent significantly less time taking steps at all intensities, particularly medium-intensity, than the sacral and low lumbar groups (p 0.07). Physical Activity/Participation Session 1 S53 Conclusions Children with sacral and low lumbar MM had walking activity similar to typically developing children despite a common need for braces and assistive devices. Children with mid-high lumbar MM were less active, which may lead to heightened risk for secondary health conditions in addition to those associated with MM. Understanding walking activity in youth with MM may aid in developing focused interventions. Adaptive Design: Cardboard Equipment Solutions for Toddlers with Spina Bifida Dosa, Nienke, Davis, Timothy, Carr, Donald, Smtih, Teri, McGough, Connor, Evensky, Jesse, Sefick, Peyton, Neville, Lisa, Weber, Monica, Fathers, James SUNY Upstate Medical University SUNY Cortland Syracuse University Liberty-Post Jowonio Preschool Arise Independent Living