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1 Saturday, March 18, 2017 Using initial physical assessment findings, is it possible to predict the age a child with Spina Bifida will commence independent walking: a retrospective chart audit Antoinette Botman, MD University of Amsterdam, FAFRM Paediatric rehabilitation physician, The Sydney Children s Hospitals Network, Australia Does not intend to discuss commercial products or services. Does not intend to discuss non-fda approved uses of products/providers of services. No financial relationships to disclose.

2 Using initial physical assessment findings, is it possible to predict the age a child with Spina Bifida will commence independent walking: a retrospective chart audit Antoinette Botman, Rachal Quinlan, Suzie Taylor, Ryan Harris, Michael Paulka, Verity Pacey

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4 Aim To determine if the initial physical examination of the child within the first three months of life can predict when the child commences independent walking

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6 Method Children presenting to CHW Aged 0-12 months Included Diagnosis of SB Lesion level L1 and below Sociodemographic data Physical examination Data collection Hydrocephalus +/- VP shunt Developmental milestones Walking aides Excluded Additional diagnosis or diagnosis other than SB Lesion >L1 No initial data in first 3/12 of life No data on age of walking Statistical analysis Stepwise multiple regression analysis

7 Method - stepwise multiple regression analysis 10 variables: SB diagnosis SB level of lesion Congenital deformity of hip Congenital deformity of knee Congenital deformity of ankle Hip extension power Knee extension power Ankle plantarflexion power Presence of Hydrocephalus VP-shunt

8 Results 21 lipommc L1-L2 1 L3-L4 5 L5 and below 15 VPS 0% Contractures 33% 62 children with SB 5 MC L1-L2 0 L3-L4 0 L5 and below 5 VPS 0% Contractures 40% L1-L2 VPS 92% contractures 84% 36 MMC L1-L2 13 L3-L4 4 L5 and below 19 L3-L4 VPS 50% contractures 100% L5 and below VPS 63% contractures 63%

9 Results

10 Results

11 Results Age = 27.8 (3.3 x ankle plantarflexion) + (7.4 x VP shunt) - (4.7 x hip extension) 71% variance, F = 37.4, p <

12 Results high lumbar lesion 27.8 (3.3 x ankle plantarflexion) + (7.4 x VP shunt) (4.7 x hip extension) High lumbar lesion Ankle plantar flexion 0/2 VP shunt 1 Hip extension 0/ (3.3 x 0) + (7.4 x 1) - (4.7 x 0) = = 35.2 months (2 y 11 months)

13 27.8 (3.3 x ankle plantarflexion) + (7.4 x VP shunt) (4.7 x hip extension) Sacral lesion Ankle plantar flexion 2/2 VP shunt 0 Hip extension 2/2 Results sacral lesion 27.8 (3.3 x 2) + (7.4 x 0) - (4.7 x 2) = = 11.8 months

14 Discussion Able to predict over 70 % variance at initial assessment Ankle plantarflexion hip extension VP shunting Lower limb congenital musculoskeletal complications Able to predict mobility at all lumbar lesion levels First to assess and predict within the first 3 months of life

15 Limitations Retrospective chart audit Small sample size Only applicable to SB without other diagnosis Does not consider future variables

16 Clinical Implications & Future Research Timely referral to early intervention Prospective Larger sample size Development of standardised assessment

17 Abeywardanan S, Sullican E. Neural Tube Defects in Australia. An epidemiological report. In: Unit ANPS Sydney 2008 Schoenmakers MAGC, Uiterwaal CSPM, Gooskens RHJM, Helders PJM. Determinants of functional independence and quality of life in children with spina bifida. Clinical Rehabilitation 2005;19: Lomax-Bream LE, Barnes M, Copeland K, Taylor HB, Landry SH. The impact of spina bifida on development across the first three years. Developmental Neuropsychology. 2007; 31:1 20. Alriksson-Smith AI, Thibadeau JK, Swanson ME, Marcus D, Carris KL, Siffel C. The natural history of Spina Bifida in children pilot project: Research protocol. Journal of Medical Internet Research 2013;2(1):e2 Campbell SK, Palisano RJ, Orlin MN. Physical Therapy for Children. Fourth ed. St. Louis, Missouri: Elsevier; Danielsson AJ, Bartonek A, Levey E, McHale K, Sponseller P, Saraste H. Associations between orthopaedic findings, ambulation and health related quality of life in children with myelomeningocele. Journal of Children s Orthopaedics 2008Feb;2(1):45-54 Dicianno BE, Karmarkar A, HoutrowA, Crytzer TM, Cushanick KM, McKCoy A, Wilson P, Chinarian J, Neufeld J, Smith K, Collins DM. Factors associated with mobility outcomes in a national Spina Bifida patient registry. American Journal of Physical Medicine & Rehabilitation 2015;94:

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19 Contact details Dr Antoinette Botman Paediatric rehabilitation physician Kids Rehab The Children s Hospital at Westmead Locked Bag 4001 Westmead NSW, Australia Phone: Fax: antoinette.botman@health.nsw.gov.au